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HomeMy WebLinkAbout1397DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 33. -2 -9 BOX 13 J r rp 'V rj Ir 01397 / 3 �, w PUTNAM COUNTY DEPARTMENT; OF HEALTH Dews /on of Enwronmentl Healtii..Services,' Caime% N: Y. 10512 ' ` Q V •: is - - " CERTIFICATE O CONSTRUCTION 'COMPLIANCE .FOR :'SEWAGE SYSTEM Located at -*ew p 3 Block- ' OwnerL� \�.0 i Lot'_ Job 1.-1.� CC l • V Address Separate Sewerage System built by p ^ t - . —�--(� Consisting of Gal. Septic Tank and �t-�'v �IA� r ` (`� `� `r L - �a Other requirements Water Supply: Public Supply From Y/ .. Private Supply - Drilled By . tlress Building Type TAI `jam " No., of BedroomsDatve Permit lssuetl —� er ia) �i/j i Has Erosion Control Been Completed? liii t a € fin I certify that the systern(s) as listed serving tha above premises.were constructed essentially as shown on the plans of a omple ad work (copies of which are attached), and in accordance with the standards,..rules.and regulations plans fil an rmd SSued b Pu nam ounty Department of Health. Date I !O V Cer.t�f ad by ' P. E. R A. Address License No. Any ,person occupying, premises served by the above ,system(s) shall promptly take such action as may be necessary to, ure the correction, of any unsanitary conditions resulting• from such usage . Approval. of 'the separate,., sewerage; system shall become null and void as so 'as a public' sanitary sewer becomes available and the approval of the :private, water supply - shall become;•nulf antl void when 'a public water supply becomes available. such. approvals are subject to modification or Change when, 'in the 7uogment of.ifie'Cbrimpissignek of Health, such re cats n, modification or change is necessary. Date t��� BY _ e.� Title WEL T; ETION REPORT 3/71 „e PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK This report is to be completed by well driller and submitted to County Health Department together with laboratory report of -- analysis -of Water Sam.ple.indi-sting weter is of �Zti�f3Ct^r, bacteriz! quality before CErt!ficGt2�if JGnStriii i,i4i� Gcillj)iid!iCE i5 IS5UeO. -_ REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NAME Danny Pelliccio Advanced Heating & Air Con ADDRESS Route 52 Carmel,NY LOCATION OF WELL (No. 8 Street) (Town) (Lot Number) Towners Rd Patterson TM••'- PROPOSED USE OF WELL ® DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL 11 SUPPLY El INDUSTRIAL ❑ CONDITIONING ❑ OPHER) DRILLING EQUIPMENT COMPRESSED CABLE El ROTARY ❑ AIR PERCUSSION ❑ PERCUSSION ❑ (Specify) CASING DETAILS LENGTH (feet) 0 t DIAMETER (inches) 61t WEIGHT PER FOOT 19 lb s . ® THREADED ❑ WELDED IVE S O M YES ❑ NO Z YES NO YIELD TEST HOURS G.P.M. ❑ BAILED ❑X PUMPED ❑ COMPRESSED AIR 6 8 1 YIELD (G.P.M.) 8 1 DEL MEASURE FROM 2 ;ND SURFACE —STATIC (Specilyfeet) DURING YIELD TEST jteet) Depth of Completed Well in feet below land surface: 1801 SCREEN MAKE LENGTH OPEN TO AQUIFER (feet) DETAILS A SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of well including gravel pack (inches): GRAVEL SIZE (inches) FROM (feet) TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET 0 5 Drilling in overburden clay and boulders Hit rock at 5 feet 5 30 . Drilling in rock,set a '10 180 Drilling in rock gyanifA If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED 1/2/85 DATE OF REPORT 8/14/85 WELL DRILLER (Signature) i r. P . F'. Beal & Sons , 'Inc . 11.1 MA 4- Owner or urc; aser. of Building. Section 44 f Vk`'YI Cp/J�s •'�uld�iig"C"dri�ruczed "qy -_ - - -- - - - �, .'� rock.. - ti.. ..,.._ - - ' -�"'�! �f � , ;_ Location - Street r, Lot" n . LEA f'Q- 17131 Municipality Subdivision .Name .Building Type Subdv. Lot # GUARANTEE OF SEPARATE SEWAGE 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 .success- J,.,.;,~:' ors, 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 initial use of the sewage disposal system, or.any repairs made by me to such system, except where the failure , to operate properly is .caused by the willful or negligent a.ct.of.the occu pant of the building utilizing the system. The undersigned further agrees to accept as conclusive the.determin- ati.o.n of..the Director of the Division of Environmental Health Services- -Ui -410 "-Putnam- Cour ty' -Department of Health as to whether or not'tYie fail -. ,.ure ".of*the system to operate was caused by the willful or negligent act »- ot'the occupant of the building utilizing the system ...Dated this _day "ofd`- 11 19 ®S Signature TitleG Cor oration Name if Corp. _� 2 .Address THREE (3) 'COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS-BEFORE. CERTIFICATE OF COMPLETION WILL BE ISSUEDY. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM...- - - - - - - - - - - - - - - - - - - - - - - - . - . - - - - - - - - - - Division of Environmental Health Services, Putnam County Department:oF,i�a.th,j� Yorktown ��=�^��U Laboratory, �y Inc. �«��8��x��v.. �v��x�u~~°a ���uxv�u«xuv�u�» u... %}CcucStn:cx ^' ^ Yorktown Heights, N.Y.XOS90 ' .j(914)245-32O3 -� -- - � LOCATIONS: 11a21wmARmLYORmTOWN HEIGHTS. mY. 10598 245-320 � 0zn1 BUTTONWOOD AVs,pssKSm,LL'w.v.1ossa 737-8777 C]4es MAIN oT. MT. m/Scm^w.Y'1mswe666-aaas TpmsLEvmnAns (ms I 'AL) Y. 10512 278-e330 DATE TAKEN:. OATe DATE REPORTED: SAMPLE SOURCE: Lab f_Z".7 - REFERRED BY: L ~~' - ^ _j Collector ' ' LABORATORY REPORT mn/L OAo/o/ry ........................................................... OALuM/wom ------.-,---------^---' OALoAumnv; 9=-----. A= ....................... O ANTIMONY -............................................................... ACT sn/A,roTA4mL ................ L.1 ....................... OAnosm/u ,_._---_---______------. 4]000.s DAY ........................................................... OoAn/ow .............. :....................................................... C3BROMIDE ........................................................... OocnvLumw ............................................................... OCARBON DIOXIDE, FREE ....................................... []BISMUTH ---.'—_.---------------.-. Oo*uon/oc ........................... ........... Ouonow '-'___---.--------------' OoHuon/wc ........................................................... OcAmm/mw --'_-----_-------------- Ocoo .-.----.---_.--'_------.-.--..-' OcALc/mw -.__------------------. Ocouon (units) ................................................ Om*pumimw(tm.) -.---.---._----------. [IoYAm/os ---.----..-----_------..^-' Oo*noM/umv�"mow"�._----.----------- O DETERGENT, ANIONIC ............................................ OcooAcr .............................................. ' OpLuon/os ........................................................... Ocnppsn ._____.____.____________ O*Anowssn ............................... ............................ OooLo -'...'--_-'----------------- Om Pwoou FORM COUNT/ 1oonm __-,- Omnw n�NFTcouponM«o | �»««« --'--Y��'----- O�a^o -''-'----'--'—'------------ O CONFIRMATORY TEST ._....,._....�........_..............___ OuTmmw _'___._`.._.___________..__.. ONITROGEN, AMMONIA ........................................... OmAGwsxmm ............................................................... O NITROGEN, KysLoAHL ........................................... OwmwGAwcxE ............................................................... O NITROGEN, NITRATE ........................................... Omsnounv -.-'_--.---.�---.----�'-----`. - .O-wTBOssm.O���n/c- .^--~.".`.. ........ ^_.^.,.--[]w -` - ' �---~.....'..--�����������-�-��� O 000n (units ^\ .-----.--_-----'-__- OpALLAo/mw '--'--_.--'-.------------.. On/Lm GREASE --.-------'-.--'�-.-'---'- OpoTAnu/mm ......................................... On* (uoita) -------..---------.-----'- On*oo/mw .................................. `----------.. OPHENOL ................................................................. OasLcw/mm -.'-----'--_'--'-_-_--.------- O ^ pHoapHArs(v,mn} -.-_...----- .......................... 13 SILICON ..-_'..------.'--_'.-----.-----... OPHOSPHATE konmenseu>........................................... []SILVER -----'..-------------.-_.--.----_-- O . OooLIDS, SETTLEABLE, ml/L ................................... []TIN '.-.--_---'--'---~-._-..--''----- -.�--' - --_ `� '. OSOLIDS. SUSPENDED ............................................ O ZINC ...................................... .................................... ' uoouooo|ss0Lvso ............................................ 11 .................................................................................... 13 SOLIDS, TOTAL ...................................................... [] --.--'^---'_--'--'~..' .~~.'.^^--_-^--.------.-.- Oaouoo VOLATILE ...................... ....... ................. OnsmAo � [] SPECIFIC Cowo (nbmom/cm) ............... O 11 SULFATE -`~-~^^-'^^^^-`'-.-^-.,..,..'.-^.......,.,.'.,.~. []-.-...' 11 SULFIDE .-''..^^.r~^.-,.^-,^^..-^^,-^^'^~.,~....,.,,..~ []..-....-.'- UnuLp|Tt ..... ^.-'.^-.'..'~~_.,.~-_~^._~~.~^_'�~ [] L/ uSunFACT*wTm -.... -............................................ O..-~-.....~^..^.~---~^'~'-----~'^^^~`-^``^^'^-~^'^-~^~``^^' OTwna|o/Tv <NTDl_,,._.-.,~~.~.~~~'..~~..~~~- C].-._'.,---~~.~~--.~.-.~--''_~-'.^^^^-,^'^^_~'^`'^'^^``^^^^ 'THEGE RESULTS INDICATE THAT THE WATER WAS OF ' SATISFACTORY SANITARY ' QUALITY WHEN THE SAMPLE WAS COLLECTED. 77-' THESE RESULTS INDICATE THAT THE WATER DID MEET THE SATISFACTORY CHEM- ICAL QUALITY OF THE NEW YORK STATE ADMINISTRATIVE RULES & REGULATIONS. DRINKING WATER STANDARDS (PART 72) FOR '8E PARAMETERS TESTED WHEN RUA� N/A = not applicable f��1 PUTNAM COUNTY; DEPARTMENT OF HEALTH t el 12 C/ Owisron of EnwronmenMVH6hh Services i^,erm N: -.Y 105 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM t4 i Town o► Jlage al.ocated' at�Cay,1�► - • icJt " Tax s;SUDdivitlOn Subd Lot Renewal �_ Revision Q . ;Owner /Address �L5kA " �� ��' � J �.0 -r Date :Of Previous Approval - �8uiltling Sype1 Lot Area Fill section only ❑ Number of Bedrooms 4' -- Design Flow G /P /D ;'4 P C N. D Nottfica ion; Requiredr (+ Separate Sewerage System to consist of ©d'• :Gal Septic Tank and =f�r�� rTo' be constructed 'by �t ° Atldress Vllater Supply - Public Supply From -. >5+pnvate Supply -to be dulled Address aOther Requirements "m wholl and tom letel responsible for the tlesign ,and location of the proposed system(s); `1) that -the separafe. sewage disposal system l represent that 1 a y pl . Y .!above described will be* obstructed as`shown on the approved. a mend ment there,Ag and-in accordance with the standaids, rules an" .,regq,a ons O e': r .0 nsm letion,thereof a Certificate, of ,Construction; Compliance satisfactory •to the Gomnmissioner of Heatth:will ,.County. Department of i HeaRh,iand that;on comp_ ! be submitted to ;the' Department, and a :writtan_guarantea .will De';furn�shed, the owner his sueceudrs," heirs or.assigns.by the bu,lder,'that said'•builder will _ ;• place in :good operating condiUon- any 'part of aid sewage disposal system: during 'the periOd of two (2) ye5is immediately tollovving' the date _of the;issu- ance of the approval of the Cgrilf"te: of Construction Compliance of ,the origirial.system ` or any' +repairs thereto; 2) that the drilled well Described above vvill'be focated as shown on the app[oveC plan and iliat said well will be` installed in : accordance" with `the stand s, :rules and regu a ons of the , Putnam County Department of Health -_ giA Date„ :- :A r License NO P 5 ynad .�c - y. 7APPROV.M FOR- CONSTRUCTION This.approval,",expires one yea► -from the ate issued - unless con tructeo ,of the "Dwlding has been' undertaken and ,is revocable for cause or'.msy.be <amentled or mod�f�ed: when, nsidereC:necessary.;Dy th mmissio ► of He6 fi Any change or alteration of construction `+requirei a new `permd': .Approvad for disposal of :dourest c mt _y 4 ei. and priva ec supply only F Date_ - •' Rev 9 =131" -... r ,j s ` PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES C�UN'�Y �FF10E'3NYLDING; CA "tl"EZ..YV: Y. = 105I2= DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. -Owner` P�leid Address Located at Street �', 1 c. Block Lot at ( Street n es cross street) Municipality . Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth t to Water Water Level No. Time From Ground Surface in Inches Soil. Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches . 2 O._ 3__S__ 5' /i -- 4 5 i 30-46- 4-S- Z9 4 y - 4 5_- 4-s- /, z 2, 5 1 2 3 4 5 � 1 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. 1 74 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE N0 G.L. 6" 2411 , 3011 3611 t, `h2" � 48" ° 5411 , 60" ( 6611 Ar m2lpc�?_X� :OD114 W:i!--x 7211 7811 80411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED ajr NF -TESTS* MADE BY _ _ .. _...... _ ..... -- e �� _.._ _. _ ._ -.._ Date— _«. / ..... . Soil Rate Used �Min/l "Drop: S.D. Usable Area No. of Bedrooms _-j �Septic Tank Capacity /QO Gals. Absorption Area Provided By�L.F.x24" _4 b THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by Date • � � lJooIUAN ItJE Ecf90 7 x r p,o 83 °- 22 48" "7 /68.72' .J SulevEY h = PA RC EL 0 2 b , I f q $U*3DIV,$IOaJ 'PLAT of 0 PA RcF L / TR KrR quv PELCICCID DANif L A. PR A/ m ( F %LEO "AP AREA- 44,00l SQ FT. NI , i I OF PiiTT @2£6N PUT NAM fOVi✓TY N. V• J' I scgt� I" 40' ocro96/Z r8, I'M4 I W t @r 5-ro2Y p (� Ft.AMF E t° 1 we t�,wG p, V l,o e � won ,u fLC uv!,�•n. ��„cs- -- ° 3S't S -S,, 5 3�Lo°- +�' -3S "w / �rb(y EhaE 6h.s m� L,ws made S 70 3�'. gg "w a- — _ S�4 °. rF' •20" w oa,3' S�8! l9' • _' _ -- G e.l �r. ar ec(x al s✓• ey e� Gb. propor�Ly 2 We ? $ R QALcuT7• F� Mf 6 Erc.sdal+m.nEz or , helo�+ es%e L RIl cc 6 f ce6en, hereon are vvl4 LAMP SuRVEyoRZ LfcEA.)T& Ng 4/5"54 Jradt, ,Q any, nub sh— harden, v m0 and ev ,m ov ".-f �or fJ+' I' P LAKS CPRrNEL f NEW YORK NTe � ,-vd }e!': P pe I °nFy ;� sz,d may or rep,es oar „e 9, q 2z s• -too8 A Pau o ,MplYSrod ito/ .F �.. s�rvayor 11 WA B SEPT /C TANK -?d.. 0"! -v3,- 0- ------ 3 1-6 7-1 look) vAL. SEPTIC TANK, DF�A//v QC O "UUnaM County Dapartment Ox Jtiwtiru Avi8l- of ftvironmental Health sorvice. approved as noted for oonformanoe with VP 0 - I Icable Rule and Regulations of' the -� Regulations I >1 t-1 ibZole, COL H lt County H .1th ant AS fJUIL7- PE-LLA-10 70 W/V ")"VAAJ IC TOWN X. 85 41 04 N.Y. .4,C--1VSC I- 5HE-WOR0CK," .N Y