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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
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