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HomeMy WebLinkAbout2148DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 30. -2 -30 BOX 19 02148 i,yti � • j {; it r T -T I 16B 'y 02148 WELL COMPLETION REPORT 3o PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 , — Re 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 sample_indicatingwater is ofrsgt factory_b gtgrja -,,q tgly_bofdrg -pertificate of construction compllatice_i Jssul2ll;`"': <,.. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NAME rake Galvano ADDRESS Richardville Road Putnam Valle LOCATION ION (No. & Street) Richardville Road (Town) (Lot Number) Putnam Valley 1 PROPOSED USE OF WELL DOMESTIC ❑ SUPPLY BUSINESS ❑ ESTABLISHMENT El INDUSTRIAL ❑ FARM ❑ CONDITIONING ❑ TEST WELL Opp «ER ify) DRILLING EQUIPMENT [I ROTARY COMPRESSED DAR PERCUSSION CABLE ❑ PERCUSSION ER ❑. (s(specify) CASING DETAILS LENGTH (feet) 21. DIAMETER (inches) 6 719 T PER FOOT D THREADED ❑WELDED [g ]YES 'S O NQ X CASING YESNO . YIELD T ST ❑ BAILED ❑' PUMPED N. COMPRESSED -AIR HOURS G.P.M. YIELD (G.P.M.) 6 WATER LEVEL � MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST fleet) Total Arawdown Depth of Completed Well 175 in feet below land surfacer SCREEN DETAILS MAKE LENGTH OPEN TO AQUIFER fleet)' 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 lees( two permanent landmarks. FEET to FEET 2 170 ledge If yield was tested at d)Serenf depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED June 1980,1 DATE OF REPORT Sept. 1, 198 WELL DRILLER (Signature) TOWN OF PUTNAM VALLEY . DRILLERS iAG..AND.. REI?ORT WELL _. WELL COMPLETION REPORT ii-iis report is to be completed by well driller and submitted to Bldg.'department, together with laboratory report of analysis of water sample indicating water is of satisfactory bacterial quality. Well Location Richardville Road _ Tax Map Street Sec. B1. Lot Well Owner Mike Galvano Richardville Rd Putnam Valleg Name Mailing Address City or Town Tel. # Well Driller Boyd, Artesian Well Co . ._.. _ Rte 52 Carmel Name Mailing Address City or Town CASING DETAILS YIELD TEST ' WATER LEVEL SCREEN DETAILS Bailed Measure from land surface Length 21 Ft. or 8 X Pumped Hrs. Statics Ft. Make: When Bailed Slot Diameter: 6Inches Yield:6 GPM or Pum ed Ft4 Len th Ft.Size 19 Kind: Diameter In. DOTAL DEPTH OF WELL 175 Feet WELL LOG Depth from Give description of formations penetrated, such peat,. _silt., .sand., - ,gravel.,_ 'clays . hardpan.,, �. shale, sandstone, granite, etc. Include size of gravel (diameter) and sand (fine, medium, coarse), color of material, structure, (Loose, packed, cemented, soft, hard), For example: 0 ft. to 27 ft. fine, packed, yellow sand; 27 ft. to 134 ft. gray granite Feet to Feet. Formatinn.,Des.cri o_tion 2 to 170 ledge Date Well Completed June 1980 Date of Report S,6 g. 1 1982 Well Driller Sa re BZS 1 -77 Owner or chaser AT Building Section n - Street Lot @' /,A/kw- Municipality Building Type Subdivision Name 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 .__.....%ate_ the_.. Pixtnam _Co.uri.ty --Depa.rtnm.ent, 6.£,..He.61tka ure 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 19,F11 Signature Title Corporation Name if corp. 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 t Owner or Purchaser of E Section Location - Street Lot Municipality Building Type Subdivision Name Subdve 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 regu.lations'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 ___._o t.h& Dutna County - Department of Health. - a -s-:to whe"�heY* or riot" tie "fail =_ ure 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 19_,EL Signature Title Corporation Name if corps 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 Owner r urchase o Building Section can g:„.C.ons.-trxio.t,ed,° ya:.. ... !_., _,.. Bloek•�.0 --... . -. - „._._. Location -'Stre'et Lot 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- 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 Putnam _Gounty- .Ilepartmen - -o Hb -t-h.as- t�= wkrether- �or-rrot• h� -fail= =___.__._,::. ure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated this 474c2 o day of 1,V FJ 19 Signature Title Corporation Name if core. 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 TOWN OF PUTNAM VALLEY WELL DRILLERS LAG AND REPORT WELL.`.COA,YLEt.10 -REPORT ':.is report is to be completed by well driller and submitted to Bldg. department, together with laboratory report of analysis of water sample indicating water is of satisfactory bacterial quality. Well Location Pichardvi 11G toac Tax Map Street Sec, Blo Lot Well Owner Mike Galvano Richardville Rd �utnan Vz11ey Name Mailing Address City or Town Tel. # Well Driller Boyd Artesian, ',Je' l Co ?t.e. L:z Carne)_ Name Mailing Address City or Town CASING DETAILS Length 21 Ft. YIELD TEST WATER LEVEL _ _SCREEN DETAILS Bailed Measure from land surface) or a Pumped HrselStatics Ft. Makes ►When Bailed ! Slot Diameters 6Inches ]Yield:6_ GPM for Pumped Length Ft .Size 19 Diamet _OTAL DEPTH OF WELL 175 Feet WELL LOG Depth from Give description of formations penetrated, such mound Surface ass peat, silt, sand, gravel, clay, hardpan, shale, sandstone, granite, etc. Include size of �av�l (diameter). and- sand- --nrediun, color of material, structure, (LAose, packed, cemented, soft, hard). For examples 0 ft, to 27 ft. fine, packed, yellow sand; 27 ft. to 134 ft. gran granite reet to Feet Formation Description 2 to 170 leome mate Well Completed June 1980 BZS 1 -77 Well Date of Report 'S� tt. 1 1902 Driller h Si re Cl-/ I IUN REPORT PUTNAM COUNTY DEPARTMENT OF HEAM 3171 ' 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 sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued....,., REPORT.,MUST .BE :SUBMI:TT-ED WITHIN "--�3&) bA OMPLETION. - in -.•sc hm. ^y ✓.- ..mow. _ OWNER NAME Iiilxe. Galvano [ADDRESS Ri chardvill e . Foad Putn:.m Va -'.le LOCATION OF WELL (No. 3 Street) (Town) (Lot Number) Richardville Road Putnam Valley PROPOSED USE OF WELL BUSINESS Ll DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify) DRILLING EQUIPMENT COMPRESSED - CABLE OTHER ❑ ROTARY a AIR PERCUSSION ❑ PERCUSSION ❑ (Specify) CASING DETAILS LENGTH (rest) 21 DIAMETER (inches) Ei WEIGHT PER FOOT lg THREADED, El WELDED YES NO WAS CASIN L= YES D NO YIELD TEST } HOURS G.P.M. ❑ BAILED ❑ PUMPED D COMPRESSED AIR YIELD 6 WATER LEVEL MEASURE FROM LAND SURFACE — STATIC (Specify feet) DURING YIELD TEST (toot) Total Drawdown Depth of Completed Well in feet below land surface: 175 SCREEN MAKE LENGTH OPEN TO AQUIFER (feet) DETAILS SLOT SIZE DIAMETER 'Inches) IF .GRAVEL PACKED: Diameter of well including gravel pack (inches): GRAVEL SIZE (inches) FROM (leer) TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with diatencea, to at least two permanent landmarks. FEET to FEET 2 170 lec'?e If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED June 1980 DATE OF REPORT Sept. 1, 198 WELL DRILLER (Signature) ._: _......__,.._ . a ._ __ __.... ____..._. .. „� . -�. - �s i x -�%'°� 4 Fr .rte Ye- '. t �' �• " I�1c PUTNAM COUNTY DEPARTMENT :OF HEALTH . DiVISion of_;Enviroiimen al Healih Sew ices, Carme% N:- Y ;,10512 x CONRUCTION PERMIT fOR 'SEWAGE DISPOSAL SYSTEM3Ct1, Town 'or. Village - Loc�Ced fax chap Block ` Subtlivisiori s A4 Lot Z z Job Owner � Address Bulidih9 •`Type wll Lot Area .r�'�l 1 1 Number of :Bedrooms 'Design Flow (. ' Mf� Total'. Hab�tatile Space. Square, feet. Separate Sewerage System to consist of �CXi -Gal Septic tTank^ 7��_�Chll1�. �t1r1 ✓s - �z To�be constructed by 4s — � � ����� `Address cuµ ( t Water Supplye Public Supply From - Y ,hPrivate Supply 't0 be drilletl cby�� Address Other Requirements Ili i•�� _ 5�` E ��� I- e.epresent that l am wholly and ,completely responsible for the design and location of the; proposed systems) `1) that -the' separate sewage disposal system. •s,` a ' e• de r ed w I . e r n nt there'to` and :in accordance with th�estantlards rules.an 'regulations o e u nam _;F p �. - Pp oved' ame dme r . y bov sc ib i I b constructed as shown on the:a County 16e arfmgnt of Health, and'that on completion thereof a• Certificate of Gonstruct(on Compliance saGsfactor to the Commissioner of Health'will be submitted. io, ;the Department,. -and aewiitten4guarantee. will be: furnished the owner, histisuccessors he�rs_:or. assigns by the builder,; that said' builder will ; place in.:..good operating ,conditior' any pact of said sewage disposal system - during; the period of two (2) years immediately following,:thedate of the' ante of,the approval of fhe Certificate ;;of Construction :,Gompliancel of the original- or any repairs thereto 2) that.,the drilled well described above will bey located as shown on the approved plan and that said well wili,be ;installed' in;, ante; with the standards rules and ,regula i —ion_s of the Putnam County Department of ,Health,., y n f r .Date .. i- Signed.. _ - P,E .]L' R.A. 8 -J s Address :. Licens No.' - qu ` .Xjand, APPROVED FOR WNST,RUCTION..This, approval expires one year+fromthe date issued unless coristructi of ..the building. has been.undert reyocabie.,for cause or may;.be amended:orm_ odifiedawher consider • s ry by tha Commissioner. o' Health: '.Any 'change; or alteration of c requires anew permd ffipproved for_dis sal 94'domestic sa tam e; ` tl or ;p to ; ;wate4Y- erit��� ewe! Title P4y, Date 7; �By - - 1 s d c" � ° b <'_ b..0 C ',. -v MS:� - �.�wMt,�N r�"x.` k Y. 1,.n #.. l�:.t^�`,•x 3.. � t c ` '1 j. COUNTY BOARD OF 'HEALTH RAYMOND S. JONES Putnam President Vice President PAUL CHANG. M.D. ALFREDO F. GARCIA. Jr.. M.D. BEVERLY TAYLOR GERALDINE A. ZAMOYSKI. M.D. HON. DAVID D. BRUEN County Executive HON. 'JOHN MADIGAN County Legislator O�N;f 77-7-,�—, 9W225-36,41 my JOI-Ih SIMMONS, M.U., Deputy Comis8ioner J. ROBERT FOLCHETTI, P.E Director Of Environmental Hea Zth Services DEPARTMENT OF NAM ELAINE K. KRUEGER R.N. M.A. County Office Building Director Of Patient Se I rvice8 Carmel, New York 10512 September 14, 1982 Mr. Marvin O'Dell Building Inspector Putnam Valley Town Oscawana Lake Road Putnam Valley, New Hall York 10579 Re: Michael Galvano Dicktown Road, Putnam Valley Tax Map 5, Block 1, Lot 2.3.1 Dear Mr. O'Dell: "Records in this di ion indicate the final inspoction for the above named site wqs performed by this depar-t4fient in 1980. Though the actual installation varies somewtiat from tne approved plan, the system as it was built, generally conforms to the applicable rules and regulatlif"I"s of the Putnam County Divisions of Environmental Health S�rvd-ces.- Please accept this letter in lieu df-the normal :Construction Compliance due to the absence of the De-,siign Erigineer,who has since moved out of state. Very Ltr ly r I url`s�11, Robert J�. utoni RJT:ci Division of Environmental Health Services cc:. Michael Galvano 11 � COUNTY BOARD OF' HEALTH RAYMOND S. JONES Putnam President S. DANIEL SELDIN, D.D.S. n;tL'ice:Precident... �, .. �,.... .a.., PAUL CHANG. M.D. ALFREDO F. GARCIA, Jr., M.D. BEVERLY TAYLOR DEPAR GERALDINE A. ZAMOYSKI, M.D. Col HON. DAVID D. BRUEN , County Executive HON. JOHN MADIGAN County LegisZator Mr. Marvin O'Dell Building Inspector Putnam Valley Town Hall Oscawana Lake Road Putnam Valley, New York 1 County 914/225 -3641 JOHN SIMMONS, M.D. Deputy Commissioner . --... �.,.° ° �^ ° .. i• J"'.• �, �Jr -ROHERT'POl'CFIETTI' ^P'E' ^M:S. � ' Director Of Environmental Health Services OF HEALTH Building W 'York tember 14, 1982 a. Re . ..,Michael Tax; Map ELAINE K. KRUEGER R.N. M.A. Director Of Patient Services Galvano n Road, Putnam Valley 5"4' Block 1, Lot 2.3.1 Dear Mr. O'Dell:xr$ '. Records in this division indicate the final inspe+ction`1 for the above named site aFs,,performed by this department in 1980. -• - -- -- •-- T-hough• th-e actual instaTlat16, va -ries somewhat from-the approved approved plan, the system as it waESbuilt, generally conforms to the applicable rules and regulat �Wn,s of the Putnam County Divisions of Environmental Health Se Please accept this letter in lieu Compliance ,due to the absence of the De since moved out of state. RJT:cj cc: Michael Galvano Rces. of the normal Construction S ign Engineer who has Very tr ly ours xA • .,. Robert J. utoni }sj Division of Environmental Health Services- F1�4 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date t 4 iq-1(0 Re: Property of MZ_M/kE, &4WN110 Located at Section rj Block Lot Gentlemen: This letter is to authorize A. `P. a duly licensed professional engineer J 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 connection with this matter and to .supervise the construction of said system or systems.in conformity with the pro- visions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sanitary Code. Countersigned: P.E,, R.A. Address *,i44•�1it;�� OF i'y£ ' ., r %�• -rYn• 0 ���U)Il�illp� Telephone Very truly yours, Signed Owner of Property — � �C Address Telephone PUTNAM COUNTY DEPARTMENT OF HEALTH D17ISION -• -OF. ENVIRONMENT AL,,HEALU ,_SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner MCL4&0— GN:t t-o Address 1�iC�iZ NN1 12L6 Located at Street Sec. S Block Lot Z .31 (Indicate nearest cross street) �� Muni cipality'_vbTV�� YAj_Ie( Watershed 1�1•`�.C. Nf4��„�id SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Ran Elapse pth 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 1 °z cad ._ 2:0'1 3 2(0 Zl i 3 v.1 2 221 Co 3 2' l S— Z- 0 3 Zl 4 Z t!a zv 2q 100 . ZCQ 21 I 10 5 Z; �p — °Z'40 10 2 V er-' 10 1 5 Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained a,t.each percolation test hole. All data to be submitted i for review. 2) Depth measurements to be made from top of hole. DEPTH 6 1211 1811 2411 3011 3611 42" 2 4811 6011 i 66 f -8411 V TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO. HOLE NO. IRDICATE.=L AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Date 1 DESIGN.-__ .Soil Rate Use _d b=Lo 1"Drop: S. D. Usable Area Provided `U_ ,...No. of Bedrooms S eptic Tank Capacity 00 Gals. Type I " , A'Absorption Area Provided By_? L. F. x24 b11- width trench. 3 Other ignature Address S _ ITHIS QQAAO= SPACI FOR USE BY HEALTH DEPARTMENT ONLY: Oil Rate Approved Sq. Ft/Gal. Checked bY. Pr "A 0 -Ess I V'y, ate [914] 225-2794 [9141225-1586 CARMEL, N.Y. 10412 oe-ro- -.F..Nnvrv"af pro RENOVATING REMODELING NEW HOMES G DEMOLITION B FIRE RESTORATION ICHAEL B. GALVANO [9141225-2794 t [914] 225 -1586 %\ RENOVATING R NEW HOMES ®G c FORE RESTORATION MICHAEL B. GALVANO, LONG �1 1 t� FORE RESTORATION MICHAEL B. GALVANO, LONG r "t r ti ,. '. . ' ..... / v. s Yii,J!! 0 � . � �`'�, r 4Y.%aYSrHu'CTt'.►ly DF`7:•��:. aF �y i i A,7SWti()A( 4W.4 r » P,� '"i C� �✓:,; *;" J '' °� fir%' O�x'' ..� 1 iR� E � K� f '�i t1 _,s,�ln•�� 1 ( r re. �F •mss ? � $+-a-0 ... �..... �.,.-. .....•.a.._.:._....0...4....... ,.. .:_r _ � .vim � � ,. • _ � 4�-M.r 1043°" a �tfll(tlfiiftis� � .w - 044 ow ... •,,...