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HomeMy WebLinkAbout3434DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.18 -1 -1 BOX 27 ,. IN IN .� i JIM ON m IN ti Ile so r IN IN I NMI ■ �k 03434 .' r`N. �' TNAM COUNTYDEP�ARTMENT OFrHEALTH PU , e a K a _ ; 4 pivrsion of Eniiir`onmental Health Services, .Cam% N Y 10512 _ ` x �•; �Tf :t'}iV1�'p�ti�`i0 - 00filt" '�1111��� FOfi `J��1��C^'����r�i^°� � .. •c ,�.v Town or- 'Village' ' ... `3. �. Other requirements• Water Supply 4- ubUc Supply From � - > Private 'Supply DnlledGBY �'�'_e :sc•a"5+,y mt,6• '� .,,�, y xt x'- x.. may,. •�' e _. dress Building -.Type, �° �►' _ ... c x 2 f s Has Erosion Control Been Completed I certify, that the system(sj tas Iisteil serving the $ ` attached) and-! !in accordance with the stands V : - --11�� r r ti QAddres 3�� +d Imeai *aFeet X, width trench No of Bedrooms J Date Permit' 1'ssuetl es5entlally " Shown 461064'p lans oft completed work (copies of which are led'and a permit issue y th Putnam Courtfy Department of',Health.. VA License., License fVo. %+Gs (1p y take such action as maybe necessary�to secure the correction of any unsanitary system shall become ri'ull and is soon as •-a public.sanitary :.sewer becomes Arid void'When a public water's ply becomes`,availabie' Such "'approvals are im)fsoner t Health; such{ rev n modFflcation or change is necessary. 6 ` r w Title;.. WELL COMPLETION REPORT PUTNAAA (COUNTY DEPARTMENT OF HEALTH lit Did lion of -Environmental Hoalth Sarvices COUNTY OFFICE BUILDING • CARMEL, NEW YORK `[bit report i's to be completed by well driller and sLI: . :sited to County Health D41irtmew together with laboratory. report of i .a „ "...: ':. ; , :�sizo�av $tom :��iiplc'i�Eti a7if�g v�btei o�o( r3�aci r� bacterial•' cqualitV- b6f ore- certificate of-eor►structiomcompliance is= issued: REPORT PdIUST BE SUBMITTED V11THIN 30 DAYS OF WELL (COMPLETION OWNER pf ADDRESS dad (No. 6 Street) f (Town) (Lot Number) QOCAYION OF WELL p i a d � T a�•. o 0 BUSINESS ® TEST WELL PROPOSED _ DOMESTIC ESTABLISHMENT FARM 414E OF YfdEll a CONDITIONING ® OTHER ) SUPP Y INDUSTRIAL DRILLING [0 COMPRESSED � CABLE � PERCUSSION ® OTHER (Specify) [EQUIPMENT ROTARY AIR PERCUSSION CASING LENGTH (feet) I DIAMETER (inches) WEIGHT PER FOOT � ❑ WELDED DRIVE SHO WAS 45ING G %O T ® YES NO YES CD NO DETAILS 0 C THREADED. — _R� HOURS G.P.D-IL YIELD (GY.M.) YIELD VEST BAILED PUMPED ® COMPRESSED AIR WATER FROM LAND SURFACE- 5TATIC(Speclfy feet) DURING YIELD TEST fleet) Dcp& of Complelad W ?11 LEVEE /1 �✓. in Qoet below Land surface: MAKE LENGTH OPEN TO AQUIFER (feet) SCREEN DETAILS SLOT SIZE DIAMETER (inches) If GRAYEL Diameter of w ell including GRAVEL SIZE (inches) FROM (last) 70 00 PACKED: gravel pack (inches): NPTH FROM LAND SURFACE[ FORMATION DESCRIPTION 'I a <-c✓ i V 4 0 a Sketch exact location of well with distances, to at least two permanent landmarks. &Z— If yield was tested of c0erent depths during drilling, list below FEET GALLONS PER MINUTE 00 p a M DAIR Witt JOMPLETED DATE Of REPORT WELL D ILLEn SEP 23 7982 OF HEALrH 6 ner or Purchaser of building w zu/ c Location - 'Street Building Type a f;a1L:;• .. Municipality Block 1 Lot GUARANTY OF SEPARATE SMIAGE 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 -t.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 guaranty 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 tc��o years imi,iediately 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 occupant of the building. utilizing the gvci -nm The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environmental 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 utilizing the Dated; this day of 19,&- Signature 1 �.' Cam✓ a Title A/4 (if corporation, give name and address; ----------- ---- a--------------------------- .---- .-------------------------- -----=------- Tf*IREE� (3) CQPIES -ARE REQUIRED WITH THREE (3) .COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETI O;1 • SILL BE ISSUED. GUARANTOR IS - REOUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. � . - .- - - -- ---,------..------------- e------------------------------------------- � Division of Environmental Heal'th.'Services., 'Putnam County Department of Health :E CE, I W pEPT, QF i-iF i; :i� .0. Box 99 321 Kc Street Yorktown "Heights, N.Y. 10598 245 -3203 LOCATIONS: I I :171 KI:AII :T., YOIIKTOWN iiriciii.rs. N.Y. 105911 :•15.3203 U 201 BUTTONWOOD AVE.. PEEKSKILL. N.Y. 105GG 737.8777 111 405 MAIN ST., MT. KISCO. N.Y. 105.10 6GG•3335 I. I STONELEICII AVE. (NCAII IIO :r ITAL1. CAIINIEL. N. Y. 10512 771 V ?�!w �sttlJ ' <p'NL9v".vbn`� "YNW46l.- • >.49Y CP� .��l,�'FT���Y.A "?'ASTi�`�4'T ^'F M�r,;fM i�.t'TAVt 9�FA•^.I'Y'F' ORCAODD PuTlifim L 1 J LA130RATORY REPORT mq /L DATE TAKEN: _ DATE RECEIVED: DATE 11121'01"ITED: SAMPLE SOURCE :, 1`1EFEnnED 0 Y: COLLECTED BY :- P. OeLil&- 7 0 ❑ ACIDITY ............................ ............................... CI ALUMINUM ... ............................... ❑ ALKALINITY ........................................... :........... CI ANTIMONY ............................ ................. XBACTERIA, TOTAL /mL ...............//....... .. ....... CI Af1SENIC .................... .............................• .............. BOD. S DAY ...................... ............................... .. CI !IAnium ....................................... ............................... ❑ BROMIDE ........................ ........... CI ocnYLL1UM ................................ ............................... OCARBON DIOXIDE. FREE .............................. .... L.I IIISMUTII .. ........... . ...........................:... ........... OCHLORIOE ............................................................. 1.1 MORON ................. ............... ............................... ❑ CHLORINE .....................:...... ............................... CI r :ADMIUM .................................... ............................... OCOO ....................... . ........ ............................... . L.1 CALCIUM .. ............................... ............................. OCOLOR ............ ............................... ................ CI f :I'InOMIUM (tot.) ........................................................... ❑ CYANIDE ........................................................... Cl CHROMIUM (hcnavalent) .................... ............................... ODETERGENT, ANIONIC ........................................... Cl COBALT .................................... ............................... OFLUORIDE . ........................................................... Cl corpm ..................... ............ ...................... .......... OHARDNESS ................. ........ ............... ....... CI GOLD ........................................ ............................... MPN COLIFORM COUNT/ 100 ml ........ CI Incr ......... ............................... ........................... H T COLIFORM COUNT/ 100 ml D ....................... CI I ra,C .............................. ........... / CONFIRMATORY TEST ............ ............................... 0 LITHIUM ....................................................... :........... ONITROGEN, AMMONIA ........................................... O MAGNESIUM ................................ ............................... O k�TROGEN. KJELOAHL ............ ............................... CI MANGANESE ... . O ROGEN, NITRATE ... CI mEnCUnY' ............................ .............................. . ROGEN, ORGANIC ......:.................... . ...............`C) NICKEL' .:....::....:.......................... ............................... ❑ ODOR ' . ....... ........................ .. 0 I`ALLAOIUM ............................ ............................... ❑ OIL & GREASE ....................................................... O POTASSIUM ............................................................... ❑ PH •• ............................ ........................... n- I10DUM ............ . ' .. ........ . ............ . .......... . ............................... . ........................... ❑ PHENO C ;. .. .................. ELENIUM ❑ PHOSPHA (ortho) ................ ............................... 0 : :ILICON ..... .. .....:....... ❑ PHOSPHATE (condensed) ........................................... ❑ ,ILVEn ........................................ ............................... ❑ PHOSPHATE (total) ................................................ CI nOOIUM ......................................... ............................... ❑ SOLIDS. SETTLEABLE, ml /L ............... CI rIN. ............................................ ............................... C} SOLIDS. SUSPENDED .. ............................... ..... Cl /.INC .......................................... ........ ..: Ell ❑ SOLIDS. DISSOLVED .......... ............................... CI ................. ............................... ...� : O soLlos, TOTAL ..................... ............................... n .................................. ....................... .....:.. . 0 SOLIDS, VOLATILE ..................... 1..,,, ........ ,..,......... Cl r1r: MAnKS: ............. ......................... .5 ...........:........... ® 3PECIPIC CONDUCTANCE ......... ............................... CI ........................ ....... . ..... ... ... . .......,.,.�5,4,,..,,.�►,,,,.,. OSULFATE ...................... rI ... ..................�f'd... .... ................. OSULFIDE ............................. ......... 0 :. p ... ❑ SULFITE ....... ....................... ............................... Cl ..............:.........: ......................pr...�':� ❑ SURFACTANTS ..................... ............................... .CI ................................................... ............................... ❑ TURBIDIT.. ...... ................................................... (.I ............. ................... ..................:... ..... _. ........ THESE RESULTS INDICATE THAT THE WATERMASLka OF A SATISFACTORY SA�4ITARY QUALITY WHEN THE SkrPLE WAS COLLECTED, THESE RESULTS INDICATE THAT THE WATER DID _ mr.0 THE SATISFACTORY CIIEIdICAL QUALITY OF NEW YORK STATE ADMINISTRATIVE.RULL:S & RI:GUI \'[TONS, DRINKING 1JATF;R STANDARDS (PART 72) ALBERT N, PADOVA>\'I Pi, T (ASCP) , DIRECTOR: %4 G2 Ae :`P hllc�Stj 5. pg- fock ldib M04 Y A eel sa or,, bd well. described.above Putharri License Sf . . 119 F I I E LT) C I U!, CK LTST. Date:o Insp. by: INITIAL 'SITE INSPECTION Yes- No. Comments Property lines or corners found o 0., 0 0 ..0 Can estimate house location o 0 Will driveway need cut . . .. . . . . ... . Must trees be removed-note these o o Is'deep hole repi-esentative of entire SDS area Additional deep holes needed. a 0 0 Sufficient SC)9 area available considering driveway cut house location,separation . driveway distances., etc. a 0 0 . 0 0. DEEP HOLE DATA Depth: Water elevation: Rock elevation: Soils description: Date: FINAL SITE INSPECTION Ins p. by:/--) House .located where shown on approved plan- ST.)S loo;l?,ted i•There spprove . . . Width of trench average 3' ..Slope of the line and trench acceptable. Room allowed for expansion :trenches --Over_ 59 Lt.. from swamp ,,,Tatercoursje,,_.. ?Ve mural soil not C) --- or; - ­7 stripped S a( 3 area - dr 7 unnecessarily graded . . . . . . 0 0. 0, a 0 .10 It. maintained from prop.line and 20. ft from house o 0 C* 0 a Separation of.trenchfrom house., well etc. follows plan e . a a 0 Number of bedrooms checks 0 0 0 0 Stones., brush, stumps., rubble, etc &eater than 15 ft . from nearest trench a 0 0 .15 F. of peripheral soil horizontally from trench 0... 0 0 0 Q� 0.. 0 .0* 0 0 Junction boxes prope-L-ly set Could surface run of'L ' from driveway, roads ground surface., etc. cr znnel near. SDS .area.. o o Does lot drainage appear 0_.i. :*in** area of SoDS' 'FINAL. GRADING OF SITE ACCEPTA= XACI a4e PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 4...� i :,i1". Ts,;- •e.•.vG. cr=.. �.s� 4 -?i'•. .. ._ ;r:;t�es:t- "rte,:.. .:wf. :y':: : _..:.faun ,:.y>s. ' i ...,.. _ ..+ti«'+;- %.:.� 1 .Y ' .3' .•n. . COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA; SHEET- SEPARATE SEWAGE DISPOSAL, SYSTEM FILE NO. Owner R0,Yi 'jG/G �7��a�v� Address._/RA'6 �le 7.x% Located at (Street / /G/ �11� . % Block Lot Indicate street) nearest cross Municipality T";" �� �, A11" 1 :zz Watershed �islr�r:c 7 SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole 17Z Number CLOCK TIME PERCOLATION 3 /:2 PERCOLATION _ ,Run Elapse Depth to Water Water Level 7.3 No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop ._.. Inches Inches Inches, 1. %* 10'-';?j f-' 2. `' WN 4�" 5 Notes: l) Tests to be repeated at same depth until ap.proximately equal. soil rates are obtained at each percolation test hole,. loll data to e submitted* for review. 2), Depth measurements to be made from top of hole. 17Z 7-3 3 /:2 / °,a te i74 3 7.3 1� r 3 /e- 2 /P' 9 4 5 2 3 5 Notes: l) Tests to be repeated at same depth until ap.proximately equal. soil rates are obtained at each percolation test hole,. loll data to e 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 fOT°N0. • ��,�'���. G.L. 6" g g 12" 7,4 q toi�- q�v- �� 2411 �1 � 30 a 36" 4211 4811 5411 60" 66 72 1r 7811 Ar 'i 4 0 K �1 .:'INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED rive. :INDICATE LEVEL TO WHICH WATER L RISES AFTER .BEING ENCOUNTERED .TESTS MADE BY �i�D�i� Date OcT, DESIGN Soil Rate Used % Min/1 "Drop: S.D. Usable Area Provided j, No. of Bedrooms Capacity .��'� Septic Tank Ca ��rczr� P p y Gals . Type Absorption Area Provided By %7? L.F.x2411 width trench. Other ZI I Address I-THI8 SPACE FOR USE BY HEALTH ure Soil Rate Approved Sq. Ft� eked by _ Date @I M PUTNAM COUNTY DEPARTMENT.OF HEALTH Date. /loll- /%% Re : Property of ko A/' o 11 e—: Located at ZUjC�l h94Z) A Al A,-- q _._-Block -Lot 41A, TI-A Gentlemen:' LEY LMDER This letter is to, authorize; STAN a duly licensed . professional en gineer LIZor registered architect (IndicaT_e7_,. to apply fora Construction Permit for a separate sewerage system; to serve the above noted property in accordance with the.standards,,'rules or regula'tionsas promulgated by.the Commissioner of the Putnam County 't of Tlealth - -A 4­0 s ign all nQ-c,-.qj3Cs,—.LY pa,,,--.,,s — r" b el— I -P In nt�partrijel _L UI.J9 CIIIU U W" LIT connectionwith this matter and to supervise.-the construction of said I$y: tem­ or,,'..* sy§�qms -_:9,qnformity with -the-provisions of Article 14 or. ., .5 147, Education law, the Public Health Law.,..and the. Putnam County Sani- tary Code.•. Col ersignIe... P.E. Very -truly -yours Signed 4xw& -.'Owner of Property Address V 9 35"- e ep one IPUTNAM COUNTY DEPARTMENT OF HEALTH DffWSRON OF ENWRONMENTAL HEALTH H SIE11 VE CIES APPLICATION TO CONSTRUCT A WATER WELL r: Wen ILocadoans Street Address: � Town/Village Tax Grid # 26 Luigi Drive Putnam Valley Map Block Lot(s) Wen Cwmea°e Name:' Address: 126 Ronald Orlando Luigi Drive, Putnam Valley, NY 10579 Use of Wen: x Residential Public Supply Air /Cond/Heat Pump Irrigation I- pnimairy Business Farm Test/Monitoring Other (specify) 2- secoandmiry Industrial Institutional Standby Ammou not of Use Yield Sought gpm # People Served Est. of Daily Usage _gal. Ressom ffoir Replace Existing Supply Test/Observation Additional Supply IIDniflftmg New Supply (new dwelling) Deepen Existing Well IIDett fled Reasons .r 11, dls h to; V0 4,kc,-t b vv� for IlDrflUimg Wen Type X Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? .................. Yes No -L Name of subdivision Lot No. Water Well Contractor: P. F. Beal & Sons, Inc. Address: 4 Rt=Ave., Bmwster, NY 10509 ............................ �. �.�...a....... p.......... Yes No ?1, Is Public Water Supply available to site? . " Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be pr i e at eet/plan. Date: 10/20/98 Applicant Signature: - PERhUT TO CO N UCT A WATER WIEILL This permit to construct one water well as set fo above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED *FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue L - �r �% Permit Issuig Official: �- Date of Expiration Title: Pea°mmit is Non- TransfferrabRe --� White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 ' c - ` �. m, ' I �. ' I •�i •s 't t Y 1 1 e J3 f L; t r! 6t •mow..¢^ {�.� ' t. -. Y i - A s'r i 1 g � �.. . � fir• J ` - <. • f 1 ((��� 1R) .. •4, T,. y <� S~ i. .. ! fttnam Co=ty pepar'tm (y, • V.r�. .y's. :. ry.'F'.. �:a<r+: . t ?,� ew G'-. t, �v. �. :`i- ,x_•.. v,' .M710im .v iT!'.1SII° A t-g . ..,. ., _ __ !{ .1 ac ro—_3 caaformaTSCe with d f'; 1 is °lis son sc d atioas bf the our i 'G2'?ep3r , 1 � t`w gnat+ae T .