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HomeMy WebLinkAbout2474DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 51. -1 -39.3 BOX 21 �L `, ., .; 0 1 , :` 02474 f PUTNAM COUNTY DEPARTMENT OF HEALTH -;ENV HEALTH- SER'- ICES- - -. ! ' - ; CERTIFICAVE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM Arlo- PCHD CONSTRUCTION PERMIT # dJV �q Located at U_iN—OLA1MFVM rOJO ti> J4-01-iO Town or Village 1'" VvIlr') V mLL0 7 Owner /Applicant Name �OY -fDMC-1`l 1 f� Tax Map S� / Formerly Block % Lot 39 Subdivision Name '50Y 'Tory GNl N Subd. Lot # 3 yD V � "r4h, Mailing Address Fl-oz)2 Zip 1 000 r Date Construction Permit Issued by PCHD Separate Sewerage System built by Iff4A Consisting of /'So 0 Gallon Septic Tank and Gd^rj�e�G7iaJ Address nov c b,k o ow g , IMk t 97Z Z- F OF F/&0,5 Other Requirements: -:�$D GRb ., DW*16. %AAI K- Water Supply: Public Supply From, Address or: X Private Supply Drilled by NO(LMW wyeoo�)/ illC-. Address ! L n-Cr Srnv' -A t4M * L� Building Type P- 66 /0&</14 ' Has erosion control been completed? YI 0 Number of Bedrooms Has garbage grinder been installed? IPJO I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County Department of Health. Date: J213 q � Certified by _ Address � r17 bA DD w 9ZA 0 W ILLIAlb J, G097b^4 P.E. R.A. (Desi n Professional) V$t"/ MY 12-'56/ License # 62 WK 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 sewage treatment 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 water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocation, modifica ' necessary. By Title: S Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Profes§ional Form CC -97 ow WELL UUMYLt'11UIN rvIlruiAi DEPARTMENT OF HEALTH . _ _.. "61 E.,Virorimbntal Health-•Serviees PUTNAM COUNTY DEPARTMENT OF HEALTH Off is Use Only - - /-—irri STREET ADDRESS: 14 WN /VI l Y TAX GRID NUMBER: I' ( 3 WELL LOCATION WELL OWNER NAM ADDRESS: 8 PRIVATE O PUBLIC USE OF WELL 1- primary 2 - secondary &RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION O OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT S gpm. /NO. PEOPLE SERVED —/ EST. OF DAILY USAGE � gal. REASON F08 DRILLING -NEW SUPPLY ❑ PROVIDEAODITIONAL SUPPLY O TEST /OBScRVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WEL► DEPTH ��� ft. STATIC WATER LEVELit. DATE MEASURED DRILLING ` EQUIPMENT gROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. 0 OPEN HOLE IN BEDROCK ❑ OTHER TOTAL LENGTH tt MATERIALS: 5ZSTEEL ❑ PLASTIC ❑ OTHER CASING DETAILS LENGTH.BELOW GRADE �� ft: JOINTS: ❑ WELDED 127HREADED ❑OTHER DIAMETER <� in. SEAL:- CEMENT GROUT ❑ BENTONITE ❑OTHER WEIGHT PER FOOT A/f Ib. /ft. DRIVE SHOE-JR YES ❑ NO LINER: ❑YES �90 DIAMETER (in) SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? SCREEN_: DETAILS.. FIRST _ ... _._ ._.._........_...._. _... _ . :..: _ - ..:. ^_ ... ::.c YES. ONO, HOURS SECOND GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE; DIAMETER OF PACK in. TOP OEM ft. BOTTOM DEPTH It. WELL YIELD TEST METHOD: O PUMPED OMPRESSED AIR O BAILED ❑ OTHER If detailed pumping i tests were done is in- , formation attached? ; 0 YES O NO WELL L� G 11 more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE water sear- ing Well Oia" meter FORMATION DESCRIPTION CODE. tt. (L WELL DEPTH it. DURATION. hr, min. ORAWOOWN it. YIELD gpm- Lana Surface ,f Alf 00 WATER XCLEAR QUALITY O CLOUDY O COLORED ANALYSIS ATTACHED? TEMP. HARDNESS ANALYZED? OYES ON O YES ❑ NO STORAGE TANK: CAPACITY % GAL. PUMP INFORMATION TYPE ` MAKER MODEL !S'O S - CAPACITY Sr DEPTH 2-M `VOLTAGEa"3') HP WELL DRILLER NA d OA ADDRESS j`r SIGI`IATURE -�j PUTNAM COUNTY DEPARTMENT OF HEALTH ....�,...:. ,r_ .. _a _.�..:... u ,. n.... ,.., „:,.., ..,�,..._�.,,.... DI�iSIOi�KOF �EI�iIIRO'AI; HFIiLTf-I° .SEEiVI�'ES" "c '" • ...,_.,.,,.: p .. , ..:: � •�:-. = x k ; .. , ,; a ;. N oZ /© �1 Owner or Purchaser of Building ValeilLan e--dn. s T Building Constructed by OSGa t'k,'dCL �Pi ,� AU' p Location - Street —� pJ ��cafn �'o�an�y Municipality pe, S 11 A Building Type Section Block Lot /44,1 .1/7 Subdivision Name �3 Subdivision Lot # GUARANTEE 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 immediately. following the date of_ approval of • the "Ceftifidate of "Construction (:ompiiance'� "for "the "sewage disposal"systen� or ariy` 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 detenuination of the Director of the Division of Environinental 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 u ilizing the system. Dated this s day of d e 19 Signatur e Title IGArieral Contractor (Owner) - Signature Corporation Name (if Corp.) .ecelcyGLoi C- i7? Address //3 ru ,rev. 9/85 mk �i� /a Corsi SC. Corporation Name (if Corp.) Z�/6 Bu�S /a j /Dc�1 /2dl Mu AOdc 41 V oSy/ Address OCL Analytical Services ELAP #10510 C L 35 Goshen Turnpike PADEP #68 -545 9g ical Service ....... r.Bloomingbur �a g ;n*Y- r-21 . ,., a .a.._.s.- :_.._.<...� 3..._�... _... t... form^rly Oinnge Counth Latoratory (914) 733 -1557 Fax: (914)733 -1944 Joy A. Tomchin 40 Schwana Heights Rd Putnam Valley NY OCL Sample No: 55536 System Name: Joy A. Tomchin Exact Location: 4 Oscawana Heights Rd Putnam Valley, NY /pressure tank Submit By: Client Type Descr : SID: 000 Fed ID: Tuesday, November 04, 1997 Page Number: 1 Client Code: 7TOMCJO Date Collected : 11/3/97 Time Collected: 13:30 Date Received: 11/3/97 Analysis I I Result I Units I MCL /DL I I Method I Lab I Date I y Total Coliform absence I I I 19223B 110510 11/3/97 HH Remarks: Passes NYSDOH drinking water standard Copies to: GT = greater than MCL = maximum contaminant level LT = less than DL = detection level ND = not detected r .: �» e:., o.. w:. .,. c�.. �.- wn.;+ �....•.:, �v: �. �.:.. a'...-.. r....- w.. u+ mr'. a. �n. �:. uo ......- ....- .,.a,.sa...x.,..uw. mn.. ...aw. .._ w.. .. ,...y.,.....•. _ .,t ;- ...::' .+�� .. ..w.: 3. If the water supply is from a drilled well: a. Satisfactory results of a water analysis, for the parameters in Table I below, conducted and reported by a NYSDOH approved laboratory under the "Environmental Laboratory Approval Program (FLAP)." CONTAMINANT MCL (1)(4)(5) Coliform bacteria Any positive result is unsatisfactory Lead 0.015 mg/l (15 ug/1) Nitrates 10 mg/l as N Nitrites 1 mg/1 as N Iron 0.3 mg/l Manganese 0.3 mg/l Iron plus. manganese 0.5 mg/1 Sodium.:::..:__: - _ No designated pH No.designated limit Hardness No designated limit Alkalinity No.designated limit Turbidity 5 NTU (3) NOTES: (1) Maximum contaminant level. (2) Water containing more than 20 mg/1 of sodium should not be used for drinking by people on severely restricted sodium diets. Water containing more than 270 mg/1 of sodium should not be used by people on moderately restricted sodium diets. (3) NTU means Nephelometric Turbidity Units. (4) mg/l means milligram per liter,. (5) ug/l means microgram per liter. OCI_ Analytical Services ELAP#10510 ®C 35 Goshen Turnpike PADEP #68 -545 Analyfigal, Service Bloomingburg;EY �2�?21 _....,,.._ ,... 'Orrnrly Count j i nboratory (914) 733 -1557 Fax: (914)733 -1944 Wednesday, November 26, 1997 Page Number: 1 Joy A. Tomchin 224 5th Ave c/o Vanguard Investors New York NY 10001 OCL Sample No: 55723 System Name: Joy A. Tomchin Exact Location: Drilled well Submit By: Client Type Descr : SID: Fed ID: Client Code: 7TOMCJO Date Collected: 11/7197 Time Collected: 11:45 Date Received: 11/7197 Analysis Result Units MCUDL I Method Lab Date By Alkalinity 70 mg /L 2320B 10510 11/11/97 PC Total Hardness 76 mg /L 2340C 10510 11/7/97 JB Nitrite 0.03 mg /L 1 MCL EPA354.1 10510 11/7/97 JJ pH 7.97 4500H 10510 11/7/97 JJ Turbidity 3.8 ntu 2130 10510 11/7/97 JJ Nitrate as N 0.05 mg /L 10.0 MCL Lachat 11216 11/12/97 IC Lead, total -= := - : 0.002 mg /L 0.015 MCL EPA 200.9 11216- 11/19/97 BRJ Ifar, tofal - _ .- _.._.... -. _..._..._ , -.__ - 9.480 mg /L . 0:3" . " MCL` EPA 200:7 11216' '11114/97 BRJ Sodium, total 23.4 mg /L EPA 200.7 11216 11/14/97 BRJ Manganese, total" 0.0006 mg /L 0.3 MCL EPA 200.7 11216 11/14/97 BRJ Remarks : Copies to: GT = greater than MCL = maximum contaminant level LT = less than DL = detection level ND = not detected �lr�► C�yl�r David M. Kennedy - Director VANGUARD INVESTORS LTD. December 9, 1997 VIA OVERNIGHT MAIL Putnam County Department of Health Attn: Ms. Chris Johnson 4 Geneva Road Route 312 Brewster, NY 10509 Re: SSDS Final Plans 4 Oscawana Heights Road Putnam Valley. New York Dear Ms. Johnson: Please find enclosed the additional information needed to close out the Construction Permit at my new.house at the above- referenced address: Also, please find enclosed an additional certified check for $100.00. If there is anything else you need, please call me at the phone number below. Thank you in advance for your assistance. Very truly yours Joy A. Tomchin JAT:pa Enclosures P. S. Could you please send the certificate, when issued, to, me at the address below. -.� "b 1 .1 224 FIFTH AVENUE, NEW YORK, NEW YORK 10001 212 683 -2233 FAX: 212 683 -0374 VANGUARD INVESTORS LTD. November 6, 1997 VIA OVERNIGHT MAIL Putnam County Department of Health Attn: Mr. Bill Hedges 4 Geneva Road Route 312 Brewster, NY 10509 Re: SSDS Final Plans 4 Oscawana Heights Road Putnam Valley, New York Dear Mr. Hedges: 5 - -Please-find -enclosed the information to close oathe Construction Permit at my new house . at the above - referenced address. Also, please find enclosed a certified check for $100.00.' If there is anything else you need, please call me at the phone number below. Thank you in advance for your assistance. Very truly yours, / / Joy A. Tomchin JAT:pa Enclosures P.S. Could you please send the certificate, when issued, to me at the address below. 224 FIFTH AVENUE, NEW YORK, NEW YORK 10001 212 683 -2233 FAX: 212 683 -0374 Xa, u Mw