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HomeMy WebLinkAbout4410DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84.11 -1 -15 BOX 33 04410 DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OF PUTNAM -STATE OF NEW YORK IN THE MATTER OF THE COMPLAINT AGAINST FRANK SULLIVAN RESPONDENT(s), Arising out of the Alleged Violations of the Public Health Law of the State of New York, the Sanitary Code of the State of New York, the Sanitary Code of the County of Putnam, and Administrative Rules Regulations and Standards Promulgated Pursuant Thereto TO: Frank Sullivan, PE PREMISES 2972 Ferncrest Drive Yorktown Heights, NY 10598 NOTICE OF HEARING CASE NO. 043 -06 -19 280 Peekskill Hollow Road (T) Putnam Valley, TM # 84.11 -1 -15 PLEASE TAKE NOTICE THAT CHARGES have been preferred against you to the effect that you have violated the health laws as more fully set forth on the reverse side of this notice: YOU ARE HEREBY SUMMONED TO APPEAR at a hearing to be held under the provisions of the Putnam County Sanitary Code and Public Health Law of the State of New York before Eric S. Zaidins, Esq., an Administrative Law Judge of the Department of Health of the County of Putnam on the 2nd day of August, 2006 at 10:30 A.M., in the Hearing Room, located at Route 312, 1 Geneva Road, Terravest Corporate Park, Brewster, New York, at which time the charges will be informally discussed, and such adjourned dates as may be designated. AT ALL TIMES YOU WILL HAVE THE RIGHT to be represented by counsel and the right to deny the charges, in whole or in part, following which the matter will be rescheduled to a date certain and a Formal Hearing will be conducted thereon, and a record of all the proceedings will be made, witnesses will be sworn and examined and cross examined, and documentary evidence may be offered and received, and YOU may.produce witnesses and evidence in your behalf; _ .....:.. _..r_. _ .. >. _:::.. .. AT THE HEARING, IN THE EVENT YOU WISH. TO ADMIT TO THE CHARGES, the Hearing may be terminated by written stipulation of discontinuance provided the violations have been corrected; UPON YOUR FAILURE TO APPEAR, a warrant compelling your appearance may be issued or an Inquest Hearing conducted and a determination made; CIVIL PENALTIES up to $1,000 for a single violation, per day, may be assessed against. you, and such further orders may be made herein as the circumstances may warrant; THE BOARD OF HEALTH may issue a warrant to any.Peace Officer of the County, pursuant to Section 309 of the Public Health Law, to bring to its aid the power of the County whenever it shall be necessary to do so, with the same force and effect as if such warrant had been issued out of a court of record. PUTNAM COUNTY BOARD OF HEALTH DATED: July 21, 2006 BY: Brewster, NY 10509 Sherlita Amler, M.D. Commissioner of Health STATEMENT OF CHARGE IT IS HEREBY ALLEGED THAT THE PERSONS HEREIN" BEFORE NAMED RESPONDENTS are charged with violations of the Health Laws of the State of New York and the County of Putnam as PUBLIC HEALTH LAW Of THE STATE OF NEW YORK Violations of any and all provisions of the Public Health Law of the State of New York and the State and County Codes and Administrative Rules and Regulations promulgated pursuant thereto — which shall be found to be found to constitute a NUISANCE, particularly, and not limited to the provisions of Article 13 of the Public, Health Law. SANITARY CODE OF THE STATE OF NEW YORK PUTNAMI COUNTY SANITARY CODE Article 111, Section 2c - Any separate sewage treatment system or any separate sewage disposal system shall be constructed in accordance with the standards, rules, and regulations duly promulgated by the New York Department of Health ( NYSDOH) and the Putnam County Department of Health ( PCDOH) with the terms or conditions of the permit issued therefore or approved thereto. Specifically, run of bank fill material was not installed according to the approved plans, i.e., soils with a percolation rate between 1 min/inch and 10 min/in should have been placed in the SSTS area. On Septen ber l"` 2005 .percolation rates of 240 min/inch, 240 min/inch, 160 min/inch, and two holes that did" not percolate at all, were witnessed by the PCDOH. Acceptable percolation rates for a conventional SSTS as noted by the NYSDOH and the PCDOH are greater than or equal to 1 min/inch and less than or equal to 60 min/inch. ADJOURNM1ENTS: Public Health Law violations are serious. They affect or may `affect the health, safety and welfare of the community. They cannot be permitted to go on indefinitely. Casual adjournments or hearings will be granted. Applications for adjournments must be made in person or by counsel to the Hearing Administrative Law Judge at the time set for hearings, except for legal excuses. Persons operating an establishment, business or facility without a permit, for which a permit is required — will not be granted an adjournment. Health matters are involved and the Public Safety is a paramount consideration. SA:kly g /,�1�� _ ✓ R. Carano J. Paravati � R. Morris file �1 DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OF PUTNAM -STATE OF NEW YORK IN THE MATTER OF THE COMPLAINT AGAINST ANTHONY AND_ CAROL SA -NDY,w RESPONDENT(s), Arising out of the Alleged Violations of the Public Health Law of the State of New York, the Sanitary Code of the State of New York, the Sanitary Code of the County of Putnam, and Administrative Rules Regulations and Standards Promulgated Pursuant Thereto TO: Anthony and Carol Sandy PREMISES: 280 Peekskill Hollow Road Putnam Valley, NY 10579 NOTICE OF HEARING CASE NO. 042 -06 -19 280 Peekskill Hollow Road . (T) Putnam Valley, TM # 84.11 -1 -15 PLEASE TAKE NOTICE THAT CHARGES have been preferred against you to the effect that you have violated the health laws as more fully set forth on the reverse side of this notice: YOU ARE HEREBY SUMMONED TO APPEAR at a hearing to be held under the provisions of the Putnam County Sanitary Code and Public Health Law of the State of New York before Eric S. Zaidins, Esq., an Administrative Law Judge of the Department of Health of the County of Putnam on the 2nd day of August, 2006 at 10:30 A.M., in the Hearing Room, located at Route 312, 1 Geneva Road, Terravest Corporate Park, Brewster, New York, at which time the charges will be informally discussed, and such adjourned dates as may be designated. AT ALL TIMES YOU WILL HAVE THE RIGHT to be represented by counsel and the right to deny the charges, in whole or in part, following which the matter will be rescheduled to a date certain and a Formal Hearing will be conducted thereon, and a record of all the proceedings will be made, witnesses will be sworn and examined and cross examined, and documentary evidence may be offered and received, and you-mav produce: witnesses, and - evidence yin. your behalf,- AT THE HEARING, IN THE EVENT YOU WISH TO ADMIT TO THE CHARGES, the Hearing may be terminated by written stipulation of discontinuance provided the violations have been corrected; UPON YOUR FAILURE TO APPEAR, a warrant compelling your appearance may be issued or an Inquest Hearing conducted and a determination made; CIVIL PENALTIES up to $1,000 for a single violation, per day, may be assessed, against you, and such further orders may be made herein as the circumstances may warrant; THE BOARD OF HEALTH may issue a warrant to any Peace Officer of the County, pursuant to Section 309 of the Public Health Law, to bring to its aid the power of the County whenever it shall be necessary to do so, with the same force and effect as if such warrant had been issued out of a court of record. PUTNAM COUNTY BOARD OF HEALTH DATED: July 13, 2006 BY: Brewster, NY 10509 Sherlita Amler, M.D. Commissioner of Health STATEMENT OF CHARGE IT IS HEREBY ALLEGED =THAT THE PERSONS HEREIN BEFORE NAMED RESPON]ENTS are charged with violations of the Health Laws of the State of New York and the County of Putnam as fuilows: PUBLIC HEALTH LAW OF THE STATE OF NEW YORK Violations of any and all provisions of the Public Health Law of the State of New York and the State and County Codes and Administrative Rules and Regulations promulgated pursuant thereto — which shall be found to be found to constitute a NUISANCE, particularly, and not limited to the provisions of Article 13 of the Public Health Law. SANITARY CODE OF THE STATE OF NEW YORK PUTNAM COUNTY SANITARY CODE Article III, Section 4 - No person shall construct or maintain any privy, cesspool, sewage treatment disposal system, pipe or drain, so as to expose or discharge the sewage contents or other deleterious liquid or matter there from to the atmosphere or on the surface of the ground. A sewage discharge to the surface of the ground was witnessed by a representative of the Putnam County Department of Health on 6/14/06 and on 8/16/05. ADJOURNMENTS: Public Health Law violations are serious. They affect or may affect the health, safety and welfare of the community.' They cannot be permitted to go on indefinitely. Casual adjournments or hearings will be granted. Applications for adjournments must be made in person or by counsel to the Hearing Administrative Law Judge at the time set for hearings, except for legal excuses. Persons operating an establishment, business or facility without a permit, for which a permit is required — will not be granted an adjournment. Health matters are involved and the Public Safety is a paramount consideration. SA:kly �'� I ®� r poj ✓ R. Carano U J. Paravati 4r R. Morris [ate file ;August -0.6 : Amended d ates ,ok viojaliQ n o r-rases &044 -06-19: - Der Y� F-���� g " �oRw � �� �2 1�c�uS��� ��U �j�� Alt DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OF PUT NAM-STATE OF NEW YORK IN THE M[A T T ER OF THE COMPLAINT AGAINST t(_rrapF'5 Asa9 -Pr�tr j Pe . b j,�n►mcHrA,o RESPONDENT(s), Arising out of the Alleged Violations of the Public Health Law of the State of New York, the Sanitary Code of the State of New York, the Sanitary Code of the County of Putnam, and Administrative Rules Regulations and Standards Promulgated Pursuant Thereto STIPULATION OF DISCONTINUANCE CASE N0. Facility No.. ?fZtair'S i.AW Sa�Pr�'G IT IS HEREBY STIPULATED AND AGREED. by and between the respective parties hereto that the within matter is hereby terminated upon the following terms and conditions. 1. The Respondent(s) admit the truth of the allegations set forth in the Statement of Charges. 2. Tha�lRespondent(s) represent: ✓✓ it is in compliance with the Code(s). it will be in compliance with the Code(s) by 3. That Respondent(s) understand an appropriate civil penalty may be imposed by the Commissioner of Health by Order which amount will be determined at the discretion of the Commissioner of Health. :_4 .That�uq_m% ggitih:Resp(� 8i1Ia }�ssL�is G vV.r�- Gavai- ✓�.v W,l� ces a0t"' a0 � �V o 5 ►w9.tii� y�S ✓t L4,�� DATE: o " Brewster, New York 10509 Administrative taw Judge STIPULDISCONTAFFDV r 't y_�� d�,E_�WR A� eI For o Putnam C en F r ounty Heal Department DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OF PUTNAM- STATE,O_F_ NEW YORK.. / TXT THE MATTER OF THE COMPLAINT AOAIl\TST. G ~�Z rc 30W v 00 ��Z' rCT • RESPONDENT(s), Arising out of the Alleged Violations of the Public Health Law of the State of New York, the Sanitary Code of the State of New York; the Sanitary Code of the County of Putnam, and Administrative Rules Regulations and Standards Promulgated Pursuant. Thereto STIPULATION OF DISCONTINUANCE CASE NO. Qj3 - 19 Facility No. a STp'�.KS �04PPO PU ri I T �Jt .P IT IS HEREBY STIPULATED AND AGREED by and between the respective parties hereto that the within matter is hereby terminated upon the following terms and conditions. 1. The Respondent(s) admit the truth of the allegations set forth in the Statement of Charges. 2. ThVitis espondent(s) represent: in compliance with the Code(s). it will be in compliance with the Code(s) by 3.. That Respondent(s) understand an appropriate civil penalty may be imposed by the Commissioner of Health by Order which amount will be determined at the discretion of the Commissioner of Health. 'hatm,i�it gatidn�Respondent(s) Asserts :( c�c ai• A tU4.%, DATE: (� f �- Brewster, New York 10509 Administrative &W Judge STIPULDISCONTAFFDV st;t&w v-a..e For Putnam County Health Department DIVISION OF ENVIRONMENTAL HEALTH SERVICES COI1N1TY OF PU TNAM- ST'ATIE OF NEW FORK : �� =v� - _ . - -- - - 'i... -r �,►; �+-- - :tea.,» � :.� :�? IN THE i6 ATTElR OF THE C� COMPLAIN T AGAINST 4 w9wr f'6;v. - OZ�o 3�eeKSKuf' P0. s RESPONDENT ��ft-,p // (), Arising out of the Alleged Violations/of the Public Health Law of the State of New York, the Sanitary Code of the State of New York, the Sanitary Code of the County of Putnam, and Administrative Rules Regulations and Standards Promulgated Pursuant Thereto STIPULATION OF DISCONTINUANCE CASE NO. w. 0 Facility No. IT IS HEREBY STIPULATED AND AGREED by and between the respective parties hereto that the within matter. is hereby terminated upon the following terms and conditions. 1. The Respondents) admit the truth of the allegations set forth in the Statement of Charges. 2. That spondent(s) represent: it is in compliance with the Code(s). it will. be in compliance with the Code(s) by 3. That Respondent(s) understand an appropriate civil penalty may be imposed by the Commissioner of Health by Order which amount will be determined at the discretion of the Commissioner of Health. °�- 4:! -• Thai Yn r��itig~dtion tesp rideirt(s) Asseris:(_t 0 M Ly DATE: t " Ob Brewster, New York 10509 kxi d to,,i AV,. SI S - fN r hol n For Putnam County Health Department Administrative Law Judge WO ST �ULDISOUNTAFEPV / pf 6&1V(1Vf'P ' , . v¢�w 5 wt., ► 54/ Or .cJ �azwt e4 wf, QrvV- L Of ;y�� 'I l revs iu 're ve sf <. ... r - s ham DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OF PUTNAM -STATE OF NEW YORK IN THE MATTER OF THE Cq�ONTI AINT AGAINST 4W O���EK$K[cLeu -fj�/ 1i'1' -RESPONDENT s Arising out of the Alleged Violations/of the Public Health Law of the State of New York, the Sanitary Code of the State of New York, the Sanitary Code of the County of Putnam, and Administrative Rules Regulations -and Standards Promulgated Pursuant Thereto '�� sl •.¢R�� iP Gist'• i. .. .. . STIPULATION OF DISCONTINUANCE CASE NO. Dye • 068 Facility No. 9to Aron 000 �� L e 2 �So i �-KS iG (GC.•- � Q CGi� rJ M./ IT IS HEREBY STIPULATED AND AGREED by and between the respective parties hereto that the within matter is hereby. terminated upon the following terms and conditions. 1. The Respondent(s) admit the truth of the allegations set. forth in the Statement of Charges. 2. That spondent(s) represent: it is in compliance with the Code(s). it will be in compliance with the Code(s) by 3. That Respondent(s) understand an appropriate civil penalty may be imposed by the Commissioner of Health by Order which amount will be determined at the discretion of the Commissioner of Health. - -.�... •Uiat a6 i�ti tuan R&spandei*). Asserts: z:) wL v DATE: Oro Brewster, New York 10509 A �r fQ-2X► wM' r�fi � RRO. ��71R Fo Re n For Putnam County Health Department Administrative Law Judge *x P.f- , girl w v� ST UL IS NT V vkl i �� •ter . ve�v►ti irtiot�ry A r SNP L.rezohu wtvavj� a mf , 004000 r � Yel ye sf 1O0 / Jet E IV►S�r. hJb'1 (U�iKS y�:ln—c��s+��ie»l/)L>L The following is a time line for the Sandy residence, 280 Peekskill Hollow Road (septic failure): 0 10/18/04 —Construction Compliance package from Frank Sullivan, PE entered in. 0 10/26/04 — Construction Compliance issued by Health Department. 0 7/20/05 — Complaint by Sandy's concerning excessive water and erosion affecting their retaining wall 0 7/25/05 — Site inspection by Robert Morris, PE, Senior Public Health Engineer and Joseph Paravati Jr, Assistant Public Health Engineer in response to drainage, erosion complaint. 0 7/27/05 — Follow up letter to Mrs. Carol Sandy concerning site inspection on 7/25/05. 0 8/1/05 — Engineers list faxed to Carol Sandy. 0 8/7/05 — Letter to Joseph S. Paravati Jr, Assistant Public Health Engineer from Anthony & Carol Sandy. In the letter, Mr. & Mrs. Sandy note that the septic system is failing and they have hired an engineer. 0 8/10/05 — Site inspection by Robert Morris, PE, Senior Public Health Engineer a 8/12/05 — Letter from Robert Morris, PE, Senior Public Health Engineer to Anthony & Carol Sandy. Letter is a response to the Sandy's letter on 8/7/05 and summary of site inspection on. 8 /1.0/05. 0 8/18/05 — Received negative result for formaldehyde in water from NYSDOH. 0 8/18/05 — Violation notice issued to Carol Sandy for non - compliance with Article III, Section 4 of Putnam County Sanitary Code (apparent sewage discharge to ground surface). 0 8/18/05 — Engineers report form Donald Knapp, PE. Site investigation ford Anthony and Carol Sandy. - sr' ni .a'aar Vra�•... .a.: -: .. •, -.a. �.-Y- a. ,1 t7- •.r -r .,�.o. _ . ... -au •.:iai •a • 8/21/05 — Letter front Anthony & Carol Sandy that existing SSTS is currently under • warranty with Percy Montes of P & B Contracting. • 8/22/05 — Memo from Joseph S. Paravati Jr, Assistant Public Health Engineer to Sherlita Amler, MD, Commissioner of Health. Summary of actions during site inspection on 8/16/05. 8/22/05 — Letter to Sandy's from Joseph S. Paravati, Jr., Assistant Public Health Engineer (APHE), regarding the requirement of percolation tests. 8/30/05 — Fax from Joseph S. Paravati, Jr., Assistant Public Health Engineer, to John Delano, PE. Map for perc test locations. • 9/7/05 —Memo from Robert Morris, PE, Senior Public Health Engineer, to Dr. Amler, Commissioner of Health. Update on the Sandy residence and septic failure. • 9/7/05 — Letter to Percy Montes from Joseph S. Paravati, Jr., Assistant Public Health Engineer advising all SSTS repairs need permits from Putnam County Department of Health. • 9/12/05 — Letter from Joseph S. Paravati, Jr., Assistant Public Health Engineer to Percy Montes, Primo Landscaping. Summary of field testing on 8/18/05 & 9/1/05. Recommendation to replace. entire system. 4. .. .�. • .�.�. nVr .�•. .wu r m .... .....+N .. .®� .�v 'A•6:L.+, . .. a+ .... � u... a.�r_P ♦ �_. �. .�. ...' �/r w ... -w... ... . w..• ... ..r+F e � ;�yw ^.tiyyw . • 9/13/05 — Letter from Robert Morris, PE, Senior Public Health Engineer to Mr. & Mrs. Sandy. Same as above, including the recommendation. • 9/19/05 — Letter, guarantee forms and perc results sent to Mr. Sandy. • 9/21/05 — First repair permit issued (R- 271 -05) — exploration and replacement of damaged components and reestablishment of fill over system. - C4 10/20/05_ - Site irispectionkfo first `re "pair permit ` Repasr wasn't p ete r . 11/03/05 — Second repair permit issued (R- 314 -05). Issued for work on impervious soil barrier including removal of material where appropriate for replacement. 11%08/05 Sit nsp one, y�,RobertMorris;PE Seruo Public Health Engineer: • 11/9/05 —Letter to Percy Montes of Primo Landscaping requesting update on repair work. I;„;,�; ;:;;., , �� - � - � _ :m .l�`1110/0'S S7te rnspection by �ylrke" Luke��'FfS`,'xno�discharg �_ _ . _. ._, _ _ •,�,, �� + l l /22 /OSSiteinspectioribNy J�ose_ph S_ `Para vat; Jr ,Assistant Public Health Engineer: 0 1/17/06 —Letter to Percy Montes strongly recommending engineering plans certified by a licensed professional engineer. 2/21/06 — Letter to Percy Montes requesting update on repair. Still waiting for plans. 0 3/18/06 — Review of the repair for 280 Peekskill Hollow Road by Donald Knapp, PE engineer for the Sandy's. 0 3/27/06 — Letter, repair permit signed by Sandy's and copy of plans submitted. 3/30/06 —Repair permit issued (R- 45 -06) to install new trenches (336 LF of absorption trench in R.O.B. fill) based on plans submitted by John Delano, PE, Badey & Watson. Plans were not certified since repair is in the approved SSTS expansion area. Letter with copy of permit sent to Mr. & Mrs. Sandy. 0 5/24/06 — Letter to Percy Montes concerning length of time it is taking to complete the repair. 6/1/06 - Phone call with Percy Montes about repairs. w _ _...•... a =. -� •eta— .r,�.:,J.,_.:'..;aYi " it-,! s m .""�'�'_^r"'^_'s'.'-- �"- `a.,�.. . -.n... .y, _ �.,p•� :.. ,5, -. - _ . ...s . .. .0 ... _.c... �.�.... . _. ,..� .�.a. .a.+. ,.,.. _ ....... 6/14/06 ite rispect on� positiv tes 01 6/16/06 — Phone call with Percy Montes — Percy ready to install clay barrier, excavation complete. 6/22/06 Site inspec'to STS'area covered with e_'' 6/22/06 — Phone call with Percy Montes — clay barrier installed; sample of clay was ok; bank run not delivered yet. 0 7/10/06 — Phone call with Percy Montes — Bank run is on site. Site u`specton ams ple of bank run taken k x"7/13/06 M1+Si�e inspection �L= arger�sample of bank run taken e •�- 7/44/06 ---:,Received sieve "resdits'from :Sandy's —pas' ed sieve:" • 7/18/06 — Sieve analysis on the soil collect by the Health Department - Passed sieve. � • 7 /.25 /0.6�S�te'i`nspection of on go�,i�ng repair 7 /2:7 /06•'�`Srte�irispecfon. �trencles'b"einganstahled • 8/1/06 — Letter to Percy Montes documenting items that need correction. I:.. • a. _...e.. .ef a wy.: - r. .... -� 4«. ... sr. se` ._. ..rti... rsp� -yy.•_ .�.ry���p �r» ... o... w,w.�a. -v - i...w -. _...r . _7 r ae• f+o..,• ..�.T... ..q •. rw(:"•�[O^•r{f Le i-oz i-i-, ks L,2, k— eep --to - --------- - too., 13 G,LAJ ce, - ___..___ .. . _. _.� � -�. (4.l �.� . t�"T�f `�... (_.�lGi�,. %�?!t'T!�S " -.. �'f. ":.�.nvw� Gcir,�lsc�5o<�'y .l.%�7�cs l�7,�_ .��.- _... aw'..�.' , op ( ((7(r - 4 LA-e. AW6 J+p-6 6y 4, o.A t pezj.. 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Lot # Date Subdivision Approved Owner /Applicant Name Mailing Address Town or Village / � Aar"'. t )/a %% y' Tax Map , 1 Block 1 Lot 1-5— Renewal Revision Date of Previous Approval Amount of Fee Enclosed Building Type 1� Zip 7� Lot Area %AC, No. of Bedrooms Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage -System to consist of r—X, /d c ° gallon septic tank and eX • 3 . G Z Other Requirements: Xle w 4'e,6 To be constructed by Y c, Address ���' f5-ox r Water Supply: Public Supply From } Address or: i�' Private Supply Drilled by Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. of NEB Y Signed: GZ2 / R.A. Date Address Z /-Nffik ' ` AN License # 2489 APPROVF,D FOR CONSTRIjCTION: This appr i s rs from the date issued unless construction of the sewage treatment system has been completed and inspec a y0., 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. Approved for discharge of domestic sanitary sewage only. By - � Title: VK-C Date: 1 vok Wh' copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 SHERLIITAAMLER, MD, MS, FAAP M4 Commissioner of Health ILORETTA MOILIINARII, RN, MSN Associate Commissioner of Health 101'1 DEPARTMENT OF HEALTH 1 Geneva Road. Brewster, New York 10509 ROBERT J. BONDII County Executive ROBERT MORRIS, PE Director of Environmental Health To: Brenda Ayers From: Robert Morris, P.E., Director of Environmental Health r °f Subject: 280 Peekskill Hollow Road, (T) Putnam Valley Date: May 13, 2009 Regarding the above mentioned property, there has been no documented or reported septic failure since the repair was completed on September 25, 2006 according to the Putnam County Department of Health records. Thank 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 Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 PUTNAM COUNT? DEPARTIVIENT QE HEALTH DIVISION F EgVIRONME TAL HEALTH SERVICES, APPROVED AS'UOTED FOR CONFORMANCE WITH C} APPLICABLE RULES AND REGULATIONS OF THE �CO PUTNAM COUNTY HEALTH DEPARTMENT. ATU & NN dr , ��1741 LOCATION PROPERTY OWNER 280 'PEEKSKILL HOLLOW ROAD `ANTHONY & CAROL SANDY TOWN OF PUTNAM VALLEY � 280 PEEKSKILL HOLLOW ROAD # COUNTY' OF PUTNAM'. PUTNAM VALLEY, NY 10579 T. M. No. 84.11 -1 -1.5 , STATE OF- NE-W YORK FILED MAP DESIGNATION SUBDIVISION NAME. LOVE —PEEK ACRES LOT No. 2 MAP No. 2186 DATE: NOVEMBER 14, 1986 S SSTS "AS-- -BUILT" IPTION SCALE.: -WNCH. = 20 FEET .<<G��N E� CO 1` r- tq y n Z IS TO CERTIFY THAT THE SEWAGE TREATMENT, SYSTEM WAS CONSTRUCTED AS INDICATED ON THIS PLAN AND THAT E SYSTEM WAS INSPECTED BY ME FORE IT WAS COVERED OVER. THE YSTEM WAS CONSTRUCTED IN ACCORD - NCE.WITH ALL STANDARD RULES AND EGULATIONS OF THE PUTNAM COUNTY QA 2895 �k,= F 9 F NP LIC 5 EPARTMENT OF HEALTH AND THE NEW YORK STATE DEPARTMENT OF HEALTH. It SHERLITA AMLER, MD, IBIS, FAAP Commissioner of Health..... - - . LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road. Brewster, New York 10509 To: Brenda Ayers ROBERT J. BONIDI County Executive ROBERT MORRIS, PE Director of Environmental Health From: Robert Morris, P.E., Director of Environmental Health Subject: 280 Peekskill Hollow Road, (T) F Utnam Valley Date: May 13, 2009 Regarding the above mentioned property, there has been no septic failure since the repair was completed on September 25, 2006 according to the Putnam County Department of Health records. Thank you _. 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 Nursing home Care Fax (845) 278 -6085 WIC (845) 278 -6678 Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580 PUTNAM COUNTY DEPARTMENT OF HEALTH -- : -, ::'c"DIVISIIN -OF EN- ",RONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # 7 03 f -kr —o Located at Z Fa e� ��i s��i �% /1v %for 1f1 Town or Village�r.17��3 Owner /Applicant Name Ora ry Tax Map Y4. / Block Lot /r Formerly Subdivision Name ,c v ee -A. -4 zerzr� Subd. Lot # 21 Mailing Address 6'`�U �ri�Ysli �1 % ��� ®d el AJI. /lam, Date Construction Permit Issued by PCHD Zip 01"7 Separate Sewerage System built by —, o 4-2,f Address 7 Consisting of -ex. /ooa Gallon Septic Tank and el ij jl �r�,��i�i�' — h G h� .� ld' �• �' OT X4'0 W Jr- 0 h� Other Requirements:f �y� �^�s��� A`r% %�� jy��C✓/'�,��ry� t' Water Supply: Public Supply From. Address or: I!' Private Supply Drilled by X "3 11'n 4 Address Building Type /rs�> ��� Has erosion control been completed? Number of Bedrooms 3 1✓ Has garbage grinder been installed? A!/ Q I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issueiD Construction Permit and approved plans and the standards, rules and regulations of the AUkQW_ty Department of Health. Date: V91Z,0 G ,Certified by Address Z 9 7 2 / � ill �'� �✓� ff ��%� Any person occupying premises served by the ab to secure the correction of any unsanitary conditi treatment system shall become null and void as soo P.E.Z R.A. License # f ? W y take such action as may be necessary sage. Approval of the separate sewage sewer becomes available and the approval of the private water supply shall become null and vo ` lic water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modification or change is necessary. B Title: Date: ' /';Ls /0 C. Whi a copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 s� �;+ �� ` d __.t i' t. T St. 4AQ 42R Loql' -.1" 5' W, FOR M og N sm T177P.." - il - r"F� 'po . -' 5�,. -': �. � ..T :- ••.•�. -S. i .edy .v_ ny.. -- 3_..�.. -.. �'..Lri.:.}- '37.`•x . .�.:i^L••.eb..[_.._+.— •'.'.L -x. Y��x.. ':s_:. e..w�!:•�'^FA .� -. ..`��.•��. rr 'g 'At , "-7 i 31 2 eO, 6 1 34 33 7 --�---W- -n-7- iiroaM� :W 1. r. el PUTNAM COUNTY DEPARTMENT OF HEALTH DI�ISIO Y•_9 E vI 30 ,M Lit $.YIC _ _ .......__.... .:nc �a«�. r�%: v' �V9:+-. a..'. �du` p!,:., o.. ..�:x7t- w.�+.'e8a "vtsa'+r..+r�. ..d.. .r.�„s..o-•,.rsa:.f+:4 - �• +.r=:v.. rv- .w- .i+�- L`aP..e.• ®..:�tte. e..xFP►ci+sr�.'.r�b7o" won= GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM O h LSO 1141 C/ -9d Owner or Pu aser of Building Building Constructed by 2f� Location - StreetP,,6,;,a,,, �f ey ;W.7 5 zg 11 ,,, Building Type Tax Map' Block Lot of a11'� TownNillage Subdivision Name Subdivision Lot # A I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate ro erly is caused byythe,willful or negl gent:act of the occupant of the building utilizing the ._ - - o.._. «-.. S�t�lll... -• .--.- o .o...... .., -> -. y.. ...,Ev. o.y�.,.. ... .. ,.... - -... ....- .w-- q «•..... �.. ,. � a.ess.....r . -e...o ..- _ Jv�.r.7a. �•vly.......w ... � -. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the' failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month _� Day 2,1 Year Ad General Contractor (Owner) - Signature r Corporation Name (if corporatio Address: zpe ,9. x ? 2 State Zip WX Signature: Title: A Corporation Name (if corporation) AddressA0 /3a)r °% 2- /1%v h Al / State Zip 16,S-4;7 Form GS -97 I� CpG Sheet of -PUTNAM COUNTY DEPARTMENT'OF HEALTH ,� ,�.: •:�-�� .. �I <.q���%I4'- �-."�r.xST'�i.:���� "�'� ,�.1���. i��+:��i'�•�i�'►E�c`� %ExL� '. :,�•?' w ....:.:.. �;,,.�- ,:',.,;�= �.�- :;,.- ,-R,�. Y�4 FIELDIACT- ITY REPORT ,. TPt• A T) n,"R E. J �e� K -J (G:irf ` �d w /`-�C • ^ Street Town' State Zip PERSON N' -CHARGE Name -and >Title : TYPE OF FACILITY:: _. FINDINGS:,; 0^+ Na ' v�u n des � i `�is'� � ' �.f .:4 M, A`li�'7'.- ry„ C � 1 ,�'•` � .? j +'Y �Y: r, . ^, ,� _ e P � • of b - �i_ - f All ! ,,_ Signature and Title i RFP(?RTRF:F'FT�FF:T) RV.:. _ F T acknowledge receipt' of this report SIGNATURE;. `' f 02/96:: Title. . •�� et7t ®�wl:��t� a! CD h y1�•1 - - Sheet Of PUTNAM CO CJNTY DEPARTMENT'OF jIEALTH Y iy'1G -0 J .l\aM FIELD 'ACTIVITY REPORT = ' _ VA AJ r Street :. ,Tows, State :- Zip PERSON IN: CHARGE ng TN . `l0 Name and Title -` TYPE OF FACILITY FINDINGS: z _ ''� _ - 'x is , . -• ra . .. 4. •�� et7t ®�wl:��t� a! a SH.ERLITA AMLER, M_D,_MSt_FAAP • .• " , `' '" ��'�- Coe mWn`iusionI of Health'' LORETTA MOLINARI, RN, MSN Associate Commissioner of Health ROBERT J. BONDI .. , .. ':wd =•, n: vw.ru y;�in•�m_ .._.._•.• -moo:? w.`•m`:v�7a`snw+:r'.8+r� �COi�>�t�'Execuhve. DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Mr. Percy Montez Primo Landscaping Inc. PO Box 782 Mohegan Lake, New York 10547 Dear Mr. Montez: November 9, 2005 J Re: Separate Sewage Treatment System Failure ` 280 Peekskill Hollow Road Town of Putnam Valley This Department is requesting an update on the actions being taken to correct the septic failure at the above referenced parcel. Mr. Robert Morris, PE, Senior Public Health Engineer, performed a site inspection on November 8, 2005 and noted the following: The,SST- stj1_-l.appP4r.s..to t e",f_ailJng ;, —. ..:.; ._ .. ::: -_r . ....�. wT:...x.,_... ..... w n:,, 2.� There is clear water effluent and/or gr oundw a tW on the lower portion of the SSTS. 3. The speed levelers need to be cleaned of scum and leaves that are impeding equal flow. 4. The tarp covering the SSTS area needs to be removed to allow for natural transpo- evaporation. This Department is unclear as to the reason for the installation of the clay barrier (repair permit R- 314 -05, issued on November 3, 2005) as an attempt to correct the failure. It doesn't appear that the first permit (R- 271 -05) issued on September 21, 2005 has been executed and if it has, is the work as outlined in the proposal been completed? The water that is ponding over the trench that was excavated to install the new clay barrier appears to be groundwater and/or clear water effluent and this Department is inquiring as to how this new situation is being addressed. At this time, it appears that the actions taken have not corrected the SSTS failure. An SSTS failure is an imminent threat to the public health and the focus needs to be on stopping the discharge of effluent to the surface. Environmental Health (845) 278 -6130 Fax (845) 278 -7921 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 Sincerely, Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:qj cc: Anthony and Carol Sandy $ A P�F.FJ 9 �' j 4 j, i 4 fi' F "YF` yy y $ `47 -"'v '.. Pd.E -, i 'YA 5.' A -. . . '� . i4 v y, �t f 2 � L . "1` f .. h.. f 7 -Y,,,� t- 4, d .," y '. fix. ',.,, >�'' s y. } 1. - t ' b M �Oja' k # , ' S S `` 9 �n }. S �j 'tX Y S�,J E f: �^ � - _ _ i11 ,,, , : ° 2^ - s ! v "a„� sa a $ `77 1 nor f y 9 F .. ,. .. •' c f r ,� .E� ,. Sheet of /�c ,, . .. ,., ... .. :y Y . „ a *1 Ptu- COUNTY�WEPARTMVN OF HEALTH ,' '- r �' �- '?K `��"i r ''�� T )' 4 �T , "! ? ±iC �7 '- 'Sri . �+ �.]x 'yf` "„ ^,_w. ��Ii�it` �b'�'SL' i; 'l`Wi0'{it4'e "9j:iJ �� �"iLi I — .", � sA 16.1 r'Y� R7 ":L v• 11 sAS �%" - f�C T -11 '' �k!. Y04 x MELD ACTIVITY REPORT Y a v .. '� 1. � - d ,� a s o 'f a /� �, =l il`` TPI' ° 1. s N �NfF'' "-,. , , e . z ,��- , � �� -, 1, .1 ,4 �. . .. - , ". �-`�,�, .'I,-- .�-, � �',' - ` - , - P� �I I I- �;, � - I -- , - .:-." , n - �, �:' w Tr � I , �' �� 'I, -�-- . .,. I , I,- � - � "', I I . I I , " �`� OW , . � . � ,�,� -� ��,,� , k". 6', ,� " , .- � `�' .• . � I" -I"A'-�- I -- � I Street' Town -# State Zip - a ,� .� _ r� _p ._ - .. , a e4 v pan -° PERSON IN CHARGE s . . P%, A& , 11 ik.:�,��,, �-- � -h (7 �p rrr, �. '. (( /y) �/��y r, .9 f �.'�" �J v is `.. its' i ; ,- , ^u .r r -. . , and Title `, ! ^� --t °. - '. � sName {TYPE OF FACILITY �J , x Wm . �^,' v -. ;,. - „ r c .. . .. is Y a �. y £ F :. ,_ w fy �i < f s _ . - 5 , ~� a 6 - a :: :.n _ P T § y �,F�NDINGS _ � x fi 'Y r k `u y 'F k ti� P: 5 Y'wY f S '. T �-'_ .. 3�a .� ' a 11 J. .!' .. K i.. f F C , k.r ;x - z �, U J� �, J3 5 Plst -'� ' �5 , c r �"_p ri d p, j 4e� i- - � _ 11 I e-�. 'a^ A. a•' _- �e "?.Y 7.: i' t "1_'tE *" i h1�Yt°�*` k"1' '$. 3`t .. .R o - "Y{y=• `••# ? b"^'?"',�}P '^�$+f -- ' .f -i�eN .:��`' LF• wy4'..it w :. c.. „- _ s+ rt'�h +e...t _ . .� 11 n. _( f r �.� s _ r & 4, _ , n- -. ,;: }s -�. a ..,> ' .a - t r a;.a ,:,,ate, h^- - s '� k. a - a "w' ~ x Yom''.. �€ � .. & '!' -. p x .` ��. c ._ y.' T v? ee- " `h,} a`^ A n k vt . ie. ., o' < t "a w r >re 11 `` f � z. �'��j jff� f d 2 F. S - I �, a .. r ---,, ` t �, s f a j ,1- Jj �1 zi - ` �Tt4 `t j � 1 _ -'iV.S a}'4i t ya 3 ; s� J, i` 'Y s 's+ .' K. . d u'f <k� K� t F•} i e xb 4 .r 1. .... Ar s k _ ti a" _- x. } '.. P. M1 ,v - _ 3 P � .. � _ _ A p vi -, t.,, �' ��I sue, `- i 3: y 3> ": _: Gr -All, 1 $ 4h q'yx- y a. `� ''+ 3t m ¢ !i 'fir F . �- cC i. ',, 11 . II T�CPF('Ti1B1° 6 ,.. � P Ir �. ' } .. 4 .,y Y.- P Signature aid Title'' k { �' `— ` � RFPCIR`t' RFC,;FT�jFIn RYA T :� 'fit. .� ,, I acknowledge receipt 6 this report SIGNATURE; ' #�, � ��',� �� 02/96, Title:' — ", .. b a . SHERLITA AMLER, MD, MS, FAAP Commissioner. of Health.. o: -wi �+i+Z �a'".:v ..."�,��:.,i+> >...�P, ^.Q, ,s �qw `ri�i•4cs ":- �+w"'+e: sv'-' LORETTA MOLINARI, RN, MSN Associate Commissioner of Health R®HERT .I. H®NDI Cou. ntX_Execug . .� ... wyz� �^.r ie =:.-_ e.B�aF' i0. -�6 ,R'� .�..Pi^'d�i•iiro n': � �d-� �C�i^ DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 February 21, 2006 Carol and Anthony Sandy 280 Peekskill Hollow Road Putnam Valley, New York 10579 Re: Septic Failure 280 Peekskill Hollow Road (T) Putnam Valley Dear Mr. & Mrs. Sandy: Pursuant to our conversation approximately 2 weeks ago, it is the understanding of this Department that you do not wish to be called in for a hearing at this time, but would like to continue to work with the contractor, Mr. Percy Montes of Primo Landscaping, Inc. to reach a conclusion for the above referenced failure. Please advise this Department if this is still the case. Also, please be advised that the septic tank must be pumped out at regular intervals so sewage is not being discharged to the surface. _ Please do not hesitate to contact us if any further questions arise JSP:cj Sincerely, Joseph S. Paravati, Jr. Assistant Public Health Engineer 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 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 February 21, 2006 Percy Montes Primo Landscaping, Inc. PO Box 782 Mohegan Lake, New York 10547 01 Dear Mr. Montes: ROBERT J. BONDI County Executive Septic Failure 280 Peekskill Hollow Road (T) Putnam Valley This Department is requesting an update on the status of the repair for the above referenced failure. A letter was sent on January 17, 2006 with the understanding that you were ready to proceed with the repair. However, one month has passed and no repair sketch or engineering plans have been submitted for review and approval. If plans are ready for review, please submit them so this Department can review them. As stated in the previous letter of January 17, 2006, = thisDepaitment'.gtrmgl i4uefersi�gineerin-gp'l"aw tiEtd y';flid ensed,'g>`aEesslonal. but current guidelines do not require engineering plans if the repair is in the same location or. an approved expansion area. Please do not hesitate to contact us if any further questions arise. JSP:cj Sincerely, �oseph S. Paravati, Jr. Assistant Public Health Engineer 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 'SHERLITA AMLER, MA, MS, F'AAP . Commissioner of Health a: .�-.:i"�•`5n •i1.d�D::.n,i.; a.- �as`. -- .. '�T:.a'o= •.::v .`i -c r'- LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Percy Montes Primos Landscaping' PO BOX 782 Mohegan Lake, New York 10547 Dear Mr. Montes: January 17, 2006 ROBERT J. BONIDI ...Co aty.Executive, f ,r._-:;io=.4an a v +e �..y+ .,c. ...x:cyS", Re: SSTS Failure — Sandy 280 Peekskill Hollow Road (T) Putnam Valley . It is the understanding of this Department that you are ready to. proceed with the repair for the above referenced SSTS failure. This Department would strongly prefer.that engineering plans certified by a licensed professional engineer be submitted. However, if the SSTS is to be repaired in the same location, current guidelines do not require the submission of such plans. "- =If you have any'fiifther questions; please =do"not hesltateto- contact°us: Sincerely,. V � oseph S. Paravati, Jr. Assistant Public Health Engineer JSP:cj cc: Anthony & Carol Sandy, Owners John Delano, PE 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 InterventiowPreschool (845) 278 -6014 Fax (845) 278 -6648 JOSEPH F. SULLIVAN, P.E. 2972 FERNCREST DRIVE YORKTOWN HEIGHTS, N.Y. 10598 (914) 962-4248 dr 111114f ;Y7 7© clelww /01/z/::-� /_4 If �'e ;,';4e- 12 "'ole-o /y I;Fe; sand cep c ov Ile '74 "'oor lir "�p doop�- Pe, of t L PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION O_ F ENVIRONMENTAL HEALTH S_ ERlVICES. _ ....__ n .. e.. .. __ .. _« _.e ....� ��„ 1.- ._..i::� �.i =:aF i. �O °:- Y�.iP'�Qf'NS►� w.• -v... j::•. wo=• -+ai A,.:�m -• .ro r::.nn 'v ^•tiA t:.. .:'i LETTER OF AUTHORIZATION RE: Property of 0 Located at T/V e. Tax Map # �+ Block Lot % Subdivision of Subdivision Lot # 2 Filed Map .# Date Filed Gentlemen: This letter is to authorize ;);71 G�' d� �/ Y� a duly licensed Professional Engineer or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this i matter and to supervise the construction of said wastewater tretment and/or water supply systems in co fo_rmity with . the .prouisions_ofArticle- 145•and/or 147...o - Education. LaAv.i..the:,Publie- Health... V; L l,aw, and` the PutnamMCounty Sanitary Code. a Very truly yours, �. Countersigned: Mailing Telephone: ,X / Z y Signed: (Owner of Property) Mailing Address:. '? f e; f State Telephone:\ Form LA -97 TV �7 ljl� CQ N I t� - X5 V. f 4 XT .. COG, Sheet of ' * I? ' AM COUNTY DEPARTMENT OF HEALTH ®]f+ 1YIROI�I� °F;NT , HEA -T-LH SERVYOE -S '� � • b ,- '�: W. Y04 FIELD ACTIVITY REPQRT s ���• �— ��p ate: � F _ /. G�! `"— � - -- :, y o • P- = .Street y Town State Zip PERSON IN CHARGE OR TNTFRVTF.W.F. Name and Ti le TYPE OF F FINDINGS yei t� R Tom, G ._ ..,� T� 'y 4. - Y -, � € Fes. S•V,. M,y.,. 3 ,�.��!A /+s1 �. "1 j��,.:/5//�'.'� .[ a t. Y t. :?d7 Y'' as t ��` i E •ai ' _ '# a t: a _ .� �, t _ $ a .- > 5 k #a ,c' ^$,'r x c'-z• t .' v=" "zs -3-'- - - 44-." • .4 w 1 "t,., -y -.s '°...,a F"� , L-c' E .LL ,,r t �'a -.s'. . "< #4-k•Y n ?1r3diJ Sign e d kz Fpe)R-T P P. ur T ert F I.-acknowledg'e'receipt of thts report SIGNATURE; $` - Ti! I acknowledge. receipt of this report SIGNAT 02/96 Ti SITE LOCATION 2 OWNER'S NAME A MAILING ADDRESS PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SER`IICES �'�- :raP. ".e.. des �.iQa`ua,- �'�.�r�ee•r. .Y•_ � 'yY'„�...:ar:'....v v�.:nw �: ...,.ii.. �... ir. +',Cd+�- �i+�i »ia:eaF�o:..,mswII �.= '/:+i7a'�I'eva.r �.-.. _an. �- ��.i.. i1 Ian 1 I I ►� , o OFFICIAL USE ONLY - 115/.1-/-051- TM# A4,61-1-15 v05 i�' PERSON INTERVIEWED PCHD Complaint # ame & Relationship i.e., owner, tenant, etc. DATE TYPE FACILITY r PROPOSED INSTALLER MMO er-7 "MM °�' SMC- PHONE "704 - ADDRESS ?4.20-7 GyJ REGISTRATION# Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system ,Different location may require submittal of proposal from licensed professional engineer or registered architect. W 6VA W6WIM5 GD LL N C:dsi l,MNIG <. h'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 (e.g.,house comers). d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6' deep e. Installers' name and number. 3. System repair to be rformed in accordance with the above proposal and conditions. Propo al approved u pector's Signature & Title DATE COPIES: White (PCHD); Yellow (Town BI)-,Pb1c (applicant) PC -RP 99ML w w. PUTNAM COUNTY HEALTH DEPARTMENT _. ,..,,DIV.ISION OF•.ENVJ.RONN4ENTA.L HEALTH SERVICES_..._ _.....__._._ _. �.rs �q e'�S'to''"''�'�ii= �-r .:,i.: �v'b.:+ne -..�na a...w'V�i..�•�w�,.z "�'�+'"�+�: w-... Pte. e.::,� :.4�: w.��i:rirn+e. w..,��e.. �,_wi= •..+ri �� PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR OFFICIAL USE ONLY -a � _ 0 SITE LOCATION Z O ft 5kU-L- 1.i W A4�0 TM# ft 11 p l ° I r-) OWNER'S NAME CA 0L PHONE 114 MAILING ADDRESS `=t LL- RG W ,. PLATUA44VA4PW NI PERSON INTERVIEWED PCHD Complaint #. Name & Relationship (i.e., owner, tenant, etc. DATE TYPE FACJLITY q 1 q— "/0 & -- 7� a :?-- -c• a PROPOSED INSTALLER M lMd5' LAkD �t�PiN(!j l 14(,. PHONE Q 6� • ? �r.+- l'J� ADDRESS ?D-0,i X 78Z.W & %° .Q y I�5�'�' REGISTRATION# Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system .Different location may require submittal of proposal from licensed professional engineer or registered architect. 40 i,g�g t,Ir eaggg � TMA L'13M6'bM0415 tNSTAU F-D iW A'i'f - 45D TITLE &W hl el!' 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 DATE _9 i ZC) 1 r1 b. Site Street Name, Town and Tax Map number. C. Location of installed components tied to two fixed points (e.g.,house comers). d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6' deep e. 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X�, ray q1 ,z,.1• 'to :,�.,. a ,�. „'t�:� i ,.. ;. ., r � .. a+'� -.' '�Z"*k?'$..7 ��'t' .4'a• �.,� a:...A_ r rs - �s. _ ..; y; . r . _ ••'vE '. .. i.,t vl`W -v6... ....: '`Ci._r.:' �� tii, A',` 1frY -3 _ ..f; �k. -` p4lt�fw d C, - ,� +•�' S'' ,:: r a r $( .. y.: `?•, C't tri , ,vswb. � �� ,.,�'.- � � , , y, .-•v' . �.:� S. + N :4 ^.' .... ell, yx' .; �`au!: `..., r � ..- :. �"': >, k'^eYr �e "`� . �', i��• '� a's`s . ;�.�:. , .....if'. r-ii' v. . rli., j '. -'r[� ,. �.R'Ry � : ,' �y�, - ..'n:. �i: '��'r:.'+•4 J r. _i+�. r•' +y_y S.> � 1aSF+h..^ .. � ar ++" 1 �� >.,w ,g 'Y ��''ttrr''����•.� TT � �: o tr'�,. ti � S . �'� � : >ri M ar. r'.' +v '�3�.^�' " x , ",A "'R, w 0 q, Qj ♦... fl �Ll 'Y-�- `-b fit. '( F'i ' - a,;;};.';,.x.A�f,.` r: <� -�, .o',dy '' -n "�j' '':.r3`F° "�'�''S:' a- ^'.i� �'•'"` ri$ " -,". 't� w; -i w3,e °'h, '�` �-.-. � ' � ,rte.'. %'�" ���G s Vy, ,.r �`.`. "� Y4 �-• w `fd�. "S'�` ���?'. l• C•3~�a4�"a� �''.' h ;+; ,yh . - .N aye+• l? � /i�� Y�'c,'�`y'_"Y�'•' {,T�.. sr vca S ;SEA reY 'i� .,,• ��� ,� .1 _ : r.� t"r °i�� ��.;,=' s .. y •4':�.. _� � '' ,� � ®o `8 V0 BR,� 0 "? ate: ±��"z�'�� , 1,_c,'�,r..hi�'• . nt,` ;.. >r -.` i "i. , ',,� k ' �,�R S -'i -�`,� � 'S ",+v .� s,em f_ + •1 9f.. SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI RN, MSN „•,__.,_ X�fiseci W: ta-,6 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 August 10, 2006 ROBERT I BONDI County Executive - - Rf?BM.Mg6tBiS�PE = ^� 5;e or of�nvironmental Health Frank Sullivan, PE 2972 Fernerest Dr. Yorktown Heights, NY 10598 Re: Field Inspection -Sandy 280 Peekskill Hollow Road (T) Putnam Valley Dear Mr. Sullivan: A site inspection was made for the above referenced project on August 10, 2006. The following comments must be corrected in the field: 0 1. The'well line needs to be located to determine the distance from the new'trench ends. 2. The system can be backfilled. All junction boxes should be marked with stakes. 3. No lines are to be plugged at this time. 4. The existing SSTS area needs to be restored to its original condition. 5. The former lines leaving the D -Box that are now stubs _need to: be completely_ . _.... - ugod {i side the bow § wel 's ` s eje ly s'u 99 6. Please continue to inspect the system for any failures over the next month. If you have any further questions, please contact me at (845) 278 -6130 ext. 2157. I Sincerely, _t (7oseph S. Paravati, Jr. Assistant Public Health Engineer JSP:mcb cc: Percy Montes 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 Sheet of PUTNAM COUNTY DEPARTMENT OF HEALTH N -N,-V-IjR.QMi P-A QPF,-K- FIELD ACTIVITY REPORT ADDRESS: Street Town State Zip PERSON IN CHARGE ng NTFRvirF—wFT)-. -arl k/ -) S) 5 1 (. 0 k) (" Name and Title TYPE OF FACILITY: FINDINGS: U"W'.., 141 ke,zll 0 tvc/'l L9, L-N kY- (, (,, lie 2 444-Ae 5A 5 /v 4e- oLkt,,,' & - I acknowledge receipt of this report: SIGNATURE, 02/96 Rev. Title: 08/06/2006 9149624248 FRANK 0/47 �ls�� /� 00SCF%H-�F.�-4SU Xjy�k!,4 2912 FERISICIFIENT DRIVE YORKTOWN HEIgHTS. N.Y, 113598 ?9 1 41 962-4248 Al, rep jr� s.��/ mares � a� �f/ PAGE 01 ,,,(t 7/1 2'sw 4/., yl f%'1/ Ao *,- 'v Ala Ile,,y 2r, fy i o"o-ed, � 71.0 4(l 0 d6 Al A. AUG-7-2006 MOH TEL:845-276-7921 NAME.:PUTNAM COUNTY DEPARTMENT OF P. 1 a TlieT611'owtng is -a time line for the Sandy residence, 280 Peekskill Hollow Road (septic failure): • 10/18/04 —Construction Compliance package from Frank Sullivan, PE entered in. 10/26/04 — Construction Compliance issued by Health Department. • 7/20/05 — Complaint by Sandy's concerning excessive water and erosion affecting their retaining wall • 7/25/05 —Site inspection by Robert Morris, PE, Senior Public Health Engineer and Joseph Paravati Jr, Assistant Public Health Engineer in response to drainage, erosion complaint. • 7/27/05 — Follow up letter to Mrs. Carol Sandy concerning site inspection on 7/25/05 • 8/1/05 — Engineers list faxed to Carol Sandy. • 8/7/05 —Letter to Joseph S. Paravati Jr, Assistant Public Health Engineer from Anthony & Carol Sandy. In the letter, Mr. & Mrs. Sandy note that the septic system is failing and they have hired an engineer. • 8/10/05.— Site inspection by Robert Morris, PE, Senior Public Health Engineer • 8/12/05 — Letter from Robert Morris, PE, Senior Public Health Engineer to Anthony & Carol Sandy. Letter is a response to the Sandy's letter on 8/7/05 and summary of site inspection on 8/10/05. _ .. • 8/15/05 — Site inspection by Robert Morris, PE, Senior Public Health Engineer. Failure witnessed, contractor Mr. Percy Montes contacted. • 8/16/05 — Site inspection by Joseph S. Paravati, Jr., Assistant Public Health Engineer with Percy Montes of Primo Landscaping, contractor. • 8/18/05 — Received negative result for formaldehyde in water from NYSDOH. • 8/18/05 — Violation notice issued to Carol Sandy for non - compliance with Article III, Section 4 of Putnam County Sanitary Code (apparent sewage discharge to ground surface). • 8/18/05 — Engineers report form Donald Knapp, PE. Site investigation form Anthony and Carol Sandy. • 8/18/05 — Site inspection by Joseph S. Paravati, Jr, Assistant Public Health Engineer with Percy Montes of Primo Landscaping, contractor. Deep test holes witnessed around system perimeter. i 1,etter`from Anthony & Carol Sandy that existing SSTS is currently under warranty with Percy Montes of P & B Contracting. 0 8/22/05 — Memo from Joseph S. Paravati Jr, Assistant Public Health Engineer to Sherlita Amler, MD, Commissioner of Health. Summary of actions during site inspection on 8/16/05. © 8/22/05 — Letter to Sandy's from Joseph S. Paravati, Jr., Assistant Public Health Engineer (APHE), regarding the requirement of percolation tests. 0 8/30/05 — Fax from Joseph S. Paravati, Jr., Assistant Public Health Engineer, to John Delano, PE. Map for perc test locations. 0 9/1/05 Perc tests conducted by Badey & Watson, PC and witnessed by Joseph S. Paravati, Jr., Assistant Public Health Engineer. All tests failed. 0 9/7/05 — Memo from Robert Morris, PE, Senior Public Health Engineer, to Dr. Amler, Commissioner of Health. Update on the Sandy residence and septic failure. 0 9/7/05 — Letter to Percy Montes from Joseph S. Paravati, Jr., Assistant Public Health Engineer advising all SSTS repairs need permits from Putnam County Department of Health. 0 9/12/05 — Letter from Joseph S. Paravati, Jr., Assistant Public Health Engineer to Percy Montes, Primo Landscaping. Summary of field testing on 8%18/05 & 9/1/05. Recommendation to replace entire system. 0 9/13/05 —Letter from Robert Morris, PE, Senior Public Health Engineer to Mr. & Mrs. Sandy. Same as above, including the recommendation. 9/19/05 — Letter, guarantee forms and perc results sent to Mr. Sandy. 9/21/05 — First repair permit issued (R- 271 -05) — exploration and replacement of damaged components and reestablishment of fill over system. 0 10/20/05 — Site inspection for first repair permit. Repair wasn't complete. 0 11/03/05 — Second repair permit issued (R- 314 -05). Issued for work on impervious soil barrier including removal of material where appropriate for replacement. 0 11/08/05 — Site inspection by Robert Morris, PE, Senior Public Health Engineer. 0 11/9/05 — Letter to Percy Montes of Primo Landscaping requesting update on repair work. V •. .11/-1,0/05 -- _Sitejnspection b�_Mike.)rulcePI�,S,:no:. ischar�e:no#ic - ...-. +:.n T� �q.::ti+s.`�•:.�HZ - V!-.'..;p;,. np�...: •- -a'c.. r.. J.:. .. .. t.�- . «. .a'^" -�v: w -ae .s` OrF•:+r ei=. ::ro w . ry .•s+�'.. �i� :..:� • 11/14/05 —Site inspection by Joseph S. Paravati, Jr., Assistant Public. Health Engineer still apparent failure. • 11/22/05 — Site inspection by Joseph S. Paravati, Jr., Assistant Public Health Engineer • 1/17/06 —Letter to Percy Montes strongly recommending engineering plans certified by a licensed professional engineer. • .2/21/06 — Letter to Percy Montes requesting update on repair.. Still waiting for plans. • 3/18/06 — Review of the repair for 280 Peekskill Hollow Road by Donald Knapp, PE engineer for the Sandy's. • 3/27/06 — Letter, repair permit signed by Sandy's and copy of plans submitted. • 3/30/06 —Repair permit issued (R- 45 -06) to install new trenches (336 LF of absorption trench in R.O.B. fill) based on plans submitted by John Delano, PE, Badey & Watson. Plans were not certified since repair is in the approved SSTS expansion area. Letter with copy of permit sent to Mr. & Mrs. Sandy. • 5/24/06 — Letter to Percy Montes concerning length of time it is tatting to complete the repair. , � +Hfws • 6/1/06 --Phone call with Percy Montes about repair states. 2%06r = -Site inspectivii SSTS -still in iaihuie=did=anotherdye'test °= • 6/14/06 —Site inspection— positive dye test. • 6/16/06 — Phone call with Percy Montes — Percy ready to install clay barrier, excavation complete. • 6/22/06 — Site inspection — SSTS area covered with tarps. • 6/22/06 — Phone call with Percy Montes — clay barrier installed; sample of clay was ok; bank run not delivered yet. • 7/10/06 — Phone call with Percy Montes — Bank run is on site. • 7/11%06 — Site inspection — sample of bank run taken. • 7/13/06 — Site inspection — Larger sample of bank run taken. 7/14/06 Received sieve results from Sandy' — ieve _ . .pass s 0 7/18/06 — Sieve analysis on the soil collect by the Health Department - Passed sieve. 0 7/25/06 — Site inspection of on -going repair. 0 7/27/06 — Site inspection — trenches being installed. 0 7/31/06 —Site inspection— trenches complete; distribution box and lines still not removed; new junction boxes ner connected and existing trenches are not connected. floc 8/1/06 — Letter to Percy Montes documenting items that need correction. SHERLITA AMLER, MD, MS, FAAP Commissioner of Health —TA-D OLINARL.RX D�1SN;: associate ommissioner of Health. August 1, 2006 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Percy Montes Primo Landscaping PO Box 782 Mohegan Lake, NY 10547 Dear Mr. Montes: ROBERT I BONDI County Executive Director of Environmental Health Re: Proposed SSTS Repair -Sandy Field Inspection 280 Peekskill Hollow Road (T) Putnam Valley A site inspection was made for the above - referenced project on July 31, 2006. The following comments must be corrected in the field. 1. The new junction boxes have not been connected to the existing system, the distribution box and lines have not been removed, and the separate junction box with baffle and 90 degree downward facing elbow has not been installed. 2. The pipe for existing trench # 6 appears to be leaking. The pipe appears to be crushed and/or cracked. If this is the case, the bad section of the pipe will have to be replaced. 3. The cover for junction box # 6 is cracked and needs to be replaced. _ ........4,..: hepiesn juu�tian.boic, #- -1ans# 2e,d.io b &ttinEd:.m ___�..._ 5. The, new trenches can be backfilled. A reinspection for item # 1 above is required. Please leave the junction boxes, connections to existing trenches, and the connections to the new trenches uncovered. 6. When completed, an inspection of the relocation of the waterline is to be made by this Department. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. JSP:mcb V v . C�_ ry truly yours � oseph S. Paravati, Jr. Assistant Public Health Engineer 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 Sheet of PUTNAM COUNTY.`DEPARTMEN-T OF HEALTH q .,DIVISION l ll' :EN NMENTAL) H-E �.TIJH:SERVICES w FIELD ACTIVITY REPORT tern : A-A4- o �a'1 Cw� { . c ,� � TP1: ATT�7T^1�n1'f 7T� ��rr (('�1 - . H I )I ):I[ f'�.,1.1s 5 _ Street r A .. Yawn" k State. Zip. PERSON IN CHARGE °7 L-3 ;i Name nd Title " TYPE OF FACILITY . It %yJyc� 11� Maud /� .1-acknowledge receipt of th s-reporrt °:' SIGNATURE: OZ/96 Title. "Rev. N 9 W a a N O d v ED M N ro CT1 T ro v m LO M W N O"i r� CD i 1 t ..,� -i ML Environmbntal Serve "': Attenuate L6cations: t. �} 321 Keer Street} Yarldo# lights, lyY 10598 Mt. Kisco, NY (914) 666 -335 Tel: (914) 2453600 [)ax: (914) 245.3170 Carmel, NY (914) 2784330 Bronx. NY* (718) 8¢3 -1145 ); (Revised 3!26198) - - I�SLruCtiott8: ' tAb um j :7 - - . rib a": MF ;0141 Colitotm . i i ; Bobs : Mist enter all requested information on this form and return it with your sample. r Nsr• York State regulations require that this information be given to the laboratory } �WN Taw Camorm Mid that am of it appears on your rgWrt_ Fill out one form per sample side pilaw ' e` to Collected: �� t h�L Time Collected: = (M*41DDNV) (Iadicat or PM) A f! i 9iarnpling Point: Kitchen Tap: OHter:Spr� �ML �il.� �Of "Mrste -N (Plied* oej' (Eaterspeei6e wmpk paint! •3Mame•1 complete' A n Malting Address N21 n�? . for Sending report: TS (Sludge) Manganese (, TVS (Sludge) d= Processing sushi ii (Extr;L..cbarge applies; goarenteed turnaroun time) Optidns: Normal (T*rnaround Came estimated) Ij (Check each) up (Cl� pick up my repot3 at the :lab when it's doge) -{�ick Y : IFBX (Ex1r a charge rtie} a y) to:' atnpling PQint Address: Couet toes Name: b� (please pro-vide a *er"Sls ftft,43FT a company name.) t if sample is not submitted on ICE, do you � w fi tie to conthe whit t�eatirng? +es No Initial: ,'bollectoes Phone No.: i - S b- ample Type: Ddriking(Potable)' c 'icheelt one) Man - drinking (idan- +patabie) water t 4 Other: hS° � Prest:rvtad.%1i # t; i H2SO4. Instructions: Ptnoe a "x" in the "WNW to fudicatewhich test(s) yori want to have performed on the samptc. Use the b1 ank fines to older tests that are not listed. NOTE; S6we -tests require the use of special containers sad coHeetion Yrdmdure(s). By makhng tests below you are pbmft awork'dideriu d are responsible for paMent, on those tests chosen, when you submit your sample to the lab for testing. LAB TEST REQUEST- ' tAb um j :7 - - . rib a": MF ;0141 Colitotm . i i ; Bobs : ;JIF Fecal CoNortn I - —TCoii i - CMD 733 } �WN Taw Camorm Ammonia -N 'WN Fftai CoMorm ; ' i = TP . - ? Basic Profile M ;— - Txw ,'Puttutn County Profile ? "Mrste -N i 1 Corrosivity ~lead Settleable Solids _ u pper � PH - `irort� i TS (Sludge) Manganese (, TVS (Sludge) Fw !? at+r use Qnfj►,. tab Number f , rJ4 z g Wdw w 3 = Co14ifca Yp�::i!lo_. Odos'iaa: Yes- Noy: m f .� - _ m me Yen ~:. Vie: Yea° = ilio m i 07/19/2006 03:43 9149372B94 PC:FIOS PAGE 01 Sieve Test Working Sheet M . y. - a w '•c _ - t. YV .2Y.a C ✓J.� . O �v RXr-. 9', f -lea -t..•. 41 0771 4106':�,R -r.� x gin. x Lab Q, (,Q�17y� Weight of Sample Tested: 1080.0 grams Sample was dried at 105 degree C for 24 Hours. Sieve Dia. mm Sieve # Weight of raatlon gram % of Total Cum. % >2.36 <8 515.0 47.7 47.7 1.70 12 55.0 5.1 52.8 1.18 16 72.0 6.7 14.4 59.4 73.8 0.600 30 155.0 0.425 i 40 105.0 9.7 83.5 0.355' 45 27.0 2.5 86.0 0.250 60 48.0 4.4 90.5 6.150 100 67.0 6.2 96.7 0.106 140 1210 1.1 97.8 0.075 I 200 12.0 1.1 98.9.. . _... � ..- ... ...i ,..' � _ _ 0.075 .. >200 � sue• •N. a= � s ~� ..�_._ .~ 12.0 � �•cY.� .r.Y . ... ... .. _ .. _ �. _�_... 1.1^ 100.0 Total VV-1-1-IL 1080.0 100 E (P10) = 0.261 mm U (P601P10) = 9.04 E = Effective Mean Size U = Coefficient of Uniformity A r1 fie; 50 � JUL -19 -2006 WED 14:44 TEL:845 7278 -7921 NAME:PUTNAM COUNTY DEPARTMENT nF P_ 07/19/2006 03:46 9149372894 PC:FIOS PAGE 01 Sieve Test Working Shea Weight of Semple Tested: 1080,0 grams Sample was dried at 105 degree C for 24 Hours, JUL -19 -2006 WED 14:47 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 Sieve Die. Sieve # Weight of Frwdon % oP Total Cum. % mm gram '2.36 c8 515:0 47.7 47.7 1.70 12 55.0 5.1 52.8 1.18 W� 16 72.0 6.7 59.4 _ 0.600 30 155.0 14.4 73.8 0.425 40 106.0 9.7 83.5 0.355 45 27.0 2.5 86.0 0.250 60 48.0 4.4 90.5 0.150 100 67.6 6.2 96.7 0.106 140 12.0 1.1 97.8 0.075 200 12.0 .1w1..;.... ..:.. ..98.9 12.0 1.1 100.0 TotalWeight 1080.0 100 E (P10) = 0.261 mm U (P60IP10) = 9,04 E = Effective Mean Size U = Coefficient of Uniformity TI / V JUL -19 -2006 WED 14:47 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 p'. A -f-'.3 N. M °w a •:_:. a_ O L� v m m N n M On V T v m LO m GD N Cr n t9 "ac� '.Alternate ibeatlons, ;E "• y1' @! le4ical Ub, InL) "i Heigief�, ihl'h' fl®59g ML Kisco, NY1914) 666 -1335 � Al Carmel, KY "4914 j a7S�►330 , . NaZ : Bronx, NY lift We ard Sheet ' (Revised 3126198) Tease enter all requested Inf6 tnation an this form ihd return It with your sample. `icon Forte State regulations requiiv that thus informs tion -be given to the laboratory � $ that all of it app�rs an your report. FiBi out ooeC farar per sample site please: dite Colleaed: Time Collected: W ilk : (44R4M1Y Y) {HEealica or PH) . + �smpfinq Point: Kitchen Tap: Meg: ( heck ame)' Grower specroc $amPIN twipt) Eta e �e J complete a ling reed 'drfts; rzi ! ;. .. ' for tonding report: Processing i/ RUshi (Extra charge applies; guaranteed turnaround time)!, i i' Options: Noma l Nrnaround time estimated) (Check each) - ick up (I'll pick up any report at the lab when It's done) +; ira x (Extra charge Jtuay a "ndtnpiirlg Point Address. .s` � ,goilectoes Nwne: ; z Mease provide s P"AMi's T a company name.) III can ple is not submi%ed cn ICE, do you wigh ua to continue with Q oUng? !; � R1u Inertia: a, ®tiectoe's Porte Rio.: - 0,ample Type: DAnkkt9jPeM09p waler (Ctoa;ck one) ' Mon i g (kon- polable) water a G 1 _ fired �nriftl, E navn - 1 - 1 instructions". Place a "x" in t<he a:olumn- to to d icate wbia testN) you want to have performed on thezoeple: -'Use the blank livers to orider tests that are not tisWd. i GiM Some tests req wire the use of special containers and collection pr6cedure(s)..B3 malting tests below you are pissing a work oeier and are responsible for pai-ment, on those tests chosen, when you submit your sample to The Iab for testing. LAB TMY "11EQU OY _ . TUSTU E9b vise I Ltsb u$e MF Total Coftrm- _ ; li3»�I7V3t . YMLE Tes t �� - - ''t3�f011rlbfel8 -� - UM Fecal Cott WM 'VD of Vor -Woio n .. TKN $ ` j paitAeetit County Profile -- i 321 Kcar S"et, tferldo `r tl�tRe -At - 't°el•-19941 245 290D "ac� '.Alternate ibeatlons, ;E "• y1' @! le4ical Ub, InL) "i Heigief�, ihl'h' fl®59g ML Kisco, NY1914) 666 -1335 � Al Carmel, KY "4914 j a7S�►330 , . NaZ : Bronx, NY lift We ard Sheet ' (Revised 3126198) Tease enter all requested Inf6 tnation an this form ihd return It with your sample. `icon Forte State regulations requiiv that thus informs tion -be given to the laboratory � $ that all of it app�rs an your report. FiBi out ooeC farar per sample site please: dite Colleaed: Time Collected: W ilk : (44R4M1Y Y) {HEealica or PH) . + �smpfinq Point: Kitchen Tap: Meg: ( heck ame)' Grower specroc $amPIN twipt) Eta e �e J complete a ling reed 'drfts; rzi ! ;. .. ' for tonding report: Processing i/ RUshi (Extra charge applies; guaranteed turnaround time)!, i i' Options: Noma l Nrnaround time estimated) (Check each) - ick up (I'll pick up any report at the lab when It's done) +; ira x (Extra charge Jtuay a "ndtnpiirlg Point Address. .s` � ,goilectoes Nwne: ; z Mease provide s P"AMi's T a company name.) III can ple is not submi%ed cn ICE, do you wigh ua to continue with Q oUng? !; � R1u Inertia: a, ®tiectoe's Porte Rio.: - 0,ample Type: DAnkkt9jPeM09p waler (Ctoa;ck one) ' Mon i g (kon- polable) water a G 1 _ fired �nriftl, E navn - 1 - 1 instructions". Place a "x" in t<he a:olumn- to to d icate wbia testN) you want to have performed on thezoeple: -'Use the blank livers to orider tests that are not tisWd. i GiM Some tests req wire the use of special containers and collection pr6cedure(s)..B3 malting tests below you are pissing a work oeier and are responsible for pai-ment, on those tests chosen, when you submit your sample to The Iab for testing. i r- OD ru { LO m" w H #iqrLW La NUWAW - 6104 t2� U Its@iQl 3 r'Les$: Yox q_ .-: 04orfess: Ves� teen,_ m •; 4 : "�s' iii n iFBi'®s" RTo _ m ter-{ r r-°" LAB TMY "11EQU OY _ . TUSTU E9b vise I Ltsb u$e MF Total Coftrm- _ ; li3»�I7V3t . - i Tes t �� - - ''t3�f011rlbfel8 -� - UM Fecal Cott WM - TO I 71 Basic Profile i ,' .. TKN $ ` j paitAeetit County Profile -- i 1�Vitrt -PI � _ 1 ' C ity i tl�tRe -At - Lead Setfleable Solids I i Copper-----, ! i ...pH i . Ftrart I TS (Sludge) - nganese. E AMW i Td�/S.(Sludge) i r- OD ru { LO m" w H #iqrLW La NUWAW - 6104 t2� U Its@iQl 3 r'Les$: Yox q_ .-: 04orfess: Ves� teen,_ m •; 4 : "�s' iii n iFBi'®s" RTo _ m ter-{ r r-°" The following notes shall be provided on all plans for individual SSTS requiring fill. Notes Required When Fill Proposed 1. Fill must be stabilized by allowing the fill material to settle naturally for a period of at least 6 months and include at least one (1) freeze -thaw cycle or fill stabilization may be achieved by mechanical compaction in approximately 6 inch lifts to the approximate density of the undisturbed underlying soil. 2. Site modification activities involving placement of fill are to be conducted during relatively dry periods to minimize soil smearing and excessive soil compaction. 3.. The required depth of fill within the sewage treatment system area is feet which. approximates to cubic yards. Fill shall be run of bank. gravel suitable for sewage absorption, be free of fines or other unsuitable material and shall have an in- place percolation rate at least equal to or faster than the natural underlying soil after the • . . re qu. ired stabilization period. The Design Professional shall perform a minimum of two (2) percolation tests in the fill after stabilization is achieved. u itabl fors vage abs rptiori shoii3d cdi `iaib nd more fihari 5:per it- d..pr'efera ly no .more than 2 percent fines by weight. Fines are clay and silt particles that pass-A-420,0 sieve. No more than 10 percent by weight of the fill material should pass a #.100 sieve: 5. The impervious fill, shall be a dense clay type soil with little or no sewage absorption capacity. !.: December 1999 .. 24 The following notes shall be provided on all plans for individual SSTS requiring fill. Notes Required When Fill Proposed 1. Fill must be stabilized by allowing the fill material to settle naturally for a period of at least 6 months and include at least one (1) freeze -thaw cycle or fill stabilization may be achieved by mechanical compaction in approximately 6 inch lifts to the approximate density of the undisturbed underlying soil. 2. Site modification activities involving placement of fill are to be conducted during relatively dry periods to minimize soil smearing and excessive soil compaction. 3.. The required depth of fill within the sewage treatment system area is feet which. approximates to cubic yards. Fill shall be run of bank. gravel suitable for sewage absorption, be free of fines or other unsuitable material and shall have an in- place percolation rate at least equal to or faster than the natural underlying soil after the • . . re qu. ired stabilization period. The Design Professional shall perform a minimum of two (2) percolation tests in the fill after stabilization is achieved. u itabl fors vage abs rptiori shoii3d cdi `iaib nd more fihari 5:per it- d..pr'efera ly no .more than 2 percent fines by weight. Fines are clay and silt particles that pass-A-420,0 sieve. No more than 10 percent by weight of the fill material should pass a #.100 sieve: 5. The impervious fill, shall be a dense clay type soil with little or no sewage absorption capacity. !.: December 1999 4 � .` •. � ._�.� ;: -.. Sheet ' . of �P.UCTT■N,A� } }M�■�rCOUNTY DEPARTME�NTy�Of HHE�yA��L�(T�('H•y���y (py( y R�J��R A�WM1.© �hs•��- ��11�'J�L1.J1�1AYl�M�`CJ a'1 \'• Sti JJV 9 �N- �•'�.. �+wpyyr�r iyy• a�R `milW 1t� TIELD:ACTIVITY REPORT 'o Si�y a 1 MV/ r • Street Towm y State Zip. PERSON IN CHARGE OR Nam_ a and: Title TYPE-OF FACILITY: J7VO. 5 STS F DINGS. •„ ^(� p�(j �� `/ (7/�� ' ems, %) ,f ter' �'�'. D PtNI. �'.� 115,/J• �R mss v illy 916 (o VA'�-. •. -ae • kzt. a ,' '# i#A `-em `+o' 2' "'�,'`:4e v� i z 'fi ;i •* P Signature d T' e. j I acknqvledge- receipt - of this report: SIGN ATITR y . b2-/,9'-6 Tale, C Rev .: SHERLITA AMLER, MD, MS, FAAP _ = Commissioner- of_E.°gllh:._ LORETTA MOLINARI, RN, MSN Associate Commissioner of Health May 24, 2006 Percy Montes Primo's Landscaping Inc. P.O. Box 782 Mohegan Lake, NY 10547 ROBERT J. BONDI - Corzntwfracutive..—""-: vc -c�5'. : -. •.:.c+i -.fir: W.sil°' :l.T. t }ti.• .r .'�'+��.+on,., r' DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT MORRIS, PE Director of Environmental Health Re: SSTS Failure and Proposed Repair 280 Peekskill Hollow Road (T) Putnam Valley Dear Mr. Montes: This Department is very concerned with the amount of time it is taking to repair the failing septic. system at the above referenced parcel. The repair permit was issued on March 30, 2006 (R -45- 06) and to date, work has not commenced. As stated in a previous correspondence, an SSTS failure is an imminent threat to public health. This is a serious matter that should be given immediate attention. Based on.our.phone- conversation on. May ,22, 2006, this Department is expecting tie repair,to,..:. •— 'COrrlrl erice°duringst'hE'woek of May22nd; 2006 ancrno' -7later tlian`tlie beginning of thF web1rbf May 29th, 2006. Please contact this Department when work is to begin so that an inspection can be made during construction. This Department is also to be notified when the system is completed so a final inspection can be conducted before backfilling. Please contact this Department no later than June 2, 2006 and provide the project status. If the Department is not notified by the above date, legal action will be initiated. Sincerely, �?tv `?`` � Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:kly cc: Sherlita Amler, MD, Commissioner of Health Robert Morris, PE, Director of Environmental Health Michael Budzinski, PE, Director of Engineering Anthony & Carol Sandy 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 SHERLITA AMLER, MD, MS, FAAP • - 'ommrssl9ner._of Kealth LORETTA MOLINARI, RN, MSN Associate Commissioner of Health May 24, 2006 Percy Montes Primo's Landscaping Inc. P.O. BOX 782 Mohegan Lake, NY 10547 Dear Mr. Montes: ROBERT J. BONDII >`..� _: _:�,�'�..._... -. �CQUrr t,IrEzecuriye•�:�-;;:�:ti..r- - JI DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT MORRIS, PE Director of Environmental Health Re: SSTS Failure and Proposed Repair 280 Peekskill Hollow Road (T) Putnam Valley This Department is very concerned with the amount of time it is taking to repair the failing septic. system at the above referenced parcel. The repair permit was issued on March 30, 2006 (R -45- 06) and to date, work has not commenced. As stated in a previous correspondence, an SSTS failure is an imminent threat to public health. This is a serious matter that should be given immediate attention. Based on our phone conversation on May 22, 2006,, this . De artment is expecting the repair tiominerice-ilur[ng the week of�VlajY22nd 2006 arid- riii'rate "than the 'begiiining'ofthe -week -6f May 29b, 2006. Please contact this Department when work is to begin so that an inspection can be made during construction. This Department is also to be notified when the system is completed so a final inspection can be conducted before backfilling. Please contact this Department no later than June 2, 2006 and provide the project status. If the Department is not notified by the above date, legal action will be initiated. Sincerely, C Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:kly cc: Sherlita Amler, MD, Commissioner of Health Robert Morris, PE, Director of Environmental Health Michael Budzinski, PE, Director of Engineering Anthony & Carol Sandy 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 ti P'i'g i T 1p' �'S� ')j� � ��xpi ,�+�,�ja3 �j � 1 '��„! a ,� � �,�q� { � t�( `,� ` < ° n i• - - --, +7' "S'.rii L" r `'r'! 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C `' --+-A ' ,� r" `sue 7 r. •, [ r, p#' �'c r .� s S J •� i ���i��; ,fi x r � zf" � ',i r � ,� y .7'�' � � r ���,t����a�+r� terra K9��r i r, � � �� sy�� t� •cF �g�Y ,fa1r,-�e"j 'i�t# w � ^F «� � � ' ^S y��'�'7'- r/ s'N r•,� h i c f'►" t 1.. a 'ib b: �' ,,�[ a r1�.. ���� � 4 i � �� t 'tl *{�• t .< i `rP ; Jr s D ? s 4 ` -'r`b� 1 fE r dt•'' + t���h��''r!rr ,A'`P �`'. ,, ,r i � �� ��� t £'�" i" � � � rF 9 �" # : s, �P r <n v{f ,i, �"V li�r� rr`• f� xu�'' a -.. -tyi:'`' 1• ,.. ? s. '.i. j e _ r z4. / �j(L: 'f�}. r � rrr•, N 't , # r ow- 'hIX, Shy. SHERLITA AMLER, MD, MS, FAAP Commissioner of Health I.Z . LORET><'A MOLINARI, RN, MSN Associate Commissioner of Health May 24, 2006 Percy Montes Primo's Landscaping Inc. P.O. Box 782 Mohegan Lake, NY 10547 Dear Mr.1VMontes: R ®BERT ,I. B ®NDI County Executive - rA DEPARTMENT OF HEALTH Geneva Road, Brewster, New York 10509 ROBERT MORRIS, PE Director of Environmental Health Re: SSTS Failure and Proposed Repair 280 Peekskill Hollow Road (T) Putnam Valley This Department is very concerned with the amount of time it is taking to repair the failing septic . system at the above referenced parcel. The repair permit was issued on March 30, 2006 (R -45- 06) and to date, work has not commenced. As stated in a previous correspondence, an SSTS failure is an imminent threat to public health. This is a serious matter that should be given immediate attention. Based on our phone conversation on May 22, 2006, this Department is expecting the repair to commend dlrnn the p eel o£mial"y22° May 27' Y6-0-6- -. Please contact this Department when work is to begin so that an inspection can be made during construction. This Department is also to be notified when the system is completed so a final inspection can be conducted before backfilling. Please contact this Department no later than June 2, 2006 and provide the project status. If the Department is not notified by the above date, legal action will be initiated. Sincerely, Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:kly cc: Sherlita Amler, MD, Commissioner of Health Robert Morris, PE, Director of Environmental Health Michael Budzinski, PE, Director of Engineering Anthony & Carol Sandy 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 SITE LOCATION OWNER'S NAME �d! MAILING ADDRESS PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR OFFICIAL USE ONLY PERSON INTERVIEWED PCHD Complaint #, Name & Relationship i.e., owner, tenant, etc. DATE PROPOSED INSTALLER ADDRESS D TYPE FACILITY PHONE g14-13�,--FW6 REGISTRATION# Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system .Different location may require submittal of proposal from licensed professional engineer or registered architect. com lorckhllins 4-5 lift- 40 be-l©cd . :owner;:o report .dc a ent"�f.'� vw'neii rE to: the -con itimh- -M: ti? of -tl t� foi =" SIGNATURE TITLE f��lktM DATE / J -7106 Proposal approved.widthe following conditions: .. 1Procurement of any Town permit, if applicable. 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 (e.g.,house comers). d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6 diam. X 6' deep e. Installers' name and number. 3. System repair to b rformed in accordance with the above proposal and conditions. '. Proposal appr%J V V.- 1pector's Signature & Title COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99ML 3 130 /'C(, DATE SHERLITA,AMLER, MD, IBIS, FAAP Commissioner of Health o.':z ^4::'ye. �. 'xsk`�l�•�yn�s: •".'N`.' _wT..ew:.�' �ri : vi�:..`'1"R� .,. y:x LORETTA MOLINARI, RN, MSN Associate Commissioner of Health March 30, 2006 Anthony & Carol Sandy 280 Peekskill Hollow Road Putnam Valley, NY 10579 Dear Mr. & Mrs. Sandy: ROBERT J. BONDI - :�w ir.;•tT�'�d'�c}�. b '.f,•_ b'9... "b�-'� rt S: zti 1 +Jq�. �.•... 5..;+" ha--- -�-• DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 Re: SSTS Repair 280 Peekskill Hollow Road TM # 84.11 -1 -15 ROBERT MORRIS, PE Director of Environmental Health This Department has received the latest repair permit and copy of the supporting plans for the above referenced lot. After reviewing the permit and plans, the proposal is approvable. Please be advised that this Department recommended in a letter dated September 13, 2005, that the fill in the primary and expansion areas be replaced with R.O.B. fill material and in addition, that the soil under the primary and expansion area be excavated to the original soil and then replaced with R.O.B. fill material (copy enclosed). Pl a e find enclosed a copy of the signed permit. Please advise Mr. Percy Montes at Primo's Landscaping, Inc., that this Department must inspect the completed repair to backfilling. Please do not hesitate to contact me if any questions arise. Sincerely, Joseph S. eParavati, Jr. Assistant Public Health Engineer JSP:kly Enc. CC: Percy Montes, Primo's Landscaping w /enclosures 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 • f. SHERLITA AMLEP MD, MS,.FAAP _ _ N- � � .. -- -- .�'oisiiniss'ior.`er' of flettlil' : ,' :,•:�; "-; -' ��,,- LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Mr. and Mrs. Sandy 280 Peekskill Hollow Road Putnam Valley, NY 10579 Re: Dear Mr. and Mrs. Sandy: County Executive September 13, 2005 SSTS Failure 280 Peekskill Hollow Road Putnam Valley This Department has conducted field investigations and witnessed soil testing at, your_ `. ; ro rt ` " f ilu e a age -reiaifing" 7" cy in res �nso; TS wall construction. The investigation by this Department has been completed, please be advised of the following. 1) Based on the results of the percolation tests and deep hole tests witnessed by a representative of the Putnam County Department of Health ( PCDOH) on August 18, 2005 and September 1, 2005, it is this Department's recommendation that the fill in the primary and expansion areas be replaced with R.O.B. fill material. In addition, based on these same soil test results, it is this Department's recommendation that the soil under the primary and expansion areas be excavated to the original soil and then replaced with R.O.B. fill material. Please also be advised of the following: A) The PCDOH requires that a repair permit be approved prior to any repair or excavation of the existing SSTS. Environmental Health (845) 278-6130 Fax (845) 278 -7921 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 retaining walls; therefore, no permit would be required from this Department to address this issue. The only circumstance that the PCDOH would have involvement with the retaining walls is if the upper retaining wall is proposed to be reconstructed closer to the SSTS. C) The PCDOH has no jurisdiction over -the drainage issues on your property; - therefore, no permit would be required from this Department to address this problem. D) This Department cannot and has not ever authorized any person not employed by this Department access to private property to investigate or, initiate an SSTS repair. If there are any questions please feel free to me at (845) 278 -6130 ext. 2166. Sincerely, fk'A'rga� Robert Morris, P.E. Senior Public Health Engineer RM:kly cc: Dr. Sherlita Amler, Commissioner of Health Joseph Paravati, Assistant Public Health Engineer Mr. Percy Montes John Delano, Badey and Watson, PC L' SHERLITA AMLER, MD, MS,,fAAP.. toner oo ealtli 7� LORETTA MOLINARI,.RN, MSN Associate Commissioner of Health - - :a ^ . RO�S>t;1Y'f',l: ""KUl`�iDi `, "''�'„�;'� -:::, ;�:�a• . County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 September 13, 2005 Mr. and Mrs. Sandy 280 Peekskill Hollow Road Putnam Valley, NY 10579 Re: SSTS Failure 280 Peekskill Hollow Road Putnam Valley Dear Mr. and Mrs. Sandy: This Department has conducted field investigations and witnessed soil. testing .at.y_pur...�,, prQpert;r 1 re pc��se'fd vUur_conc m§,,abcut th�e'SS� latlum;- &ainage; aiicl retEiing'� wall construction. The investigation by this Department has been completed, please be advised of the following. 1) Based on the results of the percolation tests and deep hole tests witnessed by a representative of the Putnam County Department of.Health ( PCDOH) on August 18, 2005 and September 1, 2005, it is this Department's recommendation that the fill in the primary and expansion areas be replaced with R.O.B. fill material. In addition, based on these same soil test results, it is this Department's recommendation that the soil under the primary and expansion areas be excavated to the original soil and then replaced with R.O.B. fill material. Please also be advised of the following: A) The PCDOH requires that a repair permit be approved prior to any repair or excavation of the existing SSTS. Environmental Health (845) 278 -6130 Fax (845) 278 -7921 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 B) The PC1�.4Ihas no iuri sclictien...ovar tl�e?�esigporvinte�r?v_ retaining walls; therefore, no permit would be required from this Department to address this issue. The only circumstance that the PCDOH would have involvement with the retaining walls is if the upper retaining wall is proposed to be reconstructed closer to the SSTS. C) The PCDOH has no jurisdiction over the drainage issues on your property; therefore, no permit would be required from this Department to address this problem. D) This Department cannot and has not ever authorized any person not employed by this Department access to private property to investigate or initiate an SSTS repair. If there are any questions please feel free to me at (845) 278 -6130 ext. 2166. Sincerely, Robert Moms, P.E. Senior Public Health Engineer RM:kly cc: Dr. Sherlita Amler, Commissioner of Health Joseph Paravati, Assistant Public Health Engineer Mr. Percy Montes John Delano, Badey and Watson, PC ............ D p E T .. Anthony & Carol Sandy 280 Peekskill Hollow Rd. Putnam Valley NY, 10579 (914) 526-4884 Robert Morris Putnam County Health Dept. I Geneva Rd. Brewster, New York 10509 Dear Mr. Morris, Enclosed, you will find the signed copy of the repair, permit, along with a copy of the drawing. Also, I have enclosed a copy of a report that was completed by our engineer that reviews the repair plan. I hope that this report 'will be helpful with the repair process. You can call me on my cell with any questions, (914) 715-1301. Sincerely, ' 4 t Anthony & aarol Sandy J l . REVIEW OF THE REPAIR SUBSURFACE SEWAGE TREATMENT SYSTEM PROPOSAL For ANTHONY AND CAROL SANDY 280 Peekskill Hollow Road Putnam Valley, New York 10579 March 18, 2006 Donald R. Knapp, P.E. - CIVIL/ENVIRONMENTAL CONSULTING ENGINEERS 2 Dale Avenue, New York 10589 914 - 248 -7726 3 �.. �c� � ` °�___e`w- j• -.itr,' ..{ .. � ter. ii�.., �.. „-. .-.. c .. � � .. ,_ _ ., n� � ��. y a � .. ..- a.) Note # 11 — 1. Provide for the extent of monitoring time, is it 6 months, one year, or other? 2. How will the system be monitored and by whom? 3. Provide for means and method of monitoring. 4. Provide for the a joint review of field observations and recommendations of field closure septic laterals by the Putnam County Health Department and the licensed professional engineer. 10. Run of Bank Notes - a. Note #1- specifies that the fill is to settle for one year with a one freeze thaw cycle. How is this possible when the existing septic system is in a state of failure now? b. Note 4 —a soil lab analysis, source of run of bank material and material sample needs to be provided to the PCHD for review and acceptance. c. ' Note 4 — the correct acceptable soil should be as follows: Grading Square mesh sieve % passing by Weight Pass %" Pass #10 25-60 15 -45 Pass #.0 a _ r 0 10 • v _._ �. �_ ..� _ ,_ Pass 5 — � O --sue - ..� Pass #200 11. Drop box detail — 12 0 -5 a. Indicate 2' separation on each side of the drop box to the start of the septic trench. Realignment of. water supply line. a. Provide for sleeve or concrete encasement of water supply line 100' min above to.a min of 10 ' below the septic disposal area. b. Provide note on plans that all septic repairs are to be made only by a septic installer license with the Putnam County Health Department. c. Provide note on plan that water supply line is to be disinfected and flushed. All repair work on the water supply line is to be performed by a licensed plumber: D Donald R. Knapp, P.E. - CIVIC. /ENVIRONMENTAL CONSULTING ENGINEERS 2 Dale Avenue, New York 10589 914 - 248 -7726 n d. Provide note on plan that a bacterial test be performed on the water supply at the completion of the realignment as per the requirements of the Putnam. County, Health Department. 13. Water line Trench Detail- a. Provide for clean fill with no stones. b. The clean granular fill material will act as a conduit for water flowing off the hillside and will present problems. 14. Existing septic system to remain note on plan - the, existing septic system is currently in a stressed conditions, the soil at the toe of the system is very saturated, and a foul septic odor is being emitted from the area: This area needs to be investigated and more than minimal corrections made. A band -aid approach will not work in this situation. 15. Provide for capping the terminal end of all septic laterals to prevent effluent break thru. 16. A drop box system is a poor choice for this area. 17. Typical section thru repair SSTS Detail - a. The setback to the outside edge of the first septic trench should be a minimum of three (3) times the height of the retaining wall. The plan provides for approximately 17', this dimension needs to be verified and provided on the plan. b. Correct detail to indicate actual conditions, not theoretical. c. 2' clay barrier, did not work for the first installation. Provide 6" minimum continuous polyethylene barrier at the septic .r system, side of the barrier -and socket it-into; -the under) in soil. This will prevent the clay from becoming supersaturated and failing. 18. Provide for soil stockpile areas. 19. Provide for disposal of 305 cubic yards of soil being removed. 20. Provide contours of the finished site grading. 21. Provide maintained of the septic disposal area. 22. Add note on trench detail — Septic trenches shall note be installed in wet soil and both the bottom and sides of each trench are to be raked before installation. 23. Add NYS Education Law note. 24. Add note — engineer to stake out the septic system prior to installation. D Donald R. Knapp, P.E. - CIVIUENVIREONMENTAL CONSULTING ENGINEERS 2 Dale Avenue, New York 10589 914 - 248 -7726 5 V. WELL Graves in the cemetery, up gradient of the existing private well serving the property are within the 100 -foot restrictive'area. Separation distance should be checked by a NYS licensed surveyor. VI. ADANDONDED WELL An abandoned well not indicated on the survey plot is located down gradient from the existing well needs to be checked to verify that the well has been closed in accordance with the rules and regulations of the Putnam County Health Department.. This well needs to be shown on the plan. VII. 100.% EXPANSION AREA None provided. D Donald R Knapp, R E - CIVIUENVIRONMENTAL CONSULTING ENGINEERS 2 Dale Avenue, New York 10589 914- 248 -7726 JTNAM COUNTY DEPARTMENT OF .HEALTH 3IWr4 -01P N- IR0NMENTALyHEAL"T11 E- t •V�f ;h CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM' "i PCHD CO TRUCTION PERMIT # �+✓ �� Located at ` ,:� S '; / }.��' .,� / � �l c� Town or Village 1r �f /77. Owner /Applicant Name > r _�rg; ��n Tax Maps. i % Block Lot 15 " Formerly Mailing Address /fl' , 5,c Subdivision Name Subd. Lot #. % T Alz-�e /V Z Zip 1.) .S . Date Construction Permit Issued by PCHD'.�'� Separate Sewerage System built by f✓� �� �, 4 G� �7 Address to rr Consisting of Gallon Septic Tank and 3 L° Other Requirements: Water Supply: Public Supply From Address or: Y, Private Supply Drilled by '� '�O /.:" /f - e' / Address Building Type _�f ! f' == +-? C - 11- f-Ias erosion c ntroTbeen`- complefed ?" Number of Bedrooms —� Has garbage grinder been installed?3 I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: � r Address Any person occupying premises ittl to secure the correction of any uns a treatment system shall become null an of the private water supply shall become null P.E. .ate R.A. Professional) IZ . /,I-- ./V! _ j License # systems) shall promptly take such action as may be necessary ns resulting from such usage. Approval of the separate sewage soon as a public sanitary sewer becomes available and the approval and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modification or change is necessary. By: 0" ,' i' Title: _P� Date: 10 copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 ' PU NAM COUN'T'Y DEPAR'Il+ENT OF HEALTH _.... ,-: DIVISION OF ENVIRO�ZER L HEALTH., SERVICES ?8 Cx'-n(:��'CA C- A-ro -A- () <-. Owner or Purchaser of Building Building Constructed by 49 PC) L rli'on' - Street t'. Municipality Buildin .4I.i I - I - IC Section Block Lot I ,/ y P, 'Y- Subdivision Name Subdivision Lot # GUARAWEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years iumediately following the date of approval. of the -�� - "Certificafie of CoPStru^�ior °Comp3"r-ance!' or- the -�s6wdge-disposal-syssta�n;Ao repairs made by me to such system, except where the failure, to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environmental Health Services of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated this day of Y X51 Signature e Title Genera ntractor (Owner) - Signature On , 0 S Corporation Name (if rp. Address rev. 9/85 mk Corporation Name (if Corp.) Address PUTNAM COUNTY DEPARTMERr OF HEALTH _ _DIVISION _OF .ENVIRONMERM HEALTH SERVICES �. j•.��7f:ar. �J�' t�•? �K.^.f� .a, aY�'wi'Y ��pF — �••v � . .+.. e r ,� ' a .r .• ... ..��. •.. •.' Y _4':.•^ Y� r.} �t .. �y.�.. .pa1�`l .`q11�.. ... ...•.. M.w..aT... �!t• W.�N• ^itll.l�•�.��.'tltl.. ., w.. tl ��i':.. �M�1tl.�y tl... .rye •} 4:i`"a^. P-6 2C Owner or Purchaser of Building Building Constructed by '920 � �SY��i rlon"- Street Municipality Buildin Section Block Lot Subdivision Name Lz r -- Subdivision Lot # GUARANIEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs, or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years inmediately'following the date of approval of the Ce'rti:fica.t6.- of'.Constructio . �Cgmpl.iance for the s va a dis sal system,. or. 5 _ ._.....P°_. _. ' any.•" repairs made by me to such system, except where the failure to operate properly is' caused by the willful or negligent act of the occupant of the building - utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environinental Health Services of the Putnam County Department of Health as to whether or not the failure cf the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated this day of l W Genera ntractor (Owner) - Signature t �S -Tn Corporation Name (if C6rp.P PO -7 Zi 2- ` O_Y_�_ i i-) I, Address �L rev. 9/85 mk Signature Title Corporation Name (if Corp.) Address PUTNAM COUNTY DEPARTMENT 11 OIL' HEALTH � G� CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTL��C:� PCHIID CO TRUCTIION PERMIT # 5 W � ; / %�� Locate J* � ; Owner /Applicant Name !.. y lrc,; c 145, Tax Map /-*�. i J Block l Lot f -5' Formerly Mailing Address Subdivision Name Subd. Lot # el Date Construction Permit Issued by PCHD Separate Seweirage System built by P/3 Address 4�r�, -,C� Consisting of Gallon Septic Tank and ! . r el C'% e> g e o� %'� /� ..� � %mac � ter► �6 Other Requirements: Wateir SunDl y: Public Supply From Address Zip '0 S; , or: Iv"- Private Supply Drilled by /` ��' ���¢�� Address Building Type�� f ,z% �J was erosion "control °peen° conipie �c ? Number of Bedrooms Has garbage grinder been installed? I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: %ell s ; Certifie ,. P.E. R.A. Mao J co `�� uG� n Professional) Address �, /���.yJC �, i/ . / License # Any person occupying premises _ �system(s) shall promptly take such action as may be necessary to secure the correction of an y resulting from such usage. Approval of the separate sewage treatment system shall become null an v'uid as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modification or change is necessary. By:/, Title: _'/�f ,+�- Date: / 0 16) Li W ' copy - HD File; Yellow copy -Building Inspector; Pink copy -Owner; Orange copy - Design Professional Form 6 i Street PERSON IN CHARGE 4�. PUTNAM COUNTY DEPARTMENT OF HEALTH FEELD ACTIVITY REPORT ZMA M Town GC: C State 'AS&LTW TEST DOSE TEST 3 Zip REQUIRED GALLONS 9�' 31k `33 11 ffi�,, 0, EL START EL. STOP' WqPFir'-TOR, TIP-T! Signature and Title RFRQRT'RFrF-TVF-n RV—• I acknowledge receipt of this report: SIGNATURE: 02/96 Title: W o 0 0� 3 Zip REQUIRED GALLONS 9�' 31k `33 11 ffi�,, 0, EL START EL. STOP' WqPFir'-TOR, TIP-T! Signature and Title RFRQRT'RFrF-TVF-n RV—• I acknowledge receipt of this report: SIGNATURE: 02/96 Title: JNIS ENVIRONMENTAL SERVICES, INC. 1500 SUMMER STREET rT--TA;W- F6- R4;,--,C -04 XIK ATO;UM, 7 rn�'NL�i4� CI°ran� "�k'Sfirte-Cs�f��ieu =�n'vrrorRmentaf I�ab'viaT"oi�� � -" .�� 'R Bailing Information: Larne: PF Beal & Sons Address: 4 Putnam Ave City: Brewster State: NY Telephone: 845 - 279 -2460 Sample's Information: Well #2 Client: P.B. General Contracting, Inc. Zip: 10509 Fax: 845 - 279 -6613 Collector's Information: Name: Perry Address of site: Peekskill Hollow Road City: Putnam Valley State: N.Y. Zip: Telephone: Site: Hose Bibb Date Collected,: 1.0 /4/04 _ _Date Received: 10/5/04 Preservative: N/A Time Collected: 4:30pm Time Received: 1:30pm Temperature: <4C . Filter: Not Present Lab No.: J0410123 Date Analyzed Test /dame Result MCL Method 10/5/2004 16:00 Total Coliform Absent Absent 10/5/04 Chlorine Free Residual <0.1 mg /L N/A 10/5/04 Color ND 15 Units 10/5/04 Odor ND 3 TONs 10/6/04 Iron <0.050 mg /L 0.3 mg /L 10/6/04 Manganese <0.050 mg /L 0.3 mg /L 10/6/04 Sodium 25.3 mg /L N/A 10/6/04 Chloride 74 mg /L 250 mg /L 10/6/04 Hardness 100 mg /L N/A 1016/'04., Nitrate::... -- _ - -: 2.58.mg /L 10. mg /L '10/6/04.10' :00..._ .. , . _ _. `Nifrite .... ....._ : - _ ,.;.... - s.� <0.1 mg /L. 10/5/04 pH 6.44 S.U. 6.5 -8.5 S.U. 10/6/04 Sulfate 29.7 mg /L 250 mg /L 10/5/04 Turbidity 0.69 NTU 5 NTUs 10/6/04 Lead <1.0 ug /L 15 ug /L 10/7/04 Alkalinity 96 mg /L N/A At the time of analysis the sample was acceptable for total coliform NIA = Not Applicable S.U.= Standard Unit MCL- Max. Contaminant Level ug /L- micrograms per Liter Signature: Michael Lapman President mg /L- milligrams per Liter NTU - Nephelometric Turbidity Unit TON- Threshold Odor Dumber SMWW 9222B SMWW 4500CIG SMWW 2120 B SMWW 2150 B SMWW 3111B SMWW 3111B SMWW 3111B SMWW 4500 Cl C SMWW 2340 C SMWW 4500 NO3E SMWW 4500 NO3E SMWW 4500 H B - SMWW 4500 SO4F SMWW 2130 B SMWW 3113 B SMWW 2320 B ND- None Detected Reviewed by',,..,) : Sharon Houlahan, Director State #: PH -0218 ELAP #: 11 115 Tel 203 961 9911 Toll Free 1 866 567 5097 Fax 203 961 9919 jmsenvironmental.com " MCIY-2'7- ,--.tO,:i 12:1:19 FROM: PUTHF41, �,OLIHTY DEPORT 845-278-792 Pubtic Veafth Drmn-or TO: AbAkfj� P D1.1. D %7PARTM,"-.,,Nr OF FEAITH' 1- cicava Road Brewsteri• New Yoik 11509• Nfivinmambil Healit (914)1,18 -6130 -Tc(P14) 2711-7921. NmIng Services (9141-218.5MI VII: (914)219•(678 Jaxe114) AN 1 5065 Xtirly Interventimi (914)278.6011 Preschool (914)r,8.6022 Fax()14),176-6648 LULWIRUS-M, KEC&=LAWU0,. nc c ux MAl?.1-1 011m.. ;2 1, AUI)RE, s 41. TOMN: •UITRAIJ7,11D TOWN .O.FFICUL- -Au 'Flike! �Iivhutju County lhparhnent of Health wiU not jsvae'a the 111m,ve, fong, is,cora,pieted-; Le..) o I 1IL"', E1ddr(m4 is iv-sjifrixed by anauth6ii v Atowndficial. ...witli the aip)Ak1t#tQnf6r, a Ce'r0fickte0f COn'StIOIC6014 C 7 0 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES J �7loy FINAL SITE INSPECTION Date: 1`E� �i Gl � Inspected by: Ts P Street Location Qwnez Location =Town TM # �`f: ii i - c S Subdivision Lot # �,QN,��� C -i fa 1;2_ 1. Sewage System Area a. STS area located as per approved plans .......... .. ................ b.. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................ ............................... d. Stone, brush, etc.,. greater than 151 from STS area...... :..: e. 100' from water course / wetlands ...... ............................... II. Sewage System a. Septic tank size - 1,000 .......... 1, 250 ......... other ................ b. Septic'tank installed level ................................................ c. 10' minimum from foundation...... .............. d. Distribution Box 1. All outlets at same elevation -water tested .......:......... 2. Protected below frost .................. ............................... 3. .. Minimum 2 ft. Original soil between box & tren h s e. Junction Box - properly set ......................... ,f�' 6. renc es . A� 1. Length required --'= Length installed 1��' 2. Distance to watercourse measured Ft.... c 3. Installed according to plan .......... ............................... 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. 5. 10 ft. from property he - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface ........... .:. 7. "Room allowed for expansion, .8. Size of gravel 3/4 - 1' /z" diameter clean .................... 9. Depth of gravel in trench 12" minimum .......:........... 10. Pipe ends cap ed .......... ... .................... . _ Puni or Dose(f S ...... ... . ysfems. . - 1 , _ . g_ 1. See of pump chamber...... .'6 ;?... ........ 2. Overflow tank ............................. ............................... 3. Alarm, visual/ audio ........:........... .................... ............ 4. Pump easily accessible, manhole to grade ................. 5. First box baffled ........................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Building a. douse located per approved plans ...................... b. Number of bedrooms ..................... ....................`'......... IV. Well Well located as per approved plans ........... : ... ......... . ........ b. Distance from STS area measured o% ft........... c. Casing. 18" above grade ............... : ........... ....... ................ d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted .. ............................... ............ . b. All pipes partially. backfilled ............... ....................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plans ' f. Curtain drain outfall protected & dinto exist watercourse � g. Footing drains discharge away from STS area ............... 'h. Surface water protection adequate ..... ...:....... .....6............... i. Erosion control provided ................. ................................ Rev. 12/02 �� . O. SITE INSPECTION FOR FILL ?AD Date: Inspected by: ;rSIP Fill pad located per the approved plan Fill Pad Length Required Length Fill Pad Width Required Width Fill Pad De th ' �1/2�D� Required Depth Ur `e e.4 P q P. Run -of -Bank Fill Quality c� Slope from.Top to Toe Impervious Layer Installed Erosion Control Installed t-Ao� Sieve Test Results (if applicable) r . :Additional Comments:... l: Reserved for Field Sketch if Applicable 5 j!S ° 'vii' ` `�". A PUTNAM CO= DEPARTMENT OF HEALTH DIVISION OF ENVIRCNKRIM HEALTH SERVICES DESIGN DATA SHEET-SUBSUFACE SDQAGE DISPOSAL SYSTEM FILE NO. j3­ /4 -d. e s Omer Addres �a Located at (Street) A4s 5,,Yl# AV111Z94,1 A:,1 Sec. ,$4- Y Block I Lot (indicate nearest cross street) Municipality & 4-2,1W //61rif Watershed SOIL PERCOLATION TEST DATA RBQUnM TO BE SUBMITTED WITH APPLICATIONS Date of Pre-Soaking p Date of Percolation Test d Lv,4-' HOLE NUMBER C= TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start stop Drop In Min/In Drop Inches Inches Inches 2 > .4 5 2 3 �3y �� � � z� 3 y 4 d 5 NOTES: 1. Tests to be repeated at same depth until approximately equal soil rates, are obtained at each percolation test hole., All data to'be submitted for review. 2. Depth measurements to be made from top of hole. rev. 9/85 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOUS ENCOi7NMM IN TEST HOLES :,a:..; -,= -;�,: :; 1nE�i'H -'° 'HG7::E;NOe .:; , - ,.. - HOLi�'�Y3®g:.... -; -:r � . _ .i�Oi�'P�,�.:•:-, - .- .. G.L. 1' 2' 3' 40 5' 6' 7' 8° 130 .. - .140. _ .. -r• .. ..r _,. _ INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: DESIGN Soil Rate Used Min/1" Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity gals. Type Absorption Area Provided By L.F. x 24" width trench Other Name Signature Address SEAL THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT NOTE: Exact location of well with distances to at Well Driller's Name P. F. Signature: Per y White copy: HD File; Yelra two permanent landmarks to be prove d on a separate sheeVplan. 1 W10ons1( Inc. Address: 4 Putnam Ave., Brewster, NY 10509 Date: 10/6/04 copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC-97 Str6et Address::;.. I age-:-,.-.` Peekskill Hollow Rd/Well #2 Putnam Valley_. TV1dX-Gnd-#­" Map T9.11 Block / Lot(s) is Well Owner: Name: Address: PB General Contracting, Inc., P.O. Box 782, Mohegan Lake,NY 10579 Use of Well: 1- primary 2-secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment X Rotary _ Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing 'X Open hole in bedrock Other Casing Details Total length 77 ft. Length below grade 76 ft. Diameter 6 in. Weight per foot 19 lb/ft. Materials: _X Steel Plastic Other Joints: — Welded X Threaded — Other Seal: X Cement grout Bentonite Other Drive shoe: X Yes No ILiner: Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First — Yes No Hours Second Well Yield Test Bailed X Pumped X Compressed Air Hours 6 Yield 15 gpm Depth Data Measure from land surface-static (specify ft) 30' During yield test(ft) 180, Depth of completed well in feet 245' Well Log If more detailed information descriptions or sieve analyses. are aviiilabk,* please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 30 Drilling in overburden clay and boulders Hit rock at 30' .30 7T. Drilling iin, rock, set_ casing,.. grouted 7'7' _2­45 --briiiingl in granite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump/Storage Tank Information Pump Type sub Capacity 1 HP Depth 200' Model 7GS10412 Voltage 230 HP —1 Tank Type wx2 1 Volum,9 Ad gallons Date Well Completed 9/27/04 Putnam County Certification o. 006 Date of Report 10/6/04 We r s . Beal ZS NOTE: Exact location of well with distances to at Well Driller's Name P. F. Signature: Per y White copy: HD File; Yelra two permanent landmarks to be prove d on a separate sheeVplan. 1 W10ons1( Inc. Address: 4 Putnam Ave., Brewster, NY 10509 Date: 10/6/04 copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC-97 PUTNAM COUNTY DEPARTMENT OF HEALTH ub IDIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT VVelloc g om'° '`` ' Sfree {Ad`cTress: -' ` - -v y" Town/Village: Tax Grid # Pe Mapt-f. f Lot(s) /g Name: Address: PB General Contractin Inc. P. 0. Box 782 &Leqan Lake NY 10579 Well Owner: Use of.Well: 1- primary 2- secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment X Rotary Cable percussion _x .Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 62 , ft. Length below grade 61 ft. Diameter 6 in. Weight per foot 19 lb/ft. Materials: X Steel _ Plastic _ Other Joints: _ Welded X Threaded _ Other Seal: -_- Cement "grout _ Bentonite Other Drive shoe: X Yes No Liner Yes X No Screen Details Diameter (in) Slot Size. Length(ft) Depth to Screen (ft) Developed? First _ Yes No Hours Second Well Yield 'Pest Bailed X Pumped X Compressed Air Hours 6 Yield 25 gpm Depth Data Measure from land surface- static (specify ft) 30' During yield test(ft) 260' Depth of completed well in feet 1 385' Well Log If more detailed information descriptions or sieve analvses are available, please attach. De th From Surface Water Bearing Well Diameteron) Formation Description fft. ft. Land Surface 30 Drilling in over urden clay and boulders Hit roolk at 30' 4V 62 385 Drillinq in rack aranite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 1 Depth 280' Model 7GS10412 Voltage 230 HP 1 Tank Type WX251 Vol u a gogallons Date Well Completed 12/4/03 Putnam County Certi ication 14o. 001* Date o eport 3/4/04 Well Dr' a s� P Beal n. ZxacL iucauon of wets wtm aistances to at 1,67t two permanent landmarks to be provide, on a separate sheet/plan. Well Driller's Name P. F Address: 4 Putnam Avenup� Arpwster, NY Signature: Date: 3/x/04 10509 Perry L al White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 CZ `l'XCR II'lT= 1NI}�AC7 ASSESSMENT (To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE-1 THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF. Yes o B. WILL ACTT RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN'6 NYCRR, PART 617.6 ?. If No, a negative declaration may superseded by another involved agency. ' Yes &`10 C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing'traffic pattern, solid waste: production or disposal,, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or comniLiriity or.neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endatigered species? Explain briefly: C4. A community's'''ee�xi__sting plans or goals as officially adopted, or a change in use or intensity of.use of land or other natural resources? Explain briefly: / v� M . C5. Growth, subsequent development, or related activities likely to be induced by the proposed •action'? Explain briefly: vow C6. Long term short term, cumulative, or other effects not identified in C1 -05? Explain briefly: C7. Other impacts (including changes in use of either quantity or type of energy? Explain briefly: ! ' D. WILL THE PROJECT HAVE- AWIMPACT ON THE EN'JIRO�IiNENT.Qi. CHARAGT6RISTIIJSd =HA? CAUSED'THE ESTFBl15NMEtVT C)f A �121TICAl °TNIRONMENTAL AREA CEA)? If yes, ex lain briefly Yes No E. IS THERE, RE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If es ex lain: Yes No PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explahations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked yes, the determination of significance must evaluate the potential impactof the proposed action on the environmental characteristics of theCEA.' Check this box if you have identified one or more potentially large or significant adverse impact's which MAY occur. Then proceed directly to the F EAF and/or prepare a positive declaration. JG Check this box if you ha'Ve determined, based on the Information and analysis above and any supporting documentation, that the proposed a, WILL NOT result in.any significant adverse environmental impacts AND provide, on attac_hm_ents as necessary, the reasons supporting determination. Name of Lead Agency or Agency Signature of Preparer (if different from responsible officer) IPUTNAM COUNTY ID EPAR7MEN7 OF HEALTH _ DIMMN C�1F ENWRONMENTAL HEALTH .. ., .. - _ _. .-:i=.=- .'.'�i'- °:;• -..- z .... 'r,..` ._yL .. .w Y..�J• -`: ..., '.. .' . _ . . -. 5. c APPLICATION TO ABAN DON A WATER WELL . .r ... _ _t=•' =r .. l or P lease print type PCHD PERMIT Well Location: ° Street Address: To la illage Tax Grid # P'le2 VA �/ Q Qrtc, �� am MXp Block Lot(s) 1-5 Well Owner: Name: J �,(1 Address: /� PCB 6a 7 ?.) IY -CA / o ro Well T y&n ° e° ` Drilled Driven Dug Gravel Other Depth Data: Well Depth ft Static Water Level ft Date Measured Use of Well: Residential Public Supply Air /Cond/Heat Pump Abandoned I-primary Business Farm Test/Observation Other (specify) 2- seconndair y Industrial Institutional Standby Water fell Name: Address: Contractor: Reason ]Fon• Abandonment: II a CIO-5'e- `7� ro d� 5 STS Description of Work To Be Performed: ... ...-.- .i• ni , .- ...w ...., ..... .a. .. - . .� ...�.... w.._ .K ,_w .w. w.... ....�... .�• .tiY'w mt'e.• r -..v .... .. Date: Applicant Signature: PERMff7 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 info at on delineated on the application for this permit has been completed. L Die of Issue Permit rssuiniz Official Title White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -97 SL -_ - IEW YORK STATE CEPARTME�NT.QF_HEALTH':; •,,.- •'�Y.' :.0 t.� Z., +i :; S O 1 lC'�%'I'VBC=' Community' anitation and'Food Protection from Requirements of Part 75 and Appendix 75- A,10NYCRR for individual Household Sewage Treatment Systems Name of Applicant lss;�y G�C�f No. el Chyliown State Zip Address C 7 Ti e �Q L eLke- �Pee.�s%� I I /V 14 1.0537 No. skeet CityrTown stab ZIP ' Site "Location idee%S �� ���Go U/ . %7,0� v� �� w, (`i,.l i¢�n 1�%i�j 4o a-7cl j. 1. Reason why site does not meet t ONYCRR Appendix 75 -A (check appropriate box(es)): Separation distance cannot be achieved. Excessive slope. High groundwater. Inadequate depth to bedrock or impermeable layer. Soil unsuitable. Other (explain) �'�►ao�P�r/ rH, o�i lno °/© e�.A!z,i.1.�4.?� �t c, ................... ( P ) ...... .:............................. ..... ............................... .................................................................. ............................... . ..................................-................. ............................... .............. .................... ......... . ........................_........................._...............................................................................................:................ _..._............_........�.�� _ ...... .�..... i iL.. r�oposed design or conditions of waiver: rr/�J .... .1... .Q P. r. /...... ... s �lb .......................................................................... ............................... limitations (check appropriate box(es)): - - ........_.... .............. _ 3. The proposed design may have the following Increased risk of well or spring contamination. Increased risk of surface water contamination. Expected design life of the system will be diminished. Operation of sewage system is subject to mechanical problems. 17 Other (explain) ., ....:............................................... ............................... ................................... ..... ........ ...................- ... ......................... 1...... ............................... ' Additional information attached Construction pursuant to this waiver request should not pose any foreseeable health or environmental problems. In accordance with New York State Department of Health Administrative Rules and Regulations, Part 75.6 (b), a waiver is hereby granted. This waiver may be revoked by the Issuing official fora change in conditions for which this waiver was granted. a 'aESENfiAfiiV'o "" " " "M' "' " "10 "' "fi "OFHEAITH "' ORIGINAL -Local Health Agency ? .•J ..d COPY - Appiicant/Design Professional 6WE.................... A BRUCE K FOLEY 'Iftblic Health Director SW — 0* A LORETTA MOLINARI R.N., M.S.N. Associate Public. Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 - Geneva Road Brewster, New York- 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845)219-6558 WIC (845) 278 - 6678 Fax (845) 278 '6085 Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (945) 278 - 6648 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAVIER NAME: S /'azA ADDRESS: 0--7 -1_-rAy� &ad Z.LAk Pwkkill P SITE LOCATION: ' .DATE: 3 _T5 P STAFF PRESENT: -EftmWe, Rob M., Mike B.,-ANAILL Gene R., Shawn R., Bill H. 7 SPECIFIC WAVIER REQUEST: 0.1 DOES .THE PROPOSED VARIANCE. REQUEST POSE A HEALTH HAZARD OR ENVIRONMENTAL CONTAMINATION PROBLEM? REQIMST APPROVAL OR DENIED <�APP:ROa�D -DENIED REASON FOR DENIAL �_ DATE: 7—,5 DIREf TOP, Of PbTtM-M-= (SPECWAIVE)A6e[r%� YES NO WILL DISAPPROVAL RESULT IN A SIGNIFICANT HARDSHIP? YES NO DISCUSSION. REQIMST APPROVAL OR DENIED <�APP:ROa�D -DENIED REASON FOR DENIAL �_ DATE: 7—,5 DIREf TOP, Of PbTtM-M-= (SPECWAIVE)A6e[r%� PUTNAM COUNTY DEPARTMENT OF HEALTH . DIVISION OF .ENVIRONMENTAL --W- A TI ,S RVI <ES , CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # IOY 71- Y7 Located at I All err- Ao e,:�4 Town or Village Subdivision name Lv re Subd. Lot # 2- Tax Map P.)1 Block _,L Lot ,Z4-' Date Subdivision Approved q Renewal Revision Owner /Applicant Name (.x 010 r 10 Date of Previous Approval Mailing Address ��� j if .d a Zip /Ua Amount of Fee Enclosed 3 o G Building Type ' 2 11�w-e Lot Area Z No. of Bedrooms „3 Design Flow GPD 1 o 0 Fill Section Only P"- Depth Z " Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of o 0, gallon septic tank and 3 3 -d l 4" wl je Other Requirements: To be constructed by Address ;.Water SuDDIV: 1!0lic,Su PP 1 From ,.... Address _ or: _� Private Supply Drilled by A6 '0 erz' Address '0 rloo��)IefJ��y I represent that I am wholly and completely responsible for the design-and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: ,� �?G� /�/�� i � � ��:! `-"' P.E. i,-' R.A. Date � J a d-3 Address License # qs a . . 4,v, 5AO/I APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system 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 p it. Approved or discharge of domestic sanitary se ge only. r f _ By: Title: e 7/ Date: White copy - HD Fil ; YeIW copy - Building Inspector; Pink copy - Own , Ora a copy - Design Professional Form CP -97 P87TPIAM COUNTY EDEPAIB'A'RRIEFi7C OF I[$lElnl[.'Il'ID[ - IIDngSION OF ENVIRONMENTAL HEALTH SERWCIES _t -v-APPLIICATIION TO CONSTRUCT A-WA ° -',; please print or type PCHD Permit # - 8 ?�' Well Location: Street Address: Town/Village ' Tax Grid # J� Cer, d Map g4. n Block Lot(s) l-s Well Owner: Name: Address: •04ollej 6,e�01d Z7 *,o - or-.5e Use of Well: _Residential Public Supply Air /Cond/Heat Pump Irrigation I -p immany Business Farm Test/Monitoring Other (specify) 2- secondlai y Industrial Institutional Standby Ammoanat of Use Yield Sought _ gpm # People Served ___* Est. of Daily Usage ,Goa gal. Restson for Replace Existing Supply Test/Observation Additional Supply Drilling /'New Supply (new dwelling) Deepen Existing Well Detailed Reason for 3xilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes i,"' No Name of subdivision j�e.,AY Lot No. -2- Water Well Contractor: . 0'�,7 rt- -Aey Address: l3v✓4 ol'�d °- Is Public Water Supply available to site? .................................. ............................... Yes No P- Name of Public Water Supply: -- Town/Village Distance to property from nearest water main: •�°�f` a% Proposed well location & sources of contamination to be provided on separate sheet/plan. 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 w�er well driller certpfied by Putnam County. / / .4 \ .1 Date of Issue 3 - Z --<fZ3 Date of Expiration ?� --f 2 ---0 Permit is Non- Transfe r>rabDe Permit Title: White copy - HD file; Yellow copy - Building Inspector; Pink copy - M Orange copy - Well driller Form WP -97 µ a PUTNAM COUNTY DEPARTMENT OF HEALTH f r - . DIVI� ,ION:.UF���TVIR()�1M�NTAI, :I�EAI,T�I..SE.RVIC.�S CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SY T PERMIT # Located at �!/S%�i%����� �� Town or Village Subdivision names arG %c/ Subd. Lot # Tax Map &. 11 Block _L Lot Date Subdivision Approved �A Owner /Applicant Name `5;!: , . 4aVe//M— el- �r Mailing Address ki Renewal Revision . Date of Previous Approval P ����� �• % Zip %�'�� Amount of Fee Enclosed e,,4to el Building Type i C Lot Area No. of Bedrooms 3 Design Flow GPDOe;;. Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of %6'Q!a gallon septic tank and 3-3 / L JL` Other Requirements: To be constructed by Address ,r Water Sup {._T, Public Supply -From _ Address or: Y Private Supply Drilled by Aeac/ &er,S Y Address M-a-^ --! I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. of NE6y Y ��• y C1SSG ��� Signed: G i * P.E. R.A. Date 19 10 Address Xe w License # 2 APPROVED FOR CONSTRUCTIO . expires two years from the date issued unless construction of the sewage treatment system has been completed an inspected by the PCHD and is revocable for cause or may be amended or modified w c nsidered ecessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe t. ppr e discharge of domestic sanitary sewa ly. 6� 0 By: Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 r PUTNAMI COUNTY DEPARTMENT 07 HEALTH IIDffVffSffCN OF E1VWRONM1ENTA1L HEALTH SERW CES 't:. ;!' idf�•. _ -...:- <:,, ":;':.,.�1'6Y' Y��4:1-3.T�:�1Tt� �Y��1� :'�ll-RU6:--11'�•��W.L'�J;E -R, W.�1C��1L1LJ �:r,�'.' ,= .4 //!.sa..: =���.. _/�::;a.. t (� I please print or type PCHD Permit #� W ' V �y v^ Well Location: Street Address: Town/Village o1% Tax Grid # MapXW,11 Block / Lot(s) WeRlOwne>r: Name: Address: Use of Welll: esidential --Public Supply Air /Cond/Heat ` ump Irrigation I- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought _ gpm # People Served _ Est. of Daily Usages gal. Reason for Replace Existing Supply Test/Observation Additional Supply IID>riIlfling /'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 P"' No Name of subdivision Lot No. A Water Well Contractor: Address: 4' 3r Is Public Water Supply available to site? .................................. ............................... Yes No y4 Name of Public Water Supply: ---° Town/Village --�° Distance to property from nearest water main: /vi&s Proposed well location & sources of contamination to be provided on separate sheet/plan. late: - 'ApplicahVSignature:....... .. e< � — l 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. revision or alteration of the approved plan requires a new permit. Well to be constructed by a water 11 iller rtified by Putnam County. Date of Issue 1 /8/0 Permit Issuing Offic �d✓ Date of Expiration' I LMLn 6 Title: Permit is Non White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PIT AM LV DEpARTMENT OF HEALTH SERVICES COUNTY H TN MENTAL HEALT 11ON:0�F:VIZON N PERMIT FOR SEW AGE TR] CONS- rRUCTIO Sra � PERMIT # _P y 71 X77 j yv ° ° Located at / r,G���' .f %�� Subdivision name Subd. Lot It Date Subdivision Approved l q gf Owner/Applicant pplicant Name b -- r Mailing Address x..03 U y ` Hof Town or Village S4.JI Block Lot %_- Tax Map 0►a�e'o'" Renewal Revision /�✓ _�— � Date of Previous Approval Zip> J � Amount of Fee Enclosed ,� Desig n Flow GPD d Building Type Lot Area No. of Bedrooms -- Depth Volume LETED Fill Section Only _� epth WHEN FILL IS COMP pCHDNOTIFICATION IS RE and 3 d �� o gallon septic tank Se crate Sewer$ e S sy tem to consist of / Other Requirements:._ To be coristruct�ed by _ or• ems` private S�► I represent that -1 accordaLnce th thereof a «Ci1 Department a ' builder wil-V -pia immediaL��, fc system o any Sig�r1e�! W Address ly_PxQr!? Address l`" 1 by n of d that th' ro osed systems) roved amendment thereto and i ad completely responsible for the deed and on the Pp p p d that on completio am wholly ent of Health, an ►tment sytffi described above will be construct County Dept ed to tl e standardsules and regulations the Putnam that sa i ns by the builder, a satisfactory to the Public Hea1� DlasstOr will be subml eE ate of Consiruct'on Compliance his successors, heirs o g o (2) y fished the owner, stem during the period of the orig» antee will be Earn' art of said sewage treatment sy Hance of rating condition any part ,,.,,,, -n.,al of the Certificate of Construction omp written gua► n good op� - fing the die Ctrs thereto. the issuan�Ot NEWY - E. R.A. ---.Date 3 �J License #_ ` `' V ction o Ac$cir��____� �� Gi'� be aanend- �"�✓ x Tres two years from the date issue ease or m ysttu ep and is revocable for roved plan rec. AP►�.L� --apt CONSTRUCTI the PC sewaL�� —,re21 stem has been completed and inspected by revision or alteration of the app mo�mf „� haidered necessary by the Public Health Director. e Any — i" —""'w a of omestic sanitary s wag_ y' ,� � � S a r�� — e i oved for discharge $r S' Date: 'J03 Title: Design Professio Form owner; Orange Orange copy copy " Ile• Yellow copy - Building Inspector; Pink copy - - '. ,I&V e2 Wbtgy-- PUS NAM COUNTY Y IlDIEPAEBTM ENT OF HEALTH IlD11VV11S11®N OF IENWRO NMIENTAL HEALTH S E1E8WcC1ES 07 P;JCA.TION. - TQ,CONSTRU please print or type PCHD Permit Well Location: Street Address: Town/Village Tax Grid # `` jai �/% o ►1t/' �� J�ii .,� k J Map ,�74./I Block t Lot(s) L:s' Well Owner: Name: / Address: IVX Use of Well: /Residential Public Supply Air /Cond/Heat Pump Irrigation I- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought _� gpm #People Served Est. of Daily Usage Zee' gal. Reason for Replace Existing Supply Test/Observation Additional Supply IDrilumg New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type D/Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes J'f No Name of subdivision 4 g; re, e Lot No. �- Water Well Contractor: Al Address: /0-hd*; ev' 11�Y Is Public Water Supply available to site? .................................. ............................... Yes No ✓' Name of Public Water Supply: 77 Town/Village -° Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Dates '.. _: �,_ • :: _- Applicant'sighatdre: PERMIT MIT 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: ION: 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 water well driller certified by Putnam County. Date of Issue �- �� Permit Issuing Official: Date of Expiration �- Title: S Permit is Non- Transfferrab e White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .�,�x,. t. u'F?1✓d� ."a` .ro. °v I '.4 t:.r.. .t,` .�•~ ,t •r� :� .p v.•`vi :1 RE: Property of Located at Subdivision of Subdivision Lot # LETTER OF AUTHORIZATION voTG1'/ LI-el i? /"G 1r // 11d 1/ � : a41 Tax Map # 9:411 Block Lot J� Filed Map # Date Filed Gentlemen: This letter is to authorize a duly licensed Professional Engineer or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in -+ . e nformity °with the provisions of Article 1.45 and/or 1147 -.of the. Education- Law,,tlie_Public.Health_.. Law, and the Putnam County Sanitary Code. N y Very tru;wner your , Cou Signed:' P.E. �, of Property) ?4856 L Mailin Z '' ee"Z's/ 4 �VMailing Address: r% h i n State Telephone: State A T Zip Io5(9 -7 Telephone: q)� 1&6- 5 �o-2 Form LA -97 CONSTRUCTION, PEI ' IT FOR EWA E 'Tpp'L ' '0 Locted,ata . ,1 Town. or Vill lag o t? SubdiN ision lame r ?v ; 5ubd, lot 4 IL i .ate Subdivision : proved t owur Ap- lcanL '� amp .� ,� :'; f €f ate of re .• . „ allang Address `' "' �: �� ,� 40 � �_- ' .�._'.__. .._.. ._s b Atr.ount offte..iEnclosed .l e a cv.cre .(Jot Area.,/ A "K, No, of - ,droorn,� Des- Ma e - ;' ? Se arate Sed�-ler- age.System to consist of o be coastruc.ted by Address pttl,lir r, 1,4.,- ' Private Supply Drilled ij� . `''. MSC. t T nor,t•�:h,�p i71t 11I] 1�'llo.d'1 " ai]d Com'pletf iy' ,responsif le. tf)t' tl?e dcslig,1 '� ,- Ehc r ail C, Iple a: C' ; t' r. e c treacrnent systrtr, describ:cd abovc will E�-p c� e' ti sl:c.��'n r � �hc ao c z �11�ir1iCi Ea � accordance vvi h, the standards. rules and replations of the Putta4n Cy 1?ep x . themof a "Certificate of ComsTructioin Compliance" satisfeetory m the p)jbfi4 � 1 rye iFLot. end a written aaarantee ,vill be furnished the w��riws,� s �1t C�� tr i � r.., �i �� ']a1 , builder ,wil'1 place i;t] good operating condition any Para of said im. lne&ately folioNvilla the date of the issuance of the approval of the Ckfio system or or any repairs thererc. Signed. _ ,.'` f ";� t,.. -, P.E , R. , .r l A Address r "'-� • __ �icetx i, V�V 4t - PR0'v,ZD' 0R W. S'TRUCTI® : This approval eXpices tNN.o , cals froM;thtjda'te se vag tre-atirerit s\ stein has been completed and inspectedby° the PAID and'is - -,r t ^&w P'odified wheP considered necessary by the Public Health Directox• Arly rerisior 'or al ' t i aclt72� a rep` peimlit Appror'ed for discharge ofdomesti: sanitary se go only. 7'itt:e'. _..— %'••K. F''� ^':f a S- "d6•' - Y lr ;:�_f _ u _...- ..._........_. -. .. Fil Y 'lane copy 1 7 ellow; dopy Butldang Inspector; Pi �.o Q p f PUTNAM COUNTY DEPARTMENT OF HEALTH "..DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # ?� w -71 -� Located at �,���/ l AVA I/ � Subdivision name Subd. Lot # 2 Date Subdivision Approved Owner /Applicant Name Town or Village lee lokm Tax Map CY // Block Lot /5` Renewal Revision Date of Previous Approval Mailing Address .22 % yr ref e /?c q d ,i,�,/f Zip Amount of Fee Enclosed 3 d 0 Building Type AfiCiewde Lot Area // � No. of Bedrooms -3 Design Flow GPD 16, v Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of /00 y gallon septic tank and 3 3 ., Other Requirements: ) � 1y,00, -, /—'-/J/ Af /7,741 /0,/,l fs To be constructed by➢iv�� �� / Address L - Water Sup ply:... - _ Public Supply From Address or: .. r- TPrivate Supply Drilled by w; .. � �-;�s vat ...: :.-tinuress: I represent-that I am wholly and completely responsible for the design and location of the proposed system(s) and that the sgparate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: —:2�Zze4Xk P.E. !.r R. A. Date Address j, q7 ,�zn /�r/ n C A-e V. oV-ryf License # 2 Y APPROVED FOR CONSTRUCTION: This approval expires two. years from the date issued unless construction of the sewage treatment system 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 pen' . App ro ed for d' ch a domestic sanitary sewa a only. By: Title: 61<- Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 x a PUT NAM COUNTY DEPARTMENT T OIF HEALTH 0 IIDR.WRON 1F lENWROIYM ENTAIL HEALTH S ERW C1ES �i ~t .4. "'✓�1.�:: r.o ... o.- _ -r ,.:y .,.:i?"'_: :$ a. d�iLLL11 `L.7�1•ll•'•115$t' ^��!-iS'lt JlC��1 L'•Y'xf'S���°1LIIO`�'7= '�gg $g 1Ei11� F.n. please print or type PCHD Permit # Well Location: Street Address: Town/Villagge Tax Grid # // // �� 1s � �/0 t�e'/1'11W / �, /`d Map W-/% Block r Lot(s) /-.r' Well Owner: Name: ay Address: I Use of Well: _Residential Public Supply Air /Cond/Heat Pump Irrigation I- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought _4' gpm # People Served __,& Est. of Daily Usage _gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed ]reason for Drilling Well Type. a/' Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No A,- Is well located in a realty subdivision? ...................................... ............................... Yes ei No Name of subdivision �� ��"��i /�Gi�� Lot No. :2— Water Well Contractor: /V Address: 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. . r I,��w App ffcant-Signature t ..�- 11 � m 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 water well driller certified by Putnam County. -19 Date of Issue 7 t Permit Issuing fficial: &A,1-1 k A Date of Expiration 1 Title: r e— ]Permit is Non- Transffer albIl White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller © �y 17 q to V For m WP -97 ® Public Health Director May 26, 1999 LOMYT'PA .:MQL3N AitI:-It R , Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914)278-6130 Fax (914) 278 - 7921 Nursing Services (914)278-6558 Fax(914)278-6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Frank Sullivan, PE 2972 Ferncrest Drive Yorktown Heights, New York 10598 Re: Cassidy, Love Peek Acres, Lot 2 TM# 84.11 -1 -15 (T) Putnam Valley Dear Mr. Sullivan: This office has received and reviewed the most recent set of plans for the above mentioned project. We would like to offer the following comments for your consideration: 1. 100% expansion must be provided for. / Please show access to well. Submit Letter of Feasibility from Putnam County Certified Well Driller. 4.. Provide force main detail. _....�, . _ 5. A "Fill Pian" is required for "any" fill-over 2' =0 "' in depth".- ` 6. Please verify proposed grading as shown on the attached plan marked in red. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact us if any questions arise. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj Attachments sit J 'C 'R :` FO LL Public Health Director June 28, 1999 RL6RETTA''M' OLINAkI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 �O Early Intervention (914) 278: 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Frank Sullivan, PE 2972 Femcrest Drive Yorktown Heights, New York 10598 Re: Cassidy, Love Peek Acres, Lot #2 TM# 84.11 -1 -15, (T) Putnam Valley Dear Mr. Sullivan: During review of re- submitted drawings and subdivision files, June 4, 1986, a note to file was made by Mike Budzinski stating "keep wells a minimum of 100' from graves. Review of plans show well is within 100' of King David Cemetery. Please verify. -1 his office will 'continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj l � `Public Health~ Director June 28, 1999 ;; .. ��:.�i,�ILi�.'d"f'h` rvI�'?�IT;�iRi''Fc.Fd.' i�:S:N: •- - Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Frank Sullivan, PE 2972 Fernerest Drive Yorktown Heights, New York 10598 Re: Cassidy, Love Peek Acres, Lot #2 TM# 84.11 -1 -15, (T) Putnam Valley Dear Mr. Sullivan: During review of re- submitted drawings and subdivision files, June 4, 1986, a note to file was made by Mike Budzinski stating "keep wells a minimum of 100' from graves. Review of plans show well is within 100' of King David Cemetery. Please verify. phis office -i O'x.6nti.Itue -its rWi6 -w u dii-'considerat 16 n 1 f the �bcve -nrn, tinned - c- oiununts. Please feel free to contact me at ext. 2157 if any questions arise. ABS:cj Very truly yours, CA.,t,�, Adam B. Stiebeling Assistant Public Health Engineer i Norman Anderson IN'C. 152 Barger Street Putnam Valley, N.Y. 10579 914- 528 -1491 Adam Speidling Putnam .County Department of Health 4 Geneva, Avenue Brewster, N.Y. 10509 Re: Well- Charles Cassidy Lot 2# Loves Peek Acres Dear Sir; Norman Anderson does not think there will be any problem with drilling a well approximately eleven feet from the rear of this property. Sincerely Yours; _ /1 air -�-- -. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH - INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEIYSH TFOR;CO \STtUCT[Q�`LPERhT:T__ _ Ah '.-..v'•' i -. :t.- y ^.�_-V' '} - =: .t ,.� i t!a•..:..._. ".6.i "AiH a .. .. p,:t...-'.!b ty. may..:.. r.P �+.r:r .. .. ... • • "d' v•I1r11rW�a - r - STREET LOCATION � >� �cc l , -� � J NAME OF O� NE 4S5 i� REVIEWED BY R I, GR, AS, MB, BH 4TE Z1 TAX NIAP # Y DOCUMENTS Y N �4- �� — ld ERMIT APPLICATION EROSION CONTROL:HOUSE,WELL, SSDS LOCATED WELL PERMIT /PWS LETTER REPRESENTATIOVE OF PRIMARY &EXPANSION dFqi'V-'THREE SETS PUSE PLANS - TWO SETS 'ARIANCE REQUEST EE SUBDIVISION EGAL SUBDIVISION UBDIVISION APPROVAL CHECKED .ERC RATE - I kL REQUIRED DEPTH 76RTAIN DRAIN REQUIRED TANDPIPES GENERAL 1OCATED IN NYC WATERSHED PANS SUBMITTED TO DEP KEGATED TO PCHV )-U APPROVAL. IFBEO'D EX- APPROVAL SSDS ADJ. LOTS WETLANDS (TOWN/DEC PERMIT REQ'D ?) DATA ON DDS PLANS & PERMIT SAME :'•RE 19E4- NEfGHBOn IOIFICAi'i ^vi1- ' LETTER BI/ZBA 100 YR. FLOOD ELEVATION OTHER REQ'D PERMIT(S) REQUIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) SSDS HYDRAULIC PROFILE GRAVITY FLOW LOCATION MAP EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE IF PUMPED, PIT & D BOX SHOWN & DETAILED HOUSE -NO.OF BEDROOMS WELLS & SSDS'S W/IN 200' OF PROPOSED SYS. PROPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) T OUSE SEWER - 1/4" FT. 4 "0; TYPE PIPE O BENDS; MAX.BENDS 450 W /CLEANOUT FILL SYSTEMS CLAY BARRIER 10- FT. HORIZONTAL;SLOPE 3:1 TO GRADE FILL SPECS FILLNOTES FILL CERTIFICATION NOTE DEPTH GAUGES FILL PROFILE & DIMENSIONS VOLUME FILL IN EXPANSION AREA LF TRENCH PROVIDED 60 FT MAX. PARALLEL TO CONTOURS 100% EXPANSION PROVIDED . SEPARATION DISTANCES SPECIFIED ON PLAN - FROM SSTS 10' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL 20'TV FGUN\DATION WALLS" '- 1YWELLTOPL " 100' TO WELL, 200' IN DLOD, 1S0' PITS 100' TO STREAM WATERCOURSE LAKE (inc. expan) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATER LINE (pits -20') 50' INTERMITTENT DRAINAGE COURSE 200'/500' RESERVOIR, ETC. _150' GALLEY SYSTEMS CONSTRUCTION NOTES 151MIN to CDS= >5 %,10'- 4 0/*,25'- 3%,30'- 2 0/o,35' -1 0/o,100' - <I% DESIGN DATA: PERC & DEEP RESULTS 20'MIN to CD discharge /100'with 182 cons day discharge T CONTOURS EXISTING & PROPOSED SEPTIC TANK DRIVEWAY & SLOPES, CUT m 10' FROM FOUNDATION; 50' TO WELL FOOTING /GUTTER/CURTAIN DRAINS WELL SOIL TYPE BOUNDARIES DIMENSIONS TO PROPERTY. LINE TITLE BLOCK; OWNERS NAME,ADDRESS ® LOCATION OF SERVICE CONNECTION TM #,PE/RA; NAME,ADDRESS,PHONE# DATE OF DRAWING/REVISION DATUM REFERENCE LOCATION OF WATERCOURSES, PONDS LAKES AND WETLANDS WITHIN 200 FEET PROPOSED FINISH FLOOR AND BASEMENT EL. COMMENTS: f PUTNAM COUNTY DEPARTMENT-OF HEALTH IDIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address ;�r Located at (Street) 5 /� 1ld %�a7� �� Tax Map �/ Block J Lot J (in "cate nearest cross street) Municipality Watershed SOIL PERCOLATION TEST DATA Date of Pre- soakine %���� fY Date of Percolation Test %�a �y" 9 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 1 min for 1 -30 min/inch, s 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 De th to Water rom Ground Water Level �ercolat�p: No. Run Time Ela se Time Surface (Inches)`" Start Stop Dro Ia pp Inches :. Rato 8a a No.. :Start . Stop Min.) :.: Nwincl 2 D5; /11 �� ?� 1;? 3 .3 % 33 �7 4 'S 2 / �3 3 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 1 min for 1 -30 min/inch, s 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 PUTNAM COUNTY DEPARTMENT-OF HEALTH DIVISHON OF ENVIRONMENTAL HEALTH SERVICES D F. ESIGN DATA SHE ET - SUBS>t RF I ACE SEWAGE TREATMENT SYSTEM Owner Address Located at (Street) Tax Map Block Lot (indicate nearest cross street) Municipality Watershed SOIL PERCOLATION TEST DATA Date of Pre-soaking Date of Percolation Test .... ....... . .. Depth to Water Wier F Ground Level Percolatio.a. .. .... . .... . :stop . Rnse Time Surface (Inche6 Dro In R 9 "­- Hole NoX U n N S6a kf ' S ail stop Unties ......... . A17 _2 2 2..2 3 J1,7 2:e2 4 5 2 3 4 5 2 3 4 - - 1 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, :5 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 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner 4 � C' //Z � Address Located at (Street) Tax Map 9! ,t/ Block I —.Lot /_T— (indicate nearest cross street) Municipality Watershed SOIL PERCOLATION TEST DATA Date of Pre-soakine Date of Percolation Test ... .. .. . ... °Hole No ...... ........... Run No .... '....................... Start ' . sk: im...p r Statt S t �ne . Mtn/Inch . ....... ...... ........................ . .. .S..�.u.. . 1 17 2 -'70 2.-3 2 2­3 3 4 2 � 3 A2 4 5 V" 2 IS 3 1 1 5 1 1 1 NOTES: 1. Tests to he reneated at same denth until annroximatelveoual nercolation rates are ahtained at percolation test hole. (i.e. s I min for 1-30 min/inch, s 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 DEPTH G.L. 0.51 1.01 1.51 2.0' 2.51 Kill] 3.51 4.01 4.5' 5.0' 5.5' 6.0' 6.5' 7.01 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES 0. HOLE NO. 7 " HOLE No. Indicate level at which groundwater is encountered Itle 7 e Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: 0 Design Professional Name: .1 Address: �1`72- Signature Desip ProfeWonaVs Seal \j 'PARTS ' ` � 1 GuUlc1s - -- - Item No. Description � 7 Submersible �� 1 Impeller -.._. - •:1 . 3 � Maatanrwlseal •�_Y...• .- -. .e�� —;: . ,. .,.::�:. _ - - U n -- um_��_- - ,_ Shall - - -- 5 6 MODEL , .. - -Motor •-- ...- -- -- -• - 4 o- Bemings - upper and 8 3 1 Io: +er 3885 Power cable - r_.._.... _.. - -- 8 0•nny _ 2 MODELS PERFORMANCE RATINGS (gallons per minute) Order No. __ HP Volts' Phase Max. Amp. RPM 3o Heator Size 30 . r"WE03t9lz�u' — WE0312L 9 115 1 94 1750 N/A 756'4 230 47 ^WE0318L 200 54 WE031tM 115 94 WE0312M 230 43 WEO318M WE-511H 200_ 5 4 20 115 230 145 3500 10 WE0512H 73 WE0518H 200 84 WE0 338H 200 3 3.9 K32 - WE0532H 230 34 K32 WE0534H 460 13 K21 r WE051 HH It 1 14.5 N/A WEO 12KH ^WE0518HH 230 7.3 200 84 WE0538HH 200 3 3 8 K32 WE053 HHH 230 3500 K31 WE0534HH 460 1.65- K21 WE07t2H 230 1 10.0 N/A 70 ,- WE0718H 200 11.5 _ ^_ WE0738H 3 6.2 K49 WE0732H 230 5.4 K39 WE0734H 460 2.7 K28 WE1012H 1 230 1 12.5 WA -WE 1018H 200 144 _ WEt038H WE 1032H 200 3 81 K43 230 70 K43 1034H -. 460 116 45 WE1512H _ J 1 ' 230 1 15.1 38 80 I r WE 1538H 2 3 10.6 K53 WEt 32H 9.2 K50 WE1534H WE 1512HH WE1538HH 460 4.6 K36 230 1 15.0 NrA 200 3 10.6 K53 WE 1532HH 230 92 K50 WE�1534HH 460 K36 ' Fur 575 V consult lactory. METERS, 1`927 i 120 as - 110 WE16Nh1 30 . 100 9 tw WEO511N u °! •• a0 wlullN WE1f11NN > >o -0• t O .0 ,5. 5J WE06NM WEOl71NN 40 C- k w'031 IM 20 5• WCI132N WIM1111 10 MODEL: 3865 SIZE 1r: SOLIDS - wE0511N wEOIIiNN r - -- WEO511N wro112N w11o1zN wlullN WE1f11NN WI1f I1NN, Order M110671N W10171N wU0]IN wt1$36 N WEOl71NN wE y74NN, No. wto3ttl w'031 IM WE0532N w111f1N WCI132N WIM1111 WEOf3211N wl Ism"I WE01121 NrE0712M 111110511111 Wt0734H 11IE1034N w111U4N 1111105341,114 111111115340110 ' WE031" W103110 11111115111" 11111011111111 1111111116" WIOf11INN Rpm 1750 1750 3500 1 3500 3500 3500 3500 3500 10 80 65 - - - 56 84 15 60 57 •69 90 104 128 53 82 20 36 45 60 83 98 Q2 48 777 25 25 50 76 92 116 45 75� A 30 38 67 85 109 40 721 3 35 26 58 78 35 70-1 540 70 _102 9•i 30 67 1 15 41 0 45 36 62 _ 52 86 25 64 0 50 25 77 18 60 55 17 42 67 12 58 60 a 32 s6 3 .54 12 65 21 46 51 1 70 11 35 . a7 75 25 43—' 40 80 15 90 33 ' - -. 25 11101 120 _ — 5 DIMENSIONS (AIL dimensions are in Inches. Do not use for construction purposes ) D' '/,.14.1'1 and 1 HP - 15' except for model WE0712H and WE1012H = 18', 1'/!HP : 18' I')-A' 1 r I I 01 81W KICK-BACK 1 IPT 1 3.1 1 EFFLUENT EJECTOR SYSTEM Effluent ejector system Package Includes: otters ease of orderihq Su0n1tI! t:,e f tlwenl P,.mp WE031 IL and installation. A single 12L or WE0311M. 12M WE0S11mm. 12TH ordering number specifies ? Met;Niucal Level Conu,K Switch C1. 6 w 40 50 60 ro so 10 100 OPM ` A2 51115V1 ALI.61MJi o to eo : a complete system designed Basal A, 150:5 ease! wvd All- tbe2 �: l0 20 m01h lot most residential and No% Va,.e 42P CAPAOT7 commercial sump and i Order No SWE0311L SWE0312L. GOULDS PUMPS. INC. effluent pump applications. 1 SWE051Ihri.SW 0512Hr, WATER TECHNOLOGIES GROUP 5EIIECA FALLS NEVJ V M 13148 SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE., PRINTED IN U.S A 77MT—�— 'COURMDEP R61M to �i CkRTffibkTE 6F 8z 00, 'its, -47 at '4000 OtIiAt � Nam Vd Dtlte Piefl ]NO S—d)r' Town F: P'CHD Nqtfflca'�� Nwilier d. 13-1&6� E6kn 'Flow G,P'�DL When' — Sepamb Sewemp S*= to ca"t &Hous'aptic T2A and Tol- SUPPV -on b pletely �s --P IFY truit-the separate 4i`s i%ste. vv��?lly a.�,c ved: stave �loicijbod.y�lh be constructed 1 5 !ds,*•!uies an j F,aqu amentlment to'4" ce wl , ... a �111 torylo*thO, mis oner 48althwill to don -,Fn Ott County, arman 'Certificate hiiiiiid bvilder Will bo bej '-h- ns, Dy 86, builder h ow i a r. issu- le, qf:.,t- 1 i;i�. 11 a abow ?"' ► 1 666 11 t i'�tfie..drlll vvoll:.doscrl"q�- "cl wilVbticated,as Shaw on the i6prt4id plan and that said well will De installed ii wi Mla Iti and r GgU a f "'h ty 6 par) Address ,. Lice' Nor 1, wo Y4, 0VElJ'FOR'--'CONSTRUCTION t building has iieen. undertaken and is 0 -N or cay'se',or. may a ormodi an can a I !ly.,-c6n or alteration construction ­ be: t �f joniir'cilo' :r�voc fied, .90. disposal dome ita, - --; requires a ppro for d: r t Rev. 1/87 DPW. *V .7 Tale DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 yr _APPLICATION. 'TO'CONSTAUCT ^`A WATER-WELL PCHD PERMIT #_t� WELL LOCATION Street Address Town/ a e City Tax Grid Number WELL OWNER Name. a,�'A_S Ma ling . Addres J A—x �'/4 /�1 ✓rrSe4V: e o rivate O Public USE, OF WELL 1- .primary 2- secondary e&IDENTIAL 0 BUSINESS 0 INDUSTRIAL PUBLIC SUPPLY OAIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION 0 INSTITUTIONAL O STAND -BY OABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED /EST.OF DAILY USAGE 668 gal REASON FOR DRILLING &KEW SUPPLY O PROVIDE ADDITIONAL SUPPLY O REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL O TEST /OBSERVATION DETAILED REASON FOR DRILLING WELL TYPE BILLED ODRIVEN ODUG OGRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES R-'NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No ;X WATER WELL CONTRACTOR: Name /Ya /n'JG*-7 A Address: PLI. IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: r, TOWN /VIL /CITY DISTANCEyTO PROPERTY - + ._.... FROM NEARES T WATER MAI'N ' —'-. ... _.._..._....__. _..... _. � ._. �.�.. _.._ ....._�_ :,. , LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED O ON REAR OF THIS APPLICATION eN SEPARATE SHEET (date) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of 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 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 attached to this p rmit. 3. Submit a Well Completion Report on a form.p vi ed by the Pu ounty Health Department. Date of Issue: f, -m 3 19� Date of Expiration: 19 Pqrmir Issuflng Official Permit is Non - Transferrable Mite copy: H.D. File Yellow copy: Building Inspector 2/87 Pink Copy: owner Orange copy: Well Driller I r _ - - APPENDIX - �� • I' Y h " COUNrY DIKOAM= OF HEALTH DIVISICM OF ENVIRCNMENTAL :1A• is 'E rES INDIVIDUAL M-NMR SUPPLY & SUBSURFAMP SF�T DISPOSAL SYSTEM LF reruired 60 ft. max. Pare_ilel to FILL SYS _ clav ier 10 ft fill rtes i new spec. de th gauges 100 vr. fl ' elev DATE REVIMED: 11 BY: _11C. (Street Location) / ) � NO DOMEM (� (J Permit Application Corporate Resolution Plans - -Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Log Consistent Perc Results Perc Hole Depth House P - Two sets Well permit; PWS letter Variance Request CQ�RAL - LeTal Subdivision Subdivision Approval Checked Ex-approval SSDS Adj. Lots Cher-kei Wet and (Tcwn/DEC Permit R & D) Data On DDS Plans & Permit Same REQUIRED DETAIIS ON PLANS Sewage System Plan - (north arrow) Se<aage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volumes D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail., Service Line if over :Cons;_ructian Mates :: JgriA der.,note$),.. _'Design• Iaata : � � ��p "' �e5u3ts'. - - ; ` ... � _ _ , Two-Foot Contours Existing & Proposed Driveway & Slopes Cut Footing/Gutter,Curtain Drains (discharge OK) Perc & Deen Holes Located Representative of primary and expansion Expansion Area; shown; gravity flow,suff. size If Pwped Pit & D Box Shown & Detailed House - 1Vo. of Bedrooms Wells & SSDS's w /in 200 ft. of Proposed Systems Property Metes & Bounds -Naus Setback .. _ (Tight lot) -mouse Sewer 1 /4" /ft. "0; Type pine No Bends; 5° w /cleanout SEPARATION DISTANCES SPECIFIED ON PAN Fields 10' to P.L., Driveway, Large Tre--s,Top of fil 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. e�xc 15' to Drains - Curtain, Leader, Footing 351to catch basin, stormdrain, piped watercour: s/s S'JEDIVISION Perc (3) Fill ca 10' to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' fran Foundation; 50' to well 15' Well to PL LLI APPENDIX pUr,px ccuNilly DEP-ArdMM OF HE• t: DIVISION OF ENVIRCNMENML E is SERVICES •E 32mIVIDUAL WNTER SUPPLY fl' /• C DISPCSAL SYSTEMS - _ ...,:, -, -. , . � . _ .., .. ..t... -.�• .><.'•�..• - . v_. .. ' REVmiyyLSam `- `CbIQSTRIICTION PEkd�.:,:a.1 ra _.... v_. _ . ,• . r ... .. DATE REVIF.WID: BY: (Name of Own (Street Location) ccbv= YES NO D0CM4DMS P_.nnit Application�L� Corporate Resolution Puns - Three sets s/s Engineers Authorization Design Data Sheet (DDS) S'JHDIVISICN Deep Hole Log Perc Consistent Perc Results (3) Fill �- Perc Hole Depth cd LF FILL S clav 10 f fill ' new de_ t 10_Y- - I House P - Two sets Wellpe -rmi t.; PWS letter Variance R nest. GL __ RAT. - L a. Subdivision Sucdivision Approval Checked Ex -ar proval SSDS P.d -j . Lots C:zec.'ced Wet ana (Tcwn/DEC Pennit R & D) Data. On DDS Plans & Permit Same ca provides I REQUIRED DEL= ON PLANS _recuired Sewage System Plan - (norluh arrcw) 60 ft. ma, e. Segaae Svst m Hydraulic Profile - Gravity Fla Par_lllel to ccn s Fill Profile & Dimensions - Volume D or 3 Box;Trench /Gallery; PuTo pit details Septic Tank - Size, Detail Well Detail, Se*vice Line if over _ _ _;� ; - -- en ru on• Notes ..Cgrinde . notes) . T� -3 --F:. - - - "; - "Design td --: perc acid - deep —i uTts Two-:Foot Contours Existing & Propcsed Driveway & Slopes Cut J I / Footin /Gutter, Cur min Drains (discnarge CK ) Perc & Deeo Holes Located �S Representative of primary and expansion ier Expansion Area;shcwn;gravity flcw,sufi. size _ If Pt�3 Pit & D Box Shaun & Detailed otes House - No. of Bedroans mec. Wells & SSDS's w /in 200 ft. of Proposed Syste 1 oauces ZH Property Metes & Bounds . use Setback .. s (Tight lot) Ouse Sewer 1 /4 " /ft. "0; T' ge Piue flccd' elev. No Bends; 5° w /cl eancut SEP...ARMGN DISTANCES SPBCUIM ON PT�•V Fields 10' to P.L., Driveway, large Trees,Too of f j 20' to Foundation Halls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. emp tj 15' to Drains - -Curtain, Leader, Footing AM 351 to catch basin, stormdrain,pir a watercou 10' to Water Line (pits -20') 50' intermittent drainage course Septic Yanks 10' frm Youndation; 50' to we-11 1 15' Well to PL O I, P. �!� i i 9,/'�' ; oAid 1 n'' �.� *• 1 ® i es (on) is b� 1m ! 7 --...,DIVISIQN--C-E..IENVURg�-NMENTAL HEALTH SERVICE RE: Property of LETTER OF AUTHORIZATION Located at 141�18*�� // A //01 W_ 115?d ec �11,c/Tax Map # Block 1 Lot Subdivision of - . `'e ��e Subdivision Lot # Filed Map # Date Filed Gentlemen: This letter is to authorize a duly licensed Professional Engineer k "or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in Law, and the Putnam County Sanitary Code. j/ a Mailing t State ;?", Zip Telephone, ?, Y > Very truly yours, Signed: (Owner of Property) V.-, Mailing Address: State Telephone: Zip gC7 Form LA -97 i RmiAm qXJNTY DEPARTMENT CF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN . DATA SHEET�- SUBSUFACE S'&qWE DISPOSAL SYSTEM. FILE NO. Owner ��� /es �;-,/ Ad dress 15d X 4/ �- /'u �fe'Located at (Street��/f�/�Wg41 Sec. ��% Block -3 Lot a- (indicate nearest cross street) Municipality � 740�/Y7 Watershed SOIL PERCOLATION TEST DATA RBQfTI M TO BE SUBMIITIED WITH APPLICATIONS Date of Pre- Soaking .> Date of Percolation Test _j >a HOLE NUMBER CI= TDE PERCOLATION PERCOLATION Run Elapse Depth to Water From Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 19 /a R 2�yO /o /a 3 U ?O z 4 5 v6p2o /o sv ?i y 4 5 1 6 3 4 5 NOTES: 1. Tests to be repeated'at same depth until approximately equal soil' rates are obtained at each percolation test hole. All data to* be submitted for review. 2. Depth measurements to be made from top of hole. rev. 9/85 TEST PIT. DATA RDQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS EN M\TIMM IN TEST HOLES DEPTH HOLE -NO. % HOLE NO. NO. G.L. 1° 2' I d s X/ 0/6r Jhlaw 3' 4' 5' 6' 71 8' 9' 10' 11° 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER: IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY:� �� > DATE: ^G �� DESIGN Soil Rate Used >-r Min /1" Drop: S.D. Usable Area Provided 6"fJ No. of Bedroans Septic Tank Capacity O o gals. 40 r y Absorption Area Provided By Other Name Address L.F. x 24" width trench Soil Rate Approved sq<ft /gal. Checked by Date ` , r PUTNAM COUNTY DEPARTMENT OF HEALTH D.IVISZON OF ENVIRONMENTAL HEA..•SERVICES Re: Property of Located at Date p �y3 .5;//' M11774e'WILI�' Section, /1t9 Block Lot �. Subdivision of Subdv,. Lot # Filed Map # Date Gentlemen: S- This letter is to authorize 6�5 ;t c ' /" /j � a duly licensed professional engineer or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in -. •,cc?nnenition with- thi- s-=ma•tt -er --and to. .supervi.se the..constructi•on of= .said• _ system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. �2, Countersignec P.E., k �,/0' Address :. �•, tea. Very truly yours, Signed Address UU Town 24 b 6 7 b oF / Telephone Telephone -.;' tit Wt I):q•f�i II: Iru^' �t�: lr tq� � . PIPE: PLASTIC a= um�t�lluB�oaa�u;_�a ^ -��a uaa_aln a� FIRICTICIN LOSS PER 103 PT. u u�a anaa: w. aaa�v��aa�arairclv�a:u:r��H!a�t Ft. Lbs. Ff. lbs. P #. Lbs, FL Lbs. Ft. ~ - !!,h, -rQ. LLB; :. 1 60 4.25 1.85 1.38 .60 .356 .155 .11 .048 � +.� - -•'- - _ - - -� _- -� -•� ~��� 2 120 -15.13 6.58 4.83 2.10 1.21 .526 .38 .164 .10 - ...0/}'!1 ' 3 180 31•.97 13.9 9.96 4.33 2.51 1.09 .77 .336 .21 .N!'10 I .11 043 4 240 54.97 23.9 17,07 7.42 4.21 1.93 1.30 .585 36 1 16 071 5 300 84.41 36.7 25:76 11.2 1 6.33 2.75 1.92 .835 .5.1- -•_.22 _ "4 y .104 6 360 36.34 15.8 8.83 3.84 169 1.17 .7•I 8 480 63.71. 27.7 15,18. 6.60 4.58 1.99 1:111 10 600 97.5d- ` 42.4 25,96 11.27 6.8.8 - 2.99 1.70 774 r AS i 36'1 15 900 49.68 21.6 14.63 :6.36 3.78�i •1.c •134 _ 155 20 1,200 86.94 37.8 25.07 10.9' 6.343 •j -._ 94 25 1,500 38.41 16.7 9.71 __:_.`�;•. 1.4• 30- 1,600 13.62 4:;.92 ,1 35 2,100 40 I 2,400 23,616 '11J.7?� =� - ! 1(7. y ,- 4.65 M _29.4 i . 21*811+ 1� ? -4,3 "6"85 w 60 3,600 23.48- 1 Iva 2 �, 2w 2yy Sze 11 -.3 OF r nF 17i¢ ON ® ®PH 1 Iva 2 �, 2w 2yy Sze 11 -.3 OF r nF 17i¢ LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (84578 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 OFFICIAL NOTICE OF PERMIT SUSPENSRON CERTIFIED RETURN RECEIPT REQUESTED September 8, 2004 Percy and Barbara Montes 7 Kingston Avenue Cortlandt, Manor, NY 10567 Re: Suspension of Permit: PB Contracting Peekskill Hollow Road, (T) Putnam Valley T.M. #84.11 -1 -15 Dear Mr. and Mrs. Montes: Please be advised that Permit SW -07 -03 for the above regarded project has been suspended by this Department for the reason noted below: Well was - drilled less than 100 feet from the. proposed SSTS The suspension of the permit will remain in effect until these issues have been satisfactorily addressed. Furthermore, pursuant to Article III, Section 3, paragraph d, of the Putnam County Sanitary Code, whenever inspection indicates construction to be otherwise than in accordance with the permit all work shall cease upon written notice served upon any person connected with or working in said system. Please be advised that appropriate steps must be taken immediately to resolve these issues. Should you have any questions or care to discuss this matter, please contact me at (845) 278 -6130 ext. 2157. Very truly yours, \ l Joseph S. Paravati Jr. Assistant Public Health Engineer JSP:cw Cc: Frank Sullivan, PE Rob Morris Mike Budzinski . �LORE'I`TA MOLINARI Public Health Director .---. -. - •� _. -:... - . - ' ROR�IiT� 'J: '13'OINI)�= _ ..... .�.;. �,: County Executive 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 OFFICIAL REQUEST FOR STOP -WORK ORDER September 8, 2004 Mr. Irving Sevelowitz Putnam Valley Building Inspector Town Hall, 265 Oscawana Lake Rd. Putnam Valley, NY 10579 Re: Stop -Work Order Request: PB Contracting ( Montes) Peekskill Hollow Road, (T) Putnam Valley T.M. #84.11 -1 -15 Dear Mr. Sevelowitz: The Permit SW -07 -03 for the above regarded project has been suspended by this Department for the reason noted below: ....._... Well was drilled less than 100 feet from the proposed SSTS. It is respectfully requested that a Stop -Work Order be issued until this item has been satisfactorily resolved. Thank you in advance for your cooperation in this matter. Should you have any questions or care to discuss this matter, please contact me at (845) 278 -6130 ext. 2157. Very truly yours, �Zoseph S. Paravati Jr. Assistant Public Health Engineer JSP:cw Cc: Frank Sullivan, PE Percy and Barbara Montes � So. tov C_ k/ 148­44 'S. 510 Z5, 50--W 70 45 30-W. ZZ,7 00 7Ccp. LOD Lot AREA Z4. t zom AREA 4-3,552'5,F PLOP. R-3 1.001 AC, —WaLL ;A.REA=43,b25.5.F =1.00 Co AC. ...... .... . —AREA= 43,5795•F N E " I R- DR. tv,q 4-- 0 A ac �( N � 3VZb,F_. 300— 56 DA N (50.00' WeLL - 4b D It A L E 550A f5o. — = 1,000 AC. 0 0 PROF WELL FTC. DR. - -0 KtV E.. �SWA L E--- A- ,,7: 55 DA I ISA.6101 f Lots 1 G it. for any lot, • the High - iting, the location, way. it the applicant's plot g water courses', springs, equired to.protect adja- Should water problems be land during construction►, are necessary to protect stems before the Building cupancy. The owner the roads, curbing or nt of his parcel of land he Certificate of Occupancy. 1 31 G s ?n LOT .. 0 RKtA, _.GErNLKAt:;;p.:t;�.rt:V4E DESCRIPTION SL:OPE AREA ! 1:0+014c. SANDY LOOM W /CLAY- # -22 6- `1:-00 3 1. 0040 AC. ►i Z4 4 1.000 Ac. ,� . 14 5 1.009 arc. !4 G 1.0&1 AC. 14 7 1.110 AC. n 15 6 1.109 AC. " 14 2) 1.1 b5 AC. �� t 10 I. I Cv4 AC. I 1 1.117 AC. t0 t Z 5231 AC 25 13 3.037AC n 10 15 5.021 AC. a 14 tCo 3.012 AC. I► I.8 * R.O.13. GRAVEL FILL REQU IRED T( V I FIEI PUTNAM' COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY . &SUBSURFACE.SEWAGE.TREATMENT, S SEMS REVIE W'SHEET-FORCOI�STItUCTIONPERMIT NAME OF OWNER: STREET LOCATION: REVIEWED.BY: RM, GR, SRDATE:as �3 TAX MAP#: (CONFIRMED) YIN DOCUMENTS PERMIT APPLICATION �6L_)YVELL PERMIT OR PWS LETTER OF AUTHORIZATION DATA SHEET (DDS) LATE RESOLUTION THREE SETS PLANS - TW( (LEGAL SUBDIVISION /L�L__)SUBDIVISION APPROVAL (_}FILL REQUIRED � � D U r'C /U/ CURTAIN IDRAIIV REQYJIIZ.ED � � GENERAL (_,,DATED IN NYC WATERSHED _PLANS SUBMITTED TO DEP �jU ELEGATED TO PCHD CV)(-: APPROVAL, IF REQ'D U(�DEEP TEST HOLES OBSERVED (_J / /UPERCS TO BE WITNESSED C_) 'L APPROVAL SSDS ADJ, LOTS ( lL) TLANDS (TOWN/DEC PERMIT REQ'D ?) U(�DATA ON DDS PLANS & PERMIT SAME L_) �✓._PRE 1969 NEIGHBOR NOTIFICATION L✓ �:ETTER BVZBA _(,)l 00 YR. FLOOD ELEVATION W1I 200' (UUSOM TESTING LOTS>10 YEARS OLD UIRED DETAILS ON PLANS :. , -GE-SYS'PEM`PL_'AN= ORTS'ARROWx): C_JSSDS HYDRAULIC PROFILE UC jffGRAVITY FLOW L—)CCONSTRUCTION NOTES 1 -15 UUDESIGN DATA: PERC & DEEP RESULTS .UC_j2' CONTOURS EXISTING & PROPOSED UCUDRIVEWAY & SLOPES, CUT UUFOOTING /GUTfER/CURTAIN DRAINS U(_,JUSDA SOIL TYPE BOUNDARIES UC__)MI.E BLOCK; OWNERS NAME ADDRESS TM#, PE/RA; NAME, ADDRESS, PHONE# UUDATE OF DRAWING/REVISION UUDATUM REFERENCE . UULOCATION OF WATERCOURSES, PONDS . LAXES,WETLANDS WITHIN 200' OF P.L. C 000PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS (_JUWELLS & SSDS'S WALK 200, OF SSTS (J(UPROPERTY METES & BOUNDS C—) ()EROSION CONTROL FOR HOUSE, WELL & SSTS, EROSION. CONTROL NOTE �" I s I A wh COMMENTS: Y N (REQUIREI) DETAILS ON PLANS CONT'D} C $OUSE SEWER - I/T FT. 44% TYPE PIPE CAST IRON L_)C.�JNO BENDS; MAX BENDS 45' W /CLEANOUT ,// RENEWALS UUSITE NOTE (NO CHANGE,_ FILL SYSTEMS ' RORIZONTAI TAST T tNCNC;H °SL -OFFS 3:1= TO =G � (FILL SPECS / FILL NOTES 1 -5 Fuzz. a, &(Z MI. c fix_ �FII,L PROFILE & DIMENSIONS r S ko w N U(__)FILL IN EXPANSION AREA CCU CLAY BARRIER U(JFILL CER�I"gN NOTE (_)C�L. ON PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS (_J SEPARATION DISTANCE FROM'TOE OF SLOPE T TRENCH J;�� C�U(_)LF TRENCH PROVIDED 3 3 60FT MAX. 3 �! >- PARALLi!�L TO CONTOURS ti r /rnl�� !U m s� 100% EXPANSION PROVIDED�� ail ( DEEUDUST FREE CRUSHED'STONE OR WASHED GRAVEL GEOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM'SSTS (x(__)10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL (__)0' TO FOUNDATION WALLS (___)(_100' TO WELL, 200' IN DLOD,150' TQ PITS C_J(__)100' TO STREAM, WATERCOURSE, LANE (inc. expan), ( -JC )50 :TO CATCH BASINj .35 . STORMDRAIr?CPiPED WA TER--' . -'C_:. j(.f-)10' TO WkI'F.It L' I1+IE (pits - 20') C-- -)U50'- INTERMITTENT DRAINAGE COURSE L_JL _)200' /500' RESERVOm ETC. 150' GALLEY SYSTEMS U(__)10' MIN TO LEDGE OUTCROP / U SEPTIC TANI{ UC10' FROM FOUNDATION; 50' TO WELL WELL 4 _)DIMENSIONS TO PROPERTY LINES �ULOCATION OF SERVICE CONNECTION (�(�MIN 15' T® PROPERTY LINE SLOPE (_JL✓)SLOPE IN SSTS AREA (Z C_)REGRADED TO 15 %, IF REQUIRED f/ DOSE/PUMP SYSTEMS (_ C_)PUMP NOTES C✓) . DOSE 95% OF PIPE VOLUME/DOSE VOLUME NOTED k �� (;DETA.IL FOR FORCE'' MAIN, (PIPE TYPE, ETC.) X00 PTT AND D -BOIL SHOWN & DETAILED /` "p �y,K C J(_J1 DAY STORAGE ABOVE ALARM CURTAIN DRAR?f� C _) _,)STANDPIPES, 5' BO S ESlE�AIY. to C D;S'io� -$0%, 25' -3 ° /m, 35' -1 %,100 % -<1% L_JC__)20' DISCHARGE/100' with 182 cons day discharge O I- PERFORATED PIPE (REVSBEIET)09lO1 /00 - 7, I /,,I n 4s, v)4 r-, I 1---A—la /1i.11 A' ZJOC;L44 AjAJ A✓d ?.'!n1i�.� ���St�hc� !S �, e: rn, q�p_rop�su.�_�:fwea.�_'�!� —���� ova �.v_►c� _�i_iC.�_�u�.l_�1�� _____ 09/16/2004 11:48 X9149624248 JOSEPH SULLIVAN PAGE 01 �U Ty:��;a;1,, - -... _ _- > >t•. �_�} -�,_ ..- n � '4p a`:i"'T�4:rr�� ---. t_. . _. -.... .. -- � _ , .�.P . r• dS !r'1 i . T - ADAM !o:ems,. �i PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF.:ENVIRONMENTAL HEALTH SERVICES_ . - LETTER OF AUTHORIZATION RE: Property of Located at T/V�hjGii 0 //e-. Tax Map # y« Subdivision of Subdivision Lot # 2. Gentlemen: Thie lPttPr ie to a11thnri7e Filed Map # Block J Lot Date Filed a duly licensed Professional Engineer ' kl' or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in foc 'bri -ity with the' provisions of Article 145' and/or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. -�— . Very trul y urs, Countersigned: ` _ Signed: P.E., �., # Z 4l O �� (Owner of Property) Mailing Addres I 1we -?'1> %Mailing Address: 271 x'' 15�''e d Telephone;'��Z � z Z State y Zip Telephone: 5-2-;7' &11 JU CD 1 r Form LA -97 WELL DRILLING 152 Barger Street Putnam Valley, New York 10579 1- 845- 528 - 8698/1- 845 - 528 -1491 Fax. 1- 845 - 528 -1490 March 11, 2003 PUTNAM COUNTY HEALTH DEPT. Re: tax map 84.11 -1 -15 280 PEEKSKILL HOLLOW ROAD, PUTNAM VALLEY, N.Y. DEAR SIR; Norman Anderson ,(Well Driller) REQUESTED BY BUTCH CASSIDY , HOME OWNER LOOKED AT THE LOCATION FOR GETTING HIS EQUIPMENT IN - I-E DOES NOT ANTICIPATE ANY PROBLEM. WE HOPE THIS WILL BE OF HELP. Sincerely Yours, norman Anderson LORETTA 1v10LINART R�T.,-I'I:S:Id: Acting Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BON151' County Executive Environmental Health (845) 278 -6130 Fax (845) 278 -7921 March 6, 2003 Nursing Services (845) 278 -6558 WIC(845)278-6678 Fax(845)278-6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 Frank Sullivan 2972 Ferncrest Drive Yorktown Heights, New York 10598 Dear Mr. Lynch: J . Re: Waiver Determination - Cassidy Peekskill Hollow Road, (T) Putnam Valley TM# 84.11 -1 -15 The Putnam County Health Department reviewed the waiver request for the above regarded project on March 5, 2003. The following determination has been made: ❑ The Waiver request was approved. ® The Waiver request was conditionally approved. However, the revision(s) noted below must be completed prior to the issuance of a permit. ❑ The Waiver request was denied. An explanation has been noted below. ..... `'.. - :. - --The Waiver request-was= iioi'voted.or.`.: `Explaiiat on:rioted:below 1. A letter must be provided from the well driller stating whether well site is accessible. 2. Topography for the entire lot needs to be provided. 3. The fill section detail should show slope at 2 horizontal to 1 vertical. If there are any questions regarding this matter, please contact me at (845) 278 -6130, ext. 2157 Very truly yours, ;Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:cj PUTNAM COUNTY ®EPART�iIENi' OF HEALTH aa MEMORANDUM r Date: May 14, 1985 rr To: John, Karel!, Jr., P.E. b� From: James S. Hodgens Subject: Separation Distances Between Cemetery and Well As a result of dialogue with. Joe Yavondette of New York State Department of Health who is ed-itor of the New York State Waste Treatment Handbook, it was a2 -eed that separation between private wells and cemeteries shou_d -ollow the same guidelines for sewage disposal -.to -well separ=on; namely, 100 feet and 200 feet i *" downhill in line of drainage. I recommend this be instituted as Putnam County Health Department policy and circulated to Environmental Health staff Dersonnel for their use. a 4�� 1�(t r 4V uaruziu4 lnu 1c;V0 CAA P.F. BEAL & SONS, INC. 4 PUTNAM AveNus ARTESIAN WELLS BREWSTER, NEW YORK 10509 WATER SYSTEMS ..... ... .• � :: c.. .6:M1'rp - � .: :�.�: .. . "�..' Pfd +'A�4j!.; uc.�' %�.. ( t�.�7i7G7!'L'/[�': • SUBMERSIBLE PUMP9 TEL. (845) 279 -2460 - 2461 FAX (848) 279 -6613 COMPLETE INSTALLATION, REPLACEMENT ANp REPAIR SERIViCE September 2, 2004 P8 General Contracting, Inc. Attn: Barbara Montes P.O. Box 782 Mohegan Lake, NY 10579 Dear Ms. Mortes; WATER TANKS COMMERCIAL. WATER SYjTFMS, , WATER CONDITIONING EQUIPMENT It is my understanding that the well which we drilled for you in December 2003 for the new house on Peekskill Hollow Road, Putnam Valley, NY, is in violation due to the proximity of tte septic system. When this well was drilled it was impossible to position the drill rig any further from the septic system than where it was drilled. The reason for this is because of the very steep terrain. One piece of information which may help is that bedrock was not encountered until 30' and in fact 62' of 6" casing was installed. Due to the location of this well, taking into cons " dera -lion tte elevation of same, it is my opinion that the septic system will have no influent= on the well wha- soever. One considera-ion *night be -o install an ultraviolet light on the discharge side of the cold crater pressure tank to ensure that all water leaving the tank for domestic use will be sanitized and any bacteria in the water would be eliminated. This ultraviolet light would be equipped with an alarm which,wo>il.d..sound Af the.. :'.Y �..... ctl,t.rav%1o1et-- bU•.1 -r ' - aiis­. • ._A ^ . _ .... _. If we can be of any assistance in this matter, please do not hesitate to call me. PLB /mm Very truly yours, Inc. gg VIM- RA PUTNW COUNTY DEPARTMENT OF HEALTH DIVISION OV NVIRONMENTAUHEALTH SERVICES CONST1kfjC°Tid 1 MITT P6R' 'S� V� T1�EA TMENT SYSTEM~ A'� PERMIT # r....%/— 97 y✓ ' 4 �'- ;;;. : Located at ��G/� �/�i f� /14/10 W 11,Fd 4.141 Town or Village,, 11 Subdivision name I- we. . ,per Subd. Lot # Tax Map Block / Lot Date'Subdivision Approved / % : Renewal Revision ^WOL 'nor ,t3 l' a� �' OwnerfApplicant Name 'P . n �QG' � y Date. of Previous Approval Mailing Address Ji��', -�G� /OW G%re: � ` /a0JI./ �a� Zipl �6i Amount -of Fee Enclosed Building Type )rG1, Lot Area �No. of Bedrooms ..3 esign Flow.GPD o.v Fill Section Only � o Depth _ -Volume 4..�' PCHD NOTIFICATION IS REQUIRED WHEN FILL IS CO FETED Separate Sewerage System to consist. of Other Requirements:, P14 To be. constructed by /ee d ,gallon, septic tank and -3 Address �= Water Supply: Public Supply From Address rivate.Sopply Dfillgd -by -P/— r� �' �: --�� . _ Add:ese- c�. !' —'�►� �5��-'- I represent Ahat I am wholly and completely responsible for the design and location of the proposed system(s) and that the - scpabat6 sewaggimatments39=4escribed above will be constructed as shown on the approved amendment thereto and,in accordance with the standards, rind regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will'be submitted to the Department, and a written guarantee will be furnished. the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period 'of two (2) years immediately following the date 4,Aie issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: G� j �� i �.,7 P.E. P" R.A. Date 3 /a Address ^ rr i v 4f. License # APPROVE OR CONSTRUCTI - This+ approval. expires two years from the date issued unless construction of the sewage treatment system has been completed add 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. Approved for discharge of omestic sanitary sewage only. By: Title: ' v► Date:. /� copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 Friction _. >. e.a;ti+.+:a 5,�- ,\ +- `�*'.✓sy�•" ;; /;,- v:'.y':,.;_il({.v",- /E - "�"/��. ��% ,':� /_ `��r.G�..+ .. _ s,<�. ♦ ,r ... • PLASTIC PIPE: GPM OPH .3/8 n 1/2 ° 3/4 n lilt 11/4 1/2" R. Lbs. Ft. Lbs. Ft. Lbs. Ft. Lbs. R. Lbs. R. Lbs. 1 60 4.25 1.85 1.38 .60 .356 .155 .11 .048 2 120 15.13 1 6.58 4.83 2.10 1.21 .526 .38 .164 .10 .044 3 180 31.97 13.9 9.96 1 4.33 2,51 1.09 .77 .336 .21 .090 .10 .043 4 240 54.97 23.9 17.07 1 7.42 4.21 1:83 1.30 .565 .35 .150 .16 .071 5 300 84.41 36.7 25.76 11.2 6.33 2.75 1.92 .835 .51 .223 .24 .104 6 360 36.34 15.8 8.83 3.84 '2.69 1.17 .71 .309 .33 .145 8 480 63.71 27.7 15.18 6.60 4.58 1.99 1.19 .518 .55 .241 10 600 97.52 1 42.4 25.98 11.27 6.88 2.99 1 1.78 .774 .83 .361 15, 900 49.68 21.6 14.63 6.36 3.75 1.63 1.74 .755 20 1,200 86.94 37.8 25.07 10.9 6.39 2.78 2.94 1.28 ..25 1,500 38.41 16.7 9.71 4.22 4.44 1.93' 30 1,800 ,.. ' " 13.62 5.92 6.26 2.72' 35 2,100 18.17 7.90 8.37 $.64 40 ._. �..2 400: - ..._�........_.....:. .. ..... :.- - :23.55...._1A.2 -.. .. ,.7.0.. :.05:..- 45 2, 700 29.44 12.80 13.46 5.85 50 3,000 16.45. 7.15 60 3,600 23.48 10.21 1 1. 3 Is, �.q� /-7 29" .��'�Ilk Via- �� o✓ �qva Id-7 J71 3o /J' 00 ' ;PART $ �z: - - ,i1;; 1111) NP:rinrl "• Illi( 1I'tl'.I o Il ir cable.. I� t g 1 0 ring l Goulds Eff I- ent Pump E. IW19O C0445,4 ,7 .MODELS PERFORMANCE 07111440S (gailo per minute) •_ Urd9r Hu, _�IP ? •voila ' T•phH�� 5,3x• A!i_I�I,,T�t,1� 3:t �!j�; te:�;trerwt. 'ibs. 0 i'Jt`031;_i.. � lie_ i•_ 11 T •' I ! - inlr0•'�11M • ; tr� 115 '��'°' '175J 56 4_ .�1 230 _ .. j� :' liatr• 1 200 ..�.._.__. 1'.....::�..:.... - - -� �11�i1`t dN 2r)0 3,4 K32 _ K32 ' NIA 1•gt,5rt ilti � I - r u� ", I j 3 -- �- :70 _:1 I 1 JJE9 RM 2 0 J.0 I tir'A oo JrkQT. e41 1i _ 2'1ti1 _ .it.G. 107 ;I�h 23r .. 70 WA _. I ••r ,: IIr.I,il a, J _ tv, ,Tt , ;41I'..a ._- . ,_ _ ti�'f� • • - I _ K'i3. - IM 1 r1'!.11`,1! -� lJ.1._�_.— .1_ —'�li it_....� ... .I ••.._.A.�........i. I _ ...��1' . .....w '!1t S75`:'COn:,ltOdor, f Ni.'L1EL: 31)x15 i } 1 , 'i I n,:t w''�y�t.'. ! ... .... i . 11 \' . L.. �. I _� 1' .. •I Y r .. I GI 1 I i is li; ;:J :'i .uf Ily .. lei .1111 ' ;u ....l� OpM I'AI•AV1YY f��i�:�!�.��.DS PUMPS. INC. f VVATP.n'TECMNOI.0"!r- +1:1C1r111P I I i I� I cu r r'� _ _ ^ W rwosliH w WE1012H W WE151214 W weuril n 1VE1912HM rder r WE053FH IWE0738H W WE1098H W WE1539H W WE0de0HH W WE 1" HH DIMENSIONS (All dimensions arP In Inches. Do not use for construction purposes.) D' ':, 'h,'.! and 1 HP =1 v vxrept icr mrttel WE0712H aort'Nr.M2H r 1B'; All, RP :• 16' I,. l I. rotaTION r I i Ly ~• ' ',� 1+�1 41r 1 •� (hr .Ir KICKBACK 1__ N P T EFFLUENT EJECTOR SYSTFNI _ Ellluenl ejector system -° �c•� Package Includes: offers ease of ordering I SubmarSiMe EtIluenl Pump 3t ,} i9 j. and installation. A single � �b 12L orWE0311M, I ?M. WEC.119t i2HH g '�•• "�'' mochan Cal level Gonv11 Swilch ordering nunlDtlr specillos 1 - _ .l k A2-5 (11511). AN (2300 a rtitnp!nt0 s,st9!ti d Sl;netl i``I pa9in A718015.0PEtr, 0werA9•t822 (nr rnos; rns►cAnilal,arc! Check Valve FB•2n rrrntmercial sump and 1 Order Nn•r •SWE0311t-, SVIE0312L t ..-�' SWE031141, SWE0312M, e:fUlent purr,: apjllihatlpnS ._..� SWE0511HH, SWF051214N: ­%I.: 1.".A .••13 1"1" $11ECIFICATI0143 ARE SUBJECT TO CHANGE WITHOUT NOTICE.. r,niNTrD IN U.S.A. ­%I.: 1.".A .••13 1"1" $11ECIFICATI0143 ARE SUBJECT TO CHANGE WITHOUT NOTICE.. r,niNTrD IN U.S.A. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CdMTRUCTION PEY.Mff- FOR 'SEWkG- 'W)r_[`ME'NT SYSTEM",• ": . PERMIT# `V =% I ` 1�7 a Located at �/ %/�i %� no Town or Village Subdivision name r4 Subd. Lot.# I_ Tax Map ey /i Block Lot Date Subdivision Approved / �' $"�" Renewal Revision Owner /Applicant Name C14 Date of Previous Approval Mailing Address 21 %rY v cr SC /�� q d G /�� �`�' }�i Zip lri_ s Amount of Fee Enclosed 3.00 Building Type A,4; Lot Area/d -e­ No. of Bedrooms 3 Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of Other Requirements: To be constructed by OWW Water Sunoly: Public Supply From /6a a gallon septic tank and 3 3 d� Address a G J Address Address: ��'. ✓ /1� �': 1 I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the sgparate sewage treatment system described above will be constructed as shown on the approved amendment thereto. and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be su�qitted to the' Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the buiRer, that:;said builder will place in good operating condition any part of said sewage treatment system during the period of lwo (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance othe`a�iginal system or any repairs thereto. r. Signed: % P.E. k/ R.A. Date 1 ' Address /e n C rt % i ' .-c V A01. License # 2 N 40°`•"'' T7 APPROVED FOR CONSTRUCTION: This approval expires two years fr om the date issued unless construction-of the sewage treatment system 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 perrqik. Approved for ch a af domestic sanitary sewage only. r By: Title / Date: -7 {,� White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form,;CP -97 ', PUTNAM COUNTY DEPARTMENT OF HEALTH :�J1111v Ok7 ).11�1�11V11�1� li�A�..EALTli:RVI.��L► LETTER OF AUTHORIZATION RE: Property of Chu,Ifs �,S,si CG Located at 4 // /��` °�✓ /���` T/Vf a Tax Map # Block / Lot Subdivision of Subdivision Lot # Filed Map # Date Filed Gentlemen: This letter is to authorize a duly licensed Professional Engineer d/ or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in XAfticle..1: 5;:�n.�ox_147. of the_•Education•�Law the Public Health , Law, and the Putnam County Sanitary Code. Countersigned: P.E., R�k., # 2 L19} Telephone,� '> G/ z z/ o Very trul yours, Signed: (Owner of Property) �,Mailing Address: 2 7 '"° r�'^3� 6 State 27 y Zip Telephone: e� 2_ Y' C-) oriri ;IA -97 C4 'ice -.w' ��\ll�ii•1 l�Y• tMl' lJ: L11VY' SLt l" 1�?l�'�''SVi70:PV °Td.;�4p"dIM-= e:+ =a. =+.T: Acting Public Health Director Director of Patient Services _' - \.. .- ... � .....��...- � � «�� ✓1/l`+ �t JJVl �Yl p 1��5 X11.... • �!^'�.w.a�'I County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 -6130 Fax(845)278-7921 March 6, 2003 Nursing Services (845),278 -6558 WIC(845)278-6678 Fax(845)278-6085 Early Intervention/Preschool (845) 278 =6014 Fax (845) 278 -6648 Frank Sullivan 2972 Ferncrest Drive Yorktown.Heights,,,New York 10.598-.- . Re: Dear Mr. Lynch: Wai�er;Determination -.Cassidy Peekskill Hollow Road, (T) Putnam Valley TM #. 84.11 -1 -15 The Putnam County Health Department reviewed the waiver request for the above regarded project on March 5, 2003. The following determination has been made: ❑ r.. The Waiver request was approved. ® The Waiver request was conditionally approved..Hoviwever,,tbe= revisions) noted below mi4st be completed prior to the issuance of a permit. , 0 The Waiver request was denied. An explanation has been noted below. .Cl... The:Waiver request:was not -.voted on. 'Explanation.noted.below: -- 1. A letter must be provided from the well driller stating whether well site is accessible. 2. Topography for the entire .lot needs to be provided. 3. The fill' sectlori 'detail sliould'show slope.at 2 horizontal to..1 vertical. If there are any questions regarding this matter, please contact me at (845) 278 -6130, ext. 2157. Very truly yours, Joseph S. Paravati, Jr. Assistant Public Healtfingirieer JSP:cj LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ....�ROBERT`J. BON'Eil �.. . County Executive 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 September 20, 2004 Frank Sullivan, P.E. 2972 Femerest Drive Yorktown Heights, NY 10598 Re: Field Inspection — PB Contracting Peekskill Hollow Rd., (T) Putnam Valley TM# 84.11 -1 -15 Dear Mr. Sullivan: A site inspection was made for the above referenced project on September 17, 2004. The following comments must be corrected in the field. all The cast iron pipe needs to be inspected when installed. The tanks nerd to .be_insec'ted urJieii:.i1St led. - - ;- .' :: 3 A portion of the force main trench needs to be exposed. S Vk `'� i he distribution box needs to be completed (force main cemented in, pipes trimmed back, etc.) The old well still needs to be abandoned and the new well needs to be drilled and U,U1� both abandoned well and new well needs to be inspected. �. A bedroom count needs to be performed. �1. A pump test needs to be witnessed by this department. , "- If you uestions, please contact me at (845) 278 -6130, ext. 2157. Sincerely, oseph S. Paravati, Jr. Assistant Public Health Engineering JSP:km e -d 3U 1N3W1dUd30 AiNnop WUNind:3WHH 1261- 8Z8- St,6:_131 10:t7T nHl t,002-t7T -100 s•rl +Y/r•rw� ar.Yr• OvL•JV'J•JIYV 'Lf'V f4 'MVG VJ BY THIS CERTIFICATIF' Olt COMPL.IANrE' THE NEW YORK BOARD CadlRE,- �JzC1�:1"F,� . . :• :, t r r xt r+•'°r•. ,_- r =,._ . - ° - ' ' ±BUREAU OF ELECTRICITY. 40 FULTON STREET - NEW YORK, NY 100 8 CERTIFIES THAT Upon the application o` upon premises owned by DIGREGORIO, RICHARD PSGENIERAL CONTRACTING IS VIC PASS P.0• BOX 762 CARMEL, NY 10612, MOHEGAN LAKE, NY 10547 Located at 280 PEEKSKILL HOLLOW.ROAD PUT NAM VALLEY„ NY 10579: Application Number: 118$441 Certftafoe Number, 1188441 Section. 64.11 Block: i Lot: is Buildirg Permit: 20034154 9150: W106 Described as a Residicn6al occupAncy, whereirt`ihe premises electrical system consisting of electrical devices and wiring, described below, located :n /on the premises at: fit, Outside, A visual inspection of the premises electrical system, i!mitec to electrical devices and wiring to the extent detai ed herein, was conducted in accordance with the requirements. of the applicable code and /or standard promulgated by toe State of New York. Department of State Code Enforcement and Administration, or other authority having juristliction, and found to be in campliance.therewith on the tq,h Day of October, 2004, IMAM 4LY F.A�� BiSllL6' S�ir�itit LLC Service Disco=ect: l 260 CB Metter: l seal 2 of This certificate may not be altered In any way and is validated only by the presence of a raised seal at the location in iicated. Z@ 3Jdd ti��F,nBgLhT6 ?b :CT POOZ /hT /0T L ❑ dU _LNdW1dUddU AINI10J W01111-1d;:3,11-41 T26L- 8L.2-SV8 :X31 80:bT nHl b008- bT -1J0 BY THIS CERTIFICATE OF COMPLIANCE THE W FIRE UNDERWRITERS . FUREAU OF ELEGi TRICOTY, d'.Q FULTON STREFFT . - NEW YORK, NY 10038 CER'E"I ift ' THAT Upon the application of upon premises owned by DIGRfEGORIO, RICHARD P6 GENERAL CONTRACTING 93 boo PASS P10, 80Jt 782 CARMEL, NY 10512. MONEGAN LAKE, NY 1ossi Located at 280 PEEKSKILL HOLLOW ROAD PUTNAM VALLEY, NY 10590 Application Pdtervt8sev: 1188441 Certificat® F UMbGr: 1188441 Section! $4,11 Block; 1 Lot: t5 Building Porinit: 2003 -454 BQC,, wills IN Described as M&Oidentai occupancy, wherein the premises electrical systern consisting of electrical devices and wiring, described below, located in /on the premises at. Ctip S visual inspection of the premises electrical system, i;r17 tecJ to electrical devices and wiring to the extent detailed herein, was conducted in accordance with the requirements of the . applicable code` and /or standard promulgated by the State of New York. De✓paften' of State Code Enforcement and AdministraVon or other authority having jurisdiction, and found to be in (10Mj)Iiancg therewith -on the 14th day of Ntobcr, 2004 SAM x2 t3ids.:g 5zit 3blia3ea6ia�f� , I A S"c pump hem and Romirgency 1riqOpme 9tat�op 7 Smoke Agppikoces and Accowraw IPunauce i Oil � Air Con tfoaer t 2 30 ,Amps I 200 40 wllrbig and amcob outlet 0- RoaopU" 12 AFC( Switch 40 Fuep038 Rovoptewte 2 GFQl FiRtm 59 incAafdescent 8s sea/ I P@►m 3W Service Ralwg 200 ,,4mylte>� Coatinued oo Next Page i cof 2 This certificate may nor be altered in any %* and i3 4fidat&9 fAij by the pri>geice of a rarsea seal at the location indicated 60 3JCd 9NIdV__- )8CJNV_1 'SON i O . 06bEs8LhTh 1.:b > b00Z /bT /0T d dU 1NJW1dUd_-iU AiNnm ,LO:t7T 11H.L t7002-t;,T-100 Phono. 914-736-SWO ContacUng hic. FAX: 91+7P*490 email: PrImoPercy(&,tol.com Far!�#nde To: Joe Paraati @Fax: 1-845-278-7921 From: Barbara Montes Dale: 10/14/03 Re: 280 Peekskill Hollow Road Pages: 2 plus cover Joe, the following 2 pages are.our certificate from -the Board of Fire underwriters indicating their final inspection on 7- - we -as the Se -otic,15Ump- As you know, we are anxious to get you to do your final so we can wrap this up. Will you be able to make it over this week? Please advise. Percy can be reached at 914. 906-7262 or me at 914-736-5608. Thank you . Sincerely, Barbara Montes PB General Contracting, Inc TO 39Vd 9NIdV0SC1l-]­1 806088016 LV:6T tOOZ/PT/OT PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH[ SERVICES WELL COMPLETION REPORT 7Y a 'o 'Street - ddm%s; ... - :vI-- - : :-•.t -; �y: � Peekskill Hollow Rd /Well #2 TowniSVillag ': =.� Putnam Valley Tax aria #A Map f' /I Block / Lot(s) is Well Owner: Name: Address: PB General Contracting, Inc., P.O. Box 782, Mohegan Lake,NY 10579 Use of Well: I- primary 2- secondary X Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment X Rotary Cable percussion X Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length 77 ft. Length below grade 76 ft. Diameter 6 in. Weight per foot 19 lb /ft. Materials: X Steel Plastic Other Joints: Welded X Threaded Other Seal: X Cement grout — Bentonite Other Drive shoe: X Yes No Liner Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed X Pumped X Compressed Air Hours 6 Yield 15 gpm Depth Data Measure from land surface - static (specify ft) 30' During yield test(ft) 180' Depth of completed well in feet 245' Well Log If more detailed information descriptions or siege analyses,.. ; , are available, please attach. Depth From Surface Water Dearing Well Diameter(in) Formation Description fft. ft. Land Surface 30 Drilling in overburden clay and boulders Hit rock. at 30' ;_. 30.; . ; ,. :,,: 7.7: - Drilling .:in rotrk; _ set casin __ , r- 77 ` 245 Drilling in rock granite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type sub Capacity 1 HP Depth 200' Model 7GS10412 Voltage 230 HP 1 Tank Type _1dX251 VOIUMIP llons Date Well Completed 9/27/04 Putnam County Certification No. 006 Date of Report 10/6/04 Well r (s' e) . Beal NUTE: Exact location of well with distances to at left two permanent landmarks to be provi d on a separate sheeVplan. .� A /! Well Driller's Name P. F. Pal, onsj( Inc. Address: 4 Putnam Ave., Brewster, NY 10509 Signature: Date: 10/6/04 T_ __ _ _ _ _ White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 L t Ap i6 X -7 5ar I., �efl K p pe Co -V 7.4,."04 ';P`i'll A/01-17 /9, c. j 20 PV 707 2em'5i-o - Ahw- U"e S W - -7 Putnam County Department of Health -ec 7f'11, t -locA Division of E.-nvirc.-mDntal Health -3r7;-1ces APPROVELM TO PLACE FILL ONLY In accordance with aDplicablla Rules and ReGulations of the Putnam County Health Department. T. 5 C/!;, gna re & M. T Date SHERLITA AMLER, MD, MS, FAAP _ Commissioner _of H_ ealth _ �i�::. e...e. •- gf•`•.,',>;,�.i•..t�.w�•e:. -� Vii.: y�.. %•�� .a w.._vr vW�+�r+'..,. .. LORETTA MOLINARI, RN, MSN Associate Commissioner of Health May 24, 2006 Percy Montes Primo's Landscaping Inc. P.O. Box 782 Mohegan Lake, NY 10547 Dear Mr. Montes: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI -I ,_ _ ... �aut�tExecutiv —ea. _ _ •jJ ROBERT MORRIS, PE Director of Environmental Health Re: SSTS Failure and Proposed Repair 280 Peekskill Hollow Road (T) Putnam Valley This Department is very concerned with the amount of time it is taking to repair the failing septic, system at the above referenced parcel. The repair permit was issued on March 30, 2006 (8 -45- 06) and to date, work has not commenced. As stated in a previous correspondence, an SSTS failure is an imminent threat to public health. This is a serious matter that should be given immediate attention. Based on our phone conversation on May 22, 2006, this Department is expecting the repair to r :.:. omr e�rj diu`i ig:flie Ake ek.:�f Xidy �'2�; 9 ah> iur later tl May 29th, 2006. Please contact this Department when work is to begin so that an inspection can be made during construction. This Department is also to be notified when the system is completed so a final inspection can be conducted before backfilling. Please contact this Department no later than June 2, 2006 and provide the project status. If the Department is not notified by the above date, legal action will be initiated. Sincerely, Joseph S. Paravati, Jr. Assistant Public Health Engineer JSP:kly cc: Sherlita Amler, MD, Commissioner of Health Robert Morris, PE, Director of Environmental Health Michael Budzinski, PE, Director of Engineering Anthony & Carol Sandy 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 16678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648