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HomeMy WebLinkAbout1426DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -2 -12 BOX 13 , Ir _6 01426 r--�; - —,—Q— {� a PUTNAM COUNTY DEPARTMENT U. HEALTH; 'Permit :# t Ofvisfon of Enwronmental Health; Services Carmel N -�Y 10512 ,,CONSTRUCTION ,PERMIT FDR SEWAGE.DISPOSAL SYSTEM or �Ilage f' ^L4 ate:i`ni���'`r • �— �1 Z�^ IViai� w 7:.a _ .c'Subdlvision '' � ='- � - Renewdl Revision _ r • - Owner /Address 4/J EA -r - • /Vll'St1Ll�l Buittling " Date Of Previous App roiia1 y TYPe,N LOt Area ,j Fill• Section Only ❑ t Number Of BedrOOTS - °Design £low G /P /D• �• '- PrC N D Notification' Required s Separate bewe7age System to consist of Gal Septie Tank, and ): • - x . , iI To be ,constructed bye "?T� —� 1111��_ Addre "ss ; Water Supply Bublic Supply From Prwate'SuPply to be drilletl Address' Other Requnement' 7 represent that I -am wholly and; completely .responsiblefor,thedesign' and- location .of the roposedst�(s); 1) that -the pa a_ sewage Oisposal system 5bove �descnbed will be constructeG as shown,on the s a s o 'a, u nam - _" - pproved:amentlinent thereto and :in accorddnce with_the standards, rules an ,►egu a wn, Count C. _ y sDepactment •bf Health; -and that on completion, thereof a, • ert�ficate` of Construction. Compliarrce'.satisfactory to the:COmrniss ==nor of Healthwill be submitted, to the Department; and a, written= guarantee- wilt 'be 'f urnished,_the owher, his. wccessors, heirs or assigns by the' builder, that said .builder will. ;place in; good operating condition. any;.pact of saitl sewage tlisposal system, during the periotl of two;,(2j years Immedia following tfiedate:of_the ; issu= Tance of the, ipproval•,of the Certificate':ot; Construction Compliance of the_original'system -or any repairs thereto j t t� a *drilled Well described�above j will be located as shown on the approved plan and that said :well will tie installed .an sceord6nee with -the,, std arils .' e . an r ions:':of 'fhe. Putnam '. 'County Department of Health Date (� - Signetl. P E R:A Address °• eense, No. .,'APPROVED FOR CONSTRUCTION This approval; expires `one -jeoi,fi- nn theAate issued u ruction of the budding has been' undertaken and is revocable for cause or may 'be amended orinotlified' when considered necessary: -by the'Co issioner'. Health.'` Any change oc:alteration'of,'construction requiceys; a new .permit. `Approved: f disposal of domestic san' sewag ; antl /or,priv to Ovate " pply-drily �— — t ,Date BY ° Title Rev 9.91 Y = �e �CER1 `L'ocate 'S_eparate', Sewerage ;System ;bwlt b'y`- Consisting Other;.requ,rements - Water Supply Public Supj YPrivate "sup We, Addrfless :- Burldrn9 Type H'as Erosion Controt Been . Completei I ,certify ;that the system(s):as Insted ser attached) an d An accordance with ;thi available;and the "approval iof the pr vate water supply shall pecome,nwl,ana ..vow wnen a; ;puonc w -subject_ao modification o.rchange when "i jtlmi "of th loner of "Health,- "such r vo Date 5uppry �ecvmes aya nap�n .au�n apyr vVara tion - modification or change is - necessary , Tdle WELL COMPLETION REPORT 3/71 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 CountXHealth.,Department ggether_With laboratory "analysis ofwater'sartiplE + inciicating water is of satisfactory�bacteriaiqua Ity before certificate of construction compliance is issued. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NAME Maffei Bros., Inc. ADDRESS 1415 Boston Post Road Larchmont, N.Y. 10538 LOCATION OF WELL (No. & Street) (Town) (Lot Number) Westgate Terrace Patterson Lot 10 PROPOSED USE OF WELL BUSINESS MR DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL 11 SUPP Y El INDUSTRIAL ❑ CONDITIONING ❑ ((Specify) DRILLING EQUIPMENT X COMPRESSED CABLE OTHER El ROTARY AIR PERCUSSION ❑ PERCUSSION ❑ (Specify) CASING DETAILS LENGTH (lest) 21 DIAMETER (inches) 6 WEIGHT PER FOOT 19 THREADED ❑ WELDED JIE SHOE YES ❑ NO CASING YES NO YIELD TEST HOURS G.P.M. ❑ BAILED ❑ PUMPED ® COMPRESSED AIR YIELD (G.P.M.) 6h gpm WATER LEVEL MEASURE FROM LAND SURFACE- STATIC(Speclly feet) 35 DURING YIELD TEST feet) � Total drawdown Depth of Completed Well in feet below Land surface: 305 SCREEN DETAILS MAKE LENGTH OPEN TO AQUIFER (lest) SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of viol[ Including gravel pack (Inches): GRAVEL SIZE (inches) FROM (lest) 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 overburden 5 305 grey gneiss If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED. 5 -17 -85 DATE OF REPORT 6 -26 -85 WELL DRILLER (Signature) ,; ,. [� PUTNAM COUNTY DEPARTMENT OF HEALTH (y U Division of EnvironmenbF Health `• Services, Carmel, N. Y. 10512 b <.....- CER�lr!��T.'F— •^—.�- EO ?e�'Fsi' �. ^.:�= .'i�:a's.OI6SRl64i�'vr - Fa-�'i ' a6' v�i�1GE'�aFa3S/4i�'•s`i('�z3i�m _^-.rte. •. p= ��i: #�-`3d%U= � --..- . -,- ' . ' - .. Town or Village Located a''t// &A67 a —d- l • Tax Map Block V, Owner ' l�l 4mtU1i5 /� [ n Lot ��Q Job Q� /. Separate Sewerage System built by PA-rrr BR-0TQ`, - s Address 14t5- ,N1 ���' ZAe46Wo "l Consisting of /coo Gal Septic Tank and 1 1-IIN Pr & 14 " -r `q Other requirements Water Supply: Public Supply From Private Supply Drilk By Address / f i / /l Building Type Tes I'd -Pfnz''! �4 L Has Erosion Control Been Completed? No, of Bedrooms Date Permit Issued I certify that the system(s)'as listed serving the above premises were constructed essentially asdhown on the plans of the c m leted work (copies of which are attached), and in accordance with the standards, rules and regulations, plans filed, and the p rm ssued b the na Cou Department of Health. Date L �" n Certified by ' P.E. R.A. • Address Q 6o License NO. 7 �4�le_ Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewerage system shall become null and void 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 w supply becomes available. Such approvals are subject to modification or change when, in the Judgment of the missioner of Health, such r vo lion, modification or change is necessary. Date By ` Title CA,— Yorktown Medical Laboratory, Inc. LOCATIONS: 11321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10596 245.3203 321' cigar street O 201 BUTTONWOOD AVE.. PEEKSKILL. N.Y. 10566 737.8777 Yorktown Hcibhts, N. Y. 1OS98 O 495 MAIN ST., MT. KISCO. N.Y. 10549 666.3335 (914) 245.3203 �UTONELEIGH AVE. INEAR HOSPITAL).CARMEL, N. Y. 10512 2789330 • Director Albert H. Padovani T. (ASCPJ _. _ _ _ .. _. _.. _ .. - F ,lam C ATE RECEIVED: DATE REPORTED: c � SAMPLE SOURCE: Lab r Lj q O� REFERRED BY: L �Ji �� /2�(3 J Collector: q, LABORATORY REPORT % mg /L ❑ ACIDITY ............................ ............................... ❑ ALUMINUM ......................:......... ............................... ❑ ALKALINITY — — ❑ ANTIMONY' — �ACTERIA, TOTAL /mL ....... ......��....................... ❑ ARSENIC .................................... ............................... LJSOD. 5 DAY ............................ ............................... ❑ BARIUM ..............:..... ............................... ................... ❑ BROMIDE ❑ BERYLLIUM ........................... .................. ............................... ..... ............................... ❑ CARBON DIOXIDE, FREE ........ ............................... ❑ BISMUTH .................................... ............................... ❑ CHLORIDE ............................ ............................... ❑ BORON .........................:.............. ............................... ❑ CHLORINE ............................ ............................... ❑ CADMIUM .................................... ............................... ❑ COD .................................... ............................... ❑ CALCIUM .................................... ............................... ❑ COLOR (units ) ................. ............................... ❑ CHROMIUM (tot.) ............................ ............................... ❑ CYANIDE ............................ ............................... ❑ CHROMIUM (hexavalent) .................... ............................... ❑ DETERGENT, ANIONIC ............ ............................... ❑ COBALT .................................... ............................... ❑ FLUORIDE — .................. ❑ COPPER ........................ .......... ............................... ........... ............................... ❑ HARDNESS ................ ................... ......................... ❑ COLD .................................. ............................... ❑ MPN COLI FORM COUNT/ 100 ml ............................... ❑ IRON .................................................. :.................... " C I 1' COLIFORM COUNT/ 100 ml ... ......••.•......... ❑ LEAD .... ONFIRMATORYTEST ............ ............................... ❑ LITHIUM.................................... ............................... ❑ NITROGEN, AMMONIA ............ ............................... ❑ MAGNESIUM ................................ ............................... ❑ NITROGEN, KJELDAHL............................................ ❑ MANGANESE ................. ............................... ........... ❑ NITROGEN, NITRATE ............ ............................... ❑ MERCURY .................. ............................... .............. ❑ NITROGEN, ORGANIC- ❑ NICKEL ............................................... .. CCODOR un i t S . ................ ............................... ❑ PALLADIUM ................................ ............................... ❑ OIL & GREASE ........................ ............................... ❑ POTASSIUM ................................ ............................... ❑ pH (Un l t S i ...................... ............................... ❑ RHODIUM .................................... ....................... ......... ❑ PHENOL ................................ ............................... ❑ SELENIUM ............................:....... ............................... ❑ PHOSPHATE (ortho) ................ ............................... ❑ SILICON .................................... ..... ........................... ❑ PHOSPHATE (condensed) ............ ............................... ❑ SILVER ........................................ ............................... ❑ PHOSPHATE (total) ...... ............................ :............ ❑ SODIUM ........................................ ............................... ❑ SOLIDS. SETTLEABLE, ml /L .... ............................... ❑ TIN ............................................ ............................... ❑ SOLIDS, SUSPENDED ............. ............................... ❑ ZINC ............................................ ............................... ❑ SOLIDS. DISSOLVED ............. ............................... O .................................................... ............................... ❑ SOLIDS. TOTAL O ................... ............................... .... ..................... ❑ SOLIDS, VOLATILE ................. ............................... O REMARKS........ ; .......................... ............................... ❑ SPECIFIC-CONDUCTANCE ( uhm0 S /cm) ............... O ...... ... .. ❑ SULFATE ............................. ............................... ❑ ......... :i1.S14:4::�: ' ... i�... :K.......... ❑ SULFIDE ....... ❑ .............. .... ........ ............................... ................ . ............. ..................... . ❑ SULFITE ............................. ............................... O ................ r r !t:.......:.....�...:...�.....I ...... ❑ SURFACTANTS .. .. , ........... ............................... ❑ ...................... ..... .. ... ..... .................... ............................... ❑ TURBIDITY ( NTU)................................................ O ..... .... ......... .................... .............. ............................... -THESE RESULTS INDICATE THAT THE WATER WAS G OF A SATISFACTORY SANITARY QUALITY WHEN THE SAMPLE WAS COLLECTED. 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 THE PARAMETERS TESTED WHE THE SAMPLE WAS COLLECTED. ` N/A = not applicable b IYQG NT 4 9NN / � if Ne{i A M's!E Owner or Purchaser of Building Section wBuilding Constructed by Block 1H I5 6,9S�r0 /V' -P&sT !fd 1 0 Location - Street Lot Y c I frcI% j Municipality Subdivision Name �or�;� 1 A Fz — �b�l�►��'— � l 0 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- 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 act of the occu- pant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determin- ation of the Director of the Division of Environmental Health Services of the Putnam County Department of Health as to whether or not the fail- ure of the system to operate was caused by the willful or negligent act of the occupant f the building utilizing the system. 3i Dated this day of 19f-5 Signature Title J JA P irGI A r, o3, , .,e Corporation Name (if corp.) 1).,/5 �3�src� © � del L,�rce��►so•��' Address THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health PUTNAM COUNTY DEPARTMENT OF HEALTH .DIVISION OF ENVIRONMENTAL HEALTH.SERVICES COUNTY OFFICE BUILDING, bARMEL, N. Y. 10512 DESIGN DATA SHEET-SEPARATE SEWAGE DISPOSAL SYSTEM `FILE NO. Owner 111\((�,F-�T ��+�i&MEU FEAddress 2 1 SACK 1� c 'T Cl 7F � y Located at (Street Sec: Block Lot 'Indicate nearest cross street) Municipality. c��aC?� Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth o a er Water Level No. Time From Ground Surface in Inches Soil Rate Start-Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches I 1 7- Z� f 2 W., Z2 33 A 21 3 i Z-4 e� 5 ZCy J? 1Z - 3q'32- /-04 5" ,3Ca �,� Z(,� 3 1 Z 4 5 1 2 3 4 5 . Notes: 1) Teskts to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. A11 data to be submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION. DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES :1_ DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. 611 211 181► 2411 3011 3611 4211 4811 5411 66" 7211 7811 8411. INDICATE-LEVEL AT WHICH GROUND WATER IS'ENCOUNTERED I EVEL- -TO WHICH WATER- -LEVEL -RISES-AFTER BEING� ENCOUNTERED TESTS MADE BYiUl Date DESIGN Soil Rate Used�Min/l"Drop: S.D. Usable Area Provided- No. of Bedrooms eptic,Tank Capacity 000 Gals. Type/0450/ idth trench. /wi Absorption Area Provided By6 L-F.x241t� OC OF N Address SEAL THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: �c 0, Soil Rate Approved Sq. It/Cal. Checked by e