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HomeMy WebLinkAbout4157DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.74 -2 -35 BOX 32 04157 Is qr'L ,- ._ _ , 04157 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health Associate Commissioner of Health June 13, 2005 DEPARTMENT ROBERT J. BONDI County Executive OF HEALTH 1 Geneva Road, Brewster, New York 10509 David Repicky 44 Argyle Street Lake Peekskill, NY 10537 Re: Well Permit Application for Repicky Property — 44 Argyle Street (T) Putnam Valley Dear Mr. Repicky: This Department has approved the well permit for Well #W39 =05 at the above referenced site. Please be advised that if site conditions and/or site plans change and/or are revised, thereby compromising the approved separation distances, siting approval of the well must be re- approved by this Department. This letter shall serve as record of approval and by initiating construction of the well covered by this approval of plans, the applicant accepts and agrees to abide by and conform to the following: 1. The well location shall be survey located and staked prior to drilling. 2. The proposed well is approved 65 feet from on -site and/or adjacent subsurface sewage treatment system areas. 3. :.. The well shal be:- installed v th..a m .� .cas�� iii d o f 7 4fer,. g µ 4.1 An ultra - violet light disinfection unit shall be installed on the incoming well line to the dwelling. 5. A water sample shall be collected and analyzed for coliform bacteria after the well is drilled. The sample result is to be submitted to this Department along with the well completion report within 30 days of completion of the water well: 6. 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. Respectfully, b'�A Michael J. dz' ski, E Director of ngineermg MJB:cw Cc: C. Santos, (T) Putnam Valley Insite Engineering Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 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 PiTTNAM COUNTY DEPARTMENT OF HEALTH 'IX o Q . IVISION ,OF ENVIRONMENTAL HEALTH SERVICES APPLICATION 'TO �t;�I�1STRtICT .�?4!�TER¢.WLL A ; - .� _..., 5 s, please print or type - PCHD Permit # JA )3 9 ' 0-'5- Well Location: Street Address: Town/Vil age Tax Grid # 8,3,-7q— —.;L- - 3, - _ re -pt-S�kl ! % Map f_? Block7�—a Lot(s) 335' Well Owner: Name: # V1,0 lC -4 JAddress. /W L�� 57. r✓e e fi- r%k-�5 , `�/J 1n3- Use of Well: _ X 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 ,­5' gpm # People Served Est. of Daily Usage J �gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason _5,e A v✓41-1 S' q P1LC0Z11PLf,W �9 , © If 9� W ISOAAOI 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: 14&v -Of),e o f✓ Address: l°gro IAM G Is Public Water Supply available to site? ... ............................... ............................... Yes No 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. F?ate � - Applicant Sigr>;at 7e Q-S 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. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a watyr well driller certified by Putnam County. ® Date of Issue 3 —06_ Permit Iss g Offi al: I `� Date of Expiration Title: Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner / Orange co6y - Well driller Form WP -97 . . . . . . . . . ....... '. �t gib W I . . . . . . . . . ....... i •:_•.MIL :7n 1 Ef t '. I a ........ 5 'Y VI Y LEGEND NOTE• 7h skefchn are based n New York Slote High Resoluflan Approx. Location Existing Well Q Stafewlde Digltal Orthoknagery Program (7000 Pilot — Present) one digltd tax Subject Property , Approx. Location SST 4 Existing SS75 LL�qq L ""`��LAKE PEEKSKILL `"`°"°`°°" N S � % E' ""� 1 -1+ —Ins 1 �� WATER SYSTEM SHUTDOWN ENGINEERING. SURVEYING & LANDSCAPE ARCHITECTURE, P.C. 3 .iiF :•i�J'P'� M ^tQttii °` 04183100 PLOT PLAN �� ���� s; J x 8374 -2 -35 44 ARGYLE ST. Phone (845) 225 -9690 s Far (845) 225 -9717 www.lnslte— eng.com i •:_•.MIL :7n 1 Ef t rY � rY:is� e.va'. �.� . .....moo. _ ate- ... •oa —ro -w.. ...— '. I a ........ 5 'Y VI Y rY � rY:is� e.va'. �.� . .....moo. _ ate- ... •oa —ro -w.. ...— I a LEGEND NOTE• 7h skefchn are based n New York Slote High Resoluflan Approx. Location Existing Well Q Stafewlde Digltal Orthoknagery Program (7000 Pilot — Present) one digltd tax Subject Property mop Info [on ham Pulnom County. These sketches ore Intended to show Approx. Location Proposed Well ♦ approxknote property line% dwelling% and septk ayetems for use In assessing Approx. Location SST Possible well locations only These sketches ore not htnded far my other Direction Of Ground Slope SLOPE purpose and are not intended to be scaled. Prior to drilling any proposed Existing SS75 Arrow Points Downhill weld the appropriate surwy% design% and PemUts must be obtalned. ""`��LAKE PEEKSKILL `"`°"°`°°" N S � % E' ""� 1 -1+ —Ins 1 �� WATER SYSTEM SHUTDOWN ENGINEERING. SURVEYING & LANDSCAPE ARCHITECTURE, P.C. °"eNG M ^tQttii °` 04183100 PLOT PLAN J Garrett Place . Corrrlel. New York 70512 8374 -2 -35 44 ARGYLE ST. Phone (845) 225 -9690 s Far (845) 225 -9717 www.lnslte— eng.com A, d.:lt Lr"AL Q'imt Pipe (914) 737-6548 BENNY SINISCALCHI PAVING, INC. MASON CONTRACTOR • BLACKTOPPING SEPTIC TANKS 118 OLD BAY STREET PEEKSKILL, NY 10566 @:j A p ^Le4v obi QA . ......... .......... Putnam County Department of Health Division of Environmental Health Services SSTS Repair — Final Site Inspection Date: Inspected by: L Installer: Street L Owner: "Rep-laii, 1. Type of System: Conventional LVAlternate U Comments: 2. Septic Tank Yes No -N/A Comments a. Septic tank size —1,000 ... 1,250 other ..... 15 o V-' b. Septic tank installed level ...................... V - ---------------- c. 10' minimum from foundation .................. Oo C d. Distribution Box i. All outlets at same elevation (water tested) ... ii. Protected below frost ............................. iii, Minimum 2 ft. Original soil between box & trenches e. Junction Box — properly set ........................... f Trenches i. System completel.4 ppened for inspection H. Length required 111A, Length installed"' iii. Pipe slope checked ... ............................... iv. Installed according to plan ..................... v. 10 ft. from property line — 20 ft — foundations ... vi. Size of gravel % -.1 V2 diameter clean ......... vii. Depth of gravel in trench 12" minimum ......... vii. Ends ......................... ........ g. Puml2 or Dosed Systems .3. Sewaze System Area a. SSTS Area located as per approved plans b. Fill section — c. Distance from water course/wetlands 4. Overall Workmanship a. Boxes properly grouted and installed correctly ........... . b. All pipes flush with inside of box .......................... c. Backfill material contains stones <4" diameter ......... d. Curtain drain & standpipes installed according to plan e.. Curtain drain outfall protected & dir to exist watercourse f Footing drains discharge away from SSTS area ......... g. Erosion control provided ............................ Additional Comments: x �� r f RFSIRev-011312 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVIC c� lc� L i Internal Use Only PERMIT i```-:3j/ �� / Li M Repair Permit issued in last 5 years L:-' Not in Watershed 0 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 l- j TOWN '�1Jr�'" v p.ilry TM # �_ 83, -71 OWNER'S NAME (fit d ? 1.c PHONE # . 111 7-71 MAILING ADDRESS 4- 1(1,.V&P S? APPLICANT A Z V t iJ r,,- /rl /C k Z —� Name & Relationship (i.e o, weer, tenant, contractor) DATE FACILITY TYPE PCHD COMPLAINT # PROPOSED INSTALLER 15912 -1 sovi 5e4'd6i` PHONE # iriq- ADDRESS 11 &OL O 644 5T hfi6s4K REGISTRATION /LICENSE # f o / 3 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. R -0tt Me.rjt IrANV, w1Tl PVC Svyuk o..1S'T.J(L Atye- To -/06 C w e/. o f' A Z G-1� 2.C. �'xre v9 0 0 ,3 5 P 616 i e L 0 4#X-4 I, as owner,agree to the condjtions stated on this form r ".i / SIGNATURE r �/� TITLE O DATE I ' z- 3 (owner) 1- tbjt septic-installer-agree to cog n ply x+ O-1he conditions 0.this. permit- fer t'ee' sep4ic system- repair , m . SIGNATURE TITLE f',`uirg,tQk DATE iY - vl - t 3 . (installer) Pr000sal anoroved 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 bockfill until authorization to do so has been obtained from the Department. A ,.A INTERNAL USE ONLY Pro sal v [ Pro osal eni —I ❑ Ins r ture & Title Date Expiratildin Date Repair proposal is in compliance with applicable codes Yes No 0 COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2107 --) '0 ar- -- h 0i 13 ,' c�`' /,j G— Vol su o rmedia December 18, 2012 Siniscalchi Benny Paving Inc 118 Old Bay Peekskill, NY 10566 1305945531 914 - 737 -6548 Dear Joe Siniscalchi: By signing this letter you acknowledge your request to cancel the following advertising for the next issue /term: Product Next Issue Pub Date Next Issue Monthly Charge Next Issue Close Date 051265 / Verizon N Westchester /Putnam 0412013 " $0 1/4/13 / / / Although you have chosen to cancel your advertising, we would like the opportunity to talk to you about how SuperMedia can manage your other advertising needs. We know you have an overwhelming number of - choices when it comes to promoting your business. The complex world of Social, Local, Mobile and advertising in general, can be confusing. The good news is that we can help you make sense of it all. At SuperMedia we have a long history of serving local businesses like yours. We'll work with you to create a marketing plan for your business using the best combination of local media. And we'll stick around to help make it work. Ask us about a complimentary market analysis for your business. Let us build a media solution for you. �- •, _. .�� :>,.:.: Thanlcyflit.io�a isrn� �e itt ., t�pet. 'a; elf we: paii n 'of a.L4bfjL.inq service In the future, please :don_'t, hesitate to contact our Client Care department at 866 -91 -SUPER (78737 ). Authorized By - Signature Print Name Cary Haddad 721254 Media Consultant Name Date Title 9 j cws .aan.aag XVA Z00 /Z 3 Vd Wd 69 :6£:9 ZTOZ /8T /ZT eTpoWaadns MEMORY TRANSMISSION REPORT FILE NUMBER 148 DATE JAN -04 04:17PM TO 819147394032 DOCUMENT PAGES 002 START TIME JAN -04 04:17PM END TIME JAN -04 04:18PM SENT PAGES 002 STATUS . OK FILE NUMBER : 148 R N • iAN 04 D'l 3 04-:1 8Px TEL � UMBE R 4527 87§2 NAME ENVIRONMENTAL HEALTH * ** SUCCESSFUL TX NOT ICE * ** PUTNAM 0OUN 7i"1l HEALTH AEPARTMENT J al\/ISION OF ENVIFRCaNMENTAL HEALTH 9mRQPC)lS^L- FOR SEW AQ[c Meg --NT SYSTEIIA ..✓ .- ..�.._ e��...... ii3001 [3 C) R ®Pair Pnrmlt iBaxUad In lam 5 years Ua— Not in WatOrshad O Repair whltin Boyd•s Garners, w. branch ax Croton t ins Rees. D 17aiagatad SITE LOCATION 1-i �( r�1 �'G� 0-12. _TOWN PiJ:''Fi �_• t./,,!, ]r QWNER•S NAME Q R V c O :� /G' �V PHONE # '(7-49a- `le ?3 MAILINCQ ADCF(ESS 4- S'-7- - r�- ,/4--�e �s.e� s /�i %/ i✓ S„! _i✓ y 3"7 & RalaHonship Cl-... ew err, tenanp oonfssctor) LATE d -�.- [ 3 FACILITY TYPE PCHa COMPLAINT # PROPOSED INSTei I FR �i�N S. M• Sc.a�dvi �1.i -�G-- PHONE a q),4- 73 -%ri t'i8 -•�.. : +'-- '..^.r»��S .,.,, .." f 1J1.., ,«'.!�!O._„_�J.�j^_./ ..ate .. Pt�k�- s- i!ast�_Fi1-cC�lSTPATIONJLiCENSE tF /d /.� Proposal pncluda< a sapsrate Olcatctt Iodating tlh® ho6lsaa, property lines, tail- adDacenB ws00s w4tGile`ti 2p5" �°''\'��"t`'jid"�" feet o9 rapaar artd the Iocatian o4 existing and proposed systam) NOTE: The Oapartment may reaauire submittal of praposai from ticensod profesaional doperrtding on tha nature, and octant of tho retpair. P- -.P 'e M pv c s�...v ne..2 .✓ 7--j- cC i+�1/ti `r `o -ion o>° a 6-e, a...cc c ,r� �_. a o......� „ 7= P---T- A -s >— �o ate. a 1, as ownar,ogroo to the, cond' n/s� stat®d on this form TITLE (Q) OATE (owner) -T„j' 1, tha septic instW[orr, jagree t/oo� C44/J,"Ply with the, conditions of this permit for the soptio systfam rapaar SIGNATURE - iG t TITLE / ^+• T- 9•L'i -elL.. OATS t (letstaller) Proposal 80iXOVad .nlitit Lha follctwines C�nditlan&: 1 . ,roea.aramOnt of any Town Permit. If applicable,. 2. submission of am built ropair alcatch by the, saptic system lr s* ®liar within 30 days of the, rapaar, in duplicate sttc wins: s. Ownar•s nama, site St-mat Name,, Town and Yax mftp number b. Locatlon of instaitad componelntss tlad to two fixad points c. system dascription (a_s., 1250 gal - Concrete &Optic tank, oto.) d- Installars' nama and phona ."mbar 3- System rapaar to be, porformad in ac mrdan6a v+h[h ttta above proposal and renditions 4. The, proposal SSTS repair is considarwd a taest fit design and thorn is no guaranta m to the, lunation at which the, cotnpletad 'SSTS r ®pair will function- 5. No eompia0a0 work is to be bacldifl pill aalettorizatlon to do. sb has taaen obtained from the, Llapartmant 1N't'EriTtAL t.lSE ONLY Pr sal A v Pr oral Roml�q/ CJ Ins or' turn 8r Title ~- Mall. F cpirati n flatter Repair proposal Is in 00m0lianea wtm appltcaDI0 QOae5 Iran iSY' No O COPIES: F4--"C>; Ownar; Installer PC -RP 99ML "Ov. WOIF ri-..• r a.�- ..i - ..�.. -•.- — r� eO _ _ - -. ter^ �... -.M1� -. 'P'M1as.. .-O. 'L�I"M16 ^.aXs •- v��- �:ef.. .. :LaeJ �- _r¢. ,• >. .. � . •s s.- - �-...- PUTNAIM COUNTY DEPARTMENT OF HEALTH DLVISION OF ENVIRONMENTAL HEAL.-TH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTF- Owner:. � Address: 1-e- 9314 Lacated at (streea): % TM Section: _ B ck ? Lot 3 VYtrnieiRality: �v.` \1��+^ y� Watershed: _ SOIL P RCOLATION TEST DATA Date of Pre- soaking: Witnessed by: Date of Percolation Test: 'Hole No. Run No. Time Start — Stop { Elapse 4 Time (min.) Depth to water from ground surface (inches) Start - Stop Water level drop in inches Percolation Rate min /inch I �. 2 1 2 3 4 5 f 1 2 3 5 i 1 � 2 4 Notes: 1. Test; to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test. hole. (i.e., < l min for 1=30 min/inch, <2 min for 31 -54 rain ;inch). All data to be submitted for review. 2. Depth measurements to be made from top of (tole. Form DD-9-,.Pt!: ;)t,2 TEST PIT DATA , DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES Indicate level at which groundwater is encountered Indicate level at which mottling is observed nnQ Indicate level to which water level rises after being encountered Deep hole observations made by: Date 2 �I Design Professional Name: Address: Signature: Design Professional = Seal I YML ENVIRONMENTAL SERVICES 321 Kear Street" Yorktown Heights, N.Y. 10598 914 2;45-2800 Albert= H . �Padovari 1, Director LAB #: 1.703225 CLIENT #: 60143 NON STAT PROC I PAGE: 1 of 1 REPICKY, DAVID DATE /TIME TAKEN: 06/12/07 10:10 44 ARGYLE STREET DATE /TIME RECD: 06/12/07 10:25 LAKE PEEKSKILL, NY 10537 REPORT DATE: 08/02/07 PHONE: (845)- 528 -2231 SAMPLING SITE: 44 ARGYLE ST, LAKE PEEKSKILL, NY SAMPLE TYPE..: POTABLE : KITCHEN TAP PRESERVATIVES: NONE COL'D BY: DAVID REPICKY TEMPERATURE..: < 4C NOTES...: COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 06/12/07 MF T. COLIFORM ABSENT /100 ML ABSENT SM 18 -20 9222B COMMENTS: MFTC THESE RESULTS INDICATE THAT THE WATE (WAS),(WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORD HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. SUBMITTED BY: Albert . Padovani, .T. ASCP) Direct Or ELAP## 10323 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 5 5" $ �✓ '. WeIIPermit #L� �_; < ; WELL COMPLETION REPORT Well Location Street Address: Drilling Equipment Town/Village: Tax Map # 9,? , f -- ;? - 3,j' GPS� .. Casing Details A '"' e, s Joints: Welded --'T'hreaded Other / k k 4'ekli'll Map ?3 Block 7NLot(s) ,� V� Well Owner: N e: Dept to Screen ft ;:Develo Address: (t a v o K e c* ' �5 ,�, � s /� I0. 3? Use of Well: Residential _Public S pply Air cond /heat pump _Ir Igation 1- Primary Business Farm Test/monitoring —Other(specify) 2- Secondary ndustrial 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 6 f t. Length below grade -sft. Diameter 4 in. Weight per foot ACIb /ft Materials: I/gteel Plastic Other Joints: Welded --'T'hreaded Other Seal: ement grout Bentonite Other , Drive shoe: Yes -Woo Liner: _Yes "low Screen Details Diameter (in) Slot Size Length ft Dept to Screen ft ;:Develo ed1-.- First .:7 Yes.. =Noy ;Flours Second ; Well Yield Test _Bailed _Pumped Compressed Air Hours 2L Yield r/ , g p m. Depth Date Measure from land surface-static specify ft) During yield test (ft) Depth of completed well in ft.r: _° Well Log If more detailed information -: desc'r ptiolis or . sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter (in) Format'on Description ft. ft. Land Surface- _. �" - s = :.._.. e U e i5 _ .... _ -, i le . If yield was tested Feet Gallons Per Minute Pump /Storage Tank Information at different depths Pump Type Lt.,Lkileis 1 Capacity ',Y- during drilling Depth 3 o.0 Model list: Voltage A,%O HP 3/1/-- Tank Type W )r 1CV Volume -sue Exact Location of well with distances to at le st two permanent landmarks to be on a separate sheet/plan. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3/06 _a