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HomeMy WebLinkAbout2892DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631 - 589 -8100 62.13 -2 -16 BOX 24 mill .T L I`` . � . - IA I� f . r 6 02892 1) PUTNAM COUNTY DEPARTMENT OF HEALTH .:DIVISION aOF_ENVIRON ENTAL HE LTLF ER I ES.. CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # A3 J � Located a'�1� �/.����' �ri Town or Village Owner /Applicant Name 157.rC' l*P- 11�irr�yi`�,, Tax Map Formerly Mailing Address /3d T Subdivision Name _� c,,,e e,=.r Date Construction Permit Issued by PCHD Subd. Lot # -4-� FIA Separate Sewerage System built by d W& e. Address W Zip /os � .SO'02;' c- Consisting of 12 _rte Gallon Septic Tank and Other Requirements: Water Supply: Public Supply From, Address or: y' Private Supply Drilled by /, iS� 9 Address Has 'vrng- gn CCri:' Bll llu.pyp-ti . 0 ^coMpl!t 2 i Number of Bedrooms 4K Has garbage grinder been installed? Ale I 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 Date:�� ®� Certified by Address -- 2-3%72 �e�"�Crrsi Ya! /�i�ivY�7 X Any person occupying premiers served by th bove Department of Health. ' - 1 ffil 11 License # ;2- yam take such action as may be necessary to secure the correction of any unsanitary conditions resultmrortich usage. Approval of the separate sewage treatment system shall become null and void as soon as a public samitary 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: Date: (-5- c 3 White copy - HD Vile; Ye copy - Building Inspector; Pink copy - ner; 0rdQ copy - Design Professional Form CC -97 U U - t F n U__ _ . - , _ _.. , : LORE'I` A;- ��!Ci,T1`M_xT .YN,., x�4.�.�.'. Public Health Director ' Associate Public Health Director W Director of Patient Services DEPARTMENT OF HEALTH ' 1 Geneva Road Brewster, . Ne York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278.7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 _ Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278.6082 Fax (914) 278 - 6648 -NAME: TAX MAP .NUMBER: E911 ADDRESS: Z� D -rl ()e TOWN: 0 .t The Putnam County Department of Health -will not issue a - Certificate -of - Construction Compliance unless the above form is completed, i.e., a legal E911 - address is assigned by an authorized town :official. - This form is to be submitted - - -with the:application for a Certificate of Construction Compliance. (E911VERRUVD PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Xx'elI- 'Ll"4aflo10 :' -. = �- tir��t-A���'z.ss: i'=G-1d i..' ... <...,.. .. ,. Map('X, /3 Block Lot(sf� Well Owner: e: Address:, t, Cwt ��it� Use of Well: 1- primary 2- secondary Residential Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment _ Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing C Open hole in bedrock Other Casing Details Total length oZ ft. Length below grade # r . Diameter P" in. Weight per foot alb /ft. Materials: Steel _ Plastic _ Other Joints: _ Welded _>< Threaded _ Other Seal: '>-'- Cement grout _ Bentonite Other Drive shoe: x Yes No Liner: Yes k No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes No Hours Second Well Yield Test _ Bailed _ Pumped >< Compressed Air Hours Yield gp Depth Data Measure from land surface - static (specify ft) as During yield test(ft) Depth of completed well in feet ;2-6 0 Well Log If more detailed information descriptions or sieve analyses are available, ` please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface - If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type.,�jb Capacity /V J_;WA, ;,v Depth / /D' Model :JrZc a Zcz Voltage 2, o HP Tank Type Otft Volume Date Well Completed Putnam County Certification No. Date of Report Well Driller (signature) N /OTEj' Exact location of well with distances to at least two permanpt landmarks to be provided on a separate sheevplan. Well Driller's Name Signature: %j ,, Address /5�� �►^, 1 Date: - v 1 White copy: HD File; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy- Well driller Form WC -97 JOSEPH F. SULLIVAN, P.E. 43nUdi&Z9 Zng42EE2. ` '- ze ii r��n)cs2�sir nalv�' YORKTOWN HEIGHTS, N.Y. 1059B (91 4) 962-4248 C�X 1;7 OX 6 ,j,4' Ire C G� -�� NE 3PUCAZ ;ii: FJL Y Public Health Director March 19, 2002 ' LORET A_ iv10'UNARi 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) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Frank Sullivan, PE 2972 Ferncrest Drive Yorktown Heights, New York 10598 Dear Mr. Sullivan: Re: Proposed SSTS Compliance 64 West Shore Drive (T) Putnam Valley, TM# 63.13 -2 -16 Review of plans and other supporting documents submitted at this time relative to the above ,regyled project has been completed. Comments are offered as follows: Provide the results of the March 5, 2002 pump test. 2. Provide well completion report completed by the well driller. It appears that the well was drilled ± 1989. tipoii receip...or a silbmissiori revised to reflect tY�e above comriients, tliis application will be considered further. Sincerel , Shawn Rogan Public Health Technician SR:cj ;� ^F i', � £ , ? 't j }l, � i.. a ,,, i. a �• }. ¢ k i DIVISION OF EIS_ VIA ONMENTAL HEALTH SERVICES. r GUARAN'T'EE OF SUBSURFACE SEWAGE TREA'TMEN'T SYSTEM Owner or Purchaser of Building? Tax Map Block Lot ii Building Constructed by TownNillage . Aw 60 a Ile Location — Street Subdivision Name Building Type Subdivision Lot # 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 properly is caused by the willful or negligent act of the occupant of the building utilizing the 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 3 Day �C YearT�o z-- General Contractor (Owner) - Signature Corporation Name (if corporation) Address: /_4 State V Zip J o5 1 Signature: Title: -?q5. Corporation Name (if orporation) SAddress: x . State Zip 1C>6-,V; Form GS -91 Public Health Director . - 7 � -.� _ f. Tim fi \T :' 7•_ T. " � 7� ' 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 -'1921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 March 19, 2002 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Frank Sullivan, PE 2972 Ferncrest drive Yorktown Heights, New York 10598 Dear Mr. Sullivan: Re: Proposed SSTS Compliance 64 West Shore Drive (T) Putnam Valley, TM# 63.13 -2 -16 Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: 1. Provide the results of the March 5, 2002 pump test. 2. Provide well completion report completed by the well driller. It appears that the well was drilled f 1989. .. .,._.._ �.. �.._.`._ -Upvv r ec E1 p4 o =a Slb I1i�ioii cv� �c d.4 u ie� e 0Ct5 i � -A v uvc CGi uieilt� 'th llS 'a p li i aliVn 1i1 "i C 01 6 - .� .._...- considered further. Sincerel , Shawn Rogan Public Health Technician SR:cj ' YML EWKI L-SERVICES (914) 245-2800 Albert H. Padovani, Director LAB #: 32.108826 CLIENT #: 55018 ~~~~~~~~~~~~~~~~~~~~~~°�~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ NON STAT PROC PAGE 1 ROCK-ALL CONST CORP DATE/TIME TAKEN: 12/18/01 04:19 1367 HAYES DRIVE DATE/TIME REC'D: 12/20/01 10:45 YORKTOWN HOTS, NY 10598 REPORT DATE: 01/16/02 PHONE: (845)-528-8513 SAMPLING SITE: 64 WEST SHORE DRIVE, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE : WELL TANK /^��'���_ - ^ � ~ ' - PRESERVATIVES: NONE COL`D BY: HRK TOMPKINS TEMPERATURE-w< 4C NOTES...: COLIFORM METH: MF DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD PUTNAM CNTY PROFILE 12/20/01 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 12/20/01 LEAD (IMS) <1 ppb 0-15 ppb 9101 12/20/01 NITRATE NITROG 1.41 MG/L 0 - 10 9139 12/20/01 NITRITE NITROG <0.01 MG/L N/A 9146 12/20/01 IRON (Fe) <0.060 MG/L .`'° 0-0.3 mg/] 2037 12/20/01 MANGANESE (Mn) 0.010 MG/L 0-0.3 mg/l 2037 12/20/01 SODIUM (Na) 12.5 MG/L N/A 12/20/01 pH 6.3 UNITS 6.5-8.5 9043 12/20/01 HARDNESS,TOTAL 132 MG/L N/A 12/20/01 ALKALINITY (AS 66.0 MG/L N/A .12/20/A1�_`;jURBIDITy_(TUR..� _ _. 51 NTU�j_�__.���O+5_NTU�����`��.�`�.'__�� COMMENTS: BACT THESE RESULTS INDICATE THAT THE WAT (WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORDlNE�-TD THE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Pb/Cu LEAD limits for p' EPA Lead & Copper than 10% of their than 15 ppb and a treatment must be potential. p i schools are set at 15 ppb. Rule for Public Systems requires that no more distribution points have a LEAD value of more COPPER value of 1.3 mg/L, else water undertaken to reduce the waters corrosive Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg/L of Sodium. For those on a moderately restricted diet, a maximum of 270 mg/L of Sodium YML ENVIRONMENTAL SERVICES 321 Keay- Street (914) 245-280O Albert H. Padovani, Director LAB #: 32.108826 CLIENT #: 55018 NON STAT PROC PAGE 2 ROCK-ALL CONST CORP DATE/TIME TAKEN: 12/18/01 04:19 1367 HAYES DRIVE DATE/TIME RECD: 12/20/01 10:45 YORKTOWN HGTS, NY 10598 REPORT DATE: 01/16/02 PHONE: (845)-528-8513 SAMPLING SITE: 64 WEST SHORE DRIVE, PUTNAM VALLEY, NY SAMPLE TYPE..: POTABLE : WELL TANK PRESERVATIVES: NONE CQL'D 8Y: MRK TOMPKINS TEMPERATURE..: < 4C NOTES...: CQL2FOR11 METH: MF ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~"°~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DATE FLAG PROC EDURE is suggested. RESULT NORMAL - RANGE pH pH SCALE IN WATER RANGES FROM 1-14. MEASUREMENT OF pH IS ONE OF THE IMPORTANT AND FREQUENTLY USED TESTS IN WATER CHEMISTRY. WATER WITH A LOW pH MIGHT BE CORROSIVE TO METAL PIPES AND FIXTURES. THE NORMAL RANGE OF pf-1 IS 6.5 TO 8.5. Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, B-07H EXPRESSED AS CALCIUM CARBONATE, lN MG/L. THE HARDNESS MAY RANGE FROM 0 TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. _SOFT WATER:0-70'MG4L ' VERYHARDHHTEF«'ABUV�-30O1G/L' MODERATELY HARD WATER: 70-140 MG/L MG/L = MILLIGRAM PER LITER HARD WATER: 140-300 MG/L (1 grain/gallon = 17.2 MG/L) SUBMITTED BY: Director METHOD EL.Al"41h 10323 t�,r✓o`y�. K1 �► :. � , . /ELI "E�a�i 3 S1 ,- :." � �_ r --- .--',_ `` - .Sy.s /6+a4 co•� si s �.3 O T a ./�d0 a /1.,� .�'�,�•�!'�' ock�et�.+u 3a8, is® ap�'te�v H9a�9�t; <:i EXr,S��sS /rti/ 9a ►FAA •' � ' r t , t�,r✓o`y�. K1 �► :. � , . /ELI "E�a�i 3 S1 ,- :." � �_ r --- .--',_ `` - .Sy.s /6+a4 co•� si s �.3 O T a ./�d0 a /1.,� .�'�,�•�!'�' ock�et�.+u 3a8, is® ap�'te�v H9a�9�t; <:i