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HomeMy WebLinkAbout3580DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631 - 589 -8100 74.09 -1 -1 BOX 28 1, 176 L , 1 h 03580 ,r -+± Re V. 31 86 PUTNAM COUNTY DEPARTMENT OF HEALTH " Divislon of Environmental Health Services, Carmel, N.Y. 10512 �. Engineer Must Provide �.;.._ _... P.C.H.D. Permit fl -= - - -_ -- RTIFICATE OF CONSTRUCTIO)) Located at ✓ °' �i ' Owner /applicant Named MaWng Address FOR SEWAGE DISPOSAL SYSTEM � �-�l 1W I%7 Town or Village Tax Map Block Lot 4 LFormerly Subdivlsioti NamQ lra, 4 :S, "Z9ubdv: Lot # Zip S Date Permit Issued 'n;� e' Separate Sewerage System built by Address r y / Consisting of Gallon Septic Tank and Water Supply: Public Supply From Address or: Private Supply Drilled by Address ry r-. F J •' Building Type r / lL ge," 'Y Has Erosion Control Been Completed? • NG Number of Bedrooms Has, Garbage Grinder Been Installed? Other Requirements I certify that the system(s) as listed serving the.above. premises were constructed essentially as shown on the plans of the completed work ( copies I f which are attached), and accordance with the standards; rules and'regulati in ac rdan th. he fi d' lan, and the permit issued by the Putnam County Department bf Health, t Date + _ ertified by P.E. R.A. .�.— Address �S,• I" " 4 Licence No. Any person occupying premises served by th above system(s) shall promptly take such action as be necessary to secure the correction of any unsanitary conditions resulting from such usage. Ap rovsl of the separate sewerage system shall become null and void as soon as a pubti: sanitary sower becomes available and the ap royal f the private water supply shall become null,.and void when a public we wpply becomes available. Such approvals are 'subject to modifi Ion o change when, in the judgment of the - Is rier. With, s r Ion, modlflcat n or change is necessary. Date /�' / BY ` Title ry .. YM L EnAronmental servicea w4{ 321 Kear Street, Yorktown Heights, NY 10598 FLAP #10323 (914) 245 -2800 RUSIN, RICHARD 81 ELIZABETH STREET SCARSDALE, NY 10583 (914) 792 -4199 COL'D BY I MR. RUSIN NOTES X ANALYTE RESULT UNITS r S.U. ALKALINITY mg/L mg/L AMMONIA mg/L mg/L CALCIUM mg/L `. mg/L CHLORIDE mg/L rrtg/L COLOR Units mg/L CONDUCTIVITY umhos /an mg/L COPPER nV/L NTU CORROSIVITY LSI LAB NUMBER 32.0048001 DATE /TIME TAKEN 9/16/91 10 AM DATE /TIME RC'D 9/18/91 11:50 AM DATE REPORTED 2 9 9 BASIN: SAMPLING 316A BARGER STREET SITE PUTNAM VALLEY, NY 10579 For Lab Use Only w'-'Potable _ HNO3 _ pH LT 2 <4C _ Nonpotable _ NaOH _ pH GT 9 _ <20 >4C _ HCl _ Na2SO3 _ >20C — STAT• H2SO4 ZnOAc DETERGENTS mg/L S.U. FLUORIDE mg/L mg/L HARDNESS mg/L mg/L IRON mg/L mg/L LEAD rrg/L rrtg/L MANGANESE mg/L mg/L MERCURY mg/L mg/L NITRATE mg/L NTU NITRITE mg/L mg/L ODOR TON LAB NUMBER 32.0048001 DATE /TIME TAKEN 9/16/91 10 AM DATE /TIME RC'D 9/18/91 11:50 AM DATE REPORTED 2 9 9 BASIN: SAMPLING 316A BARGER STREET SITE PUTNAM VALLEY, NY 10579 For Lab Use Only w'-'Potable _ HNO3 _ pH LT 2 <4C _ Nonpotable _ NaOH _ pH GT 9 _ <20 >4C _ HCl _ Na2SO3 _ >20C — STAT• H2SO4 ZnOAc 11410) 11 o MF) NIl'N P/A i ANALYTE RESULT UNITS pH S.U. PHOSPHOROUS mg/L SILVER mg/L SODIUM mg/L SULFATE rrtg/L SULFIDE mg/L SULFITE mg/L TURBIDITY NTU ZINC mg/L SPC per 1.0 mL TOTAL COLIFORM per 100 mL FECAL COLIFORM per 100 mL E. COLI per 100 mL FECAL STREP. per 100 mL These results indicate that the water sample WAS] [WAS NOT] [NA] of a satisfactory sanitary quality according to the New York State Sanitary Code, for the phkaploers tested, at ae of sample collection. These results indicate that the water sample .[WAS] [WAS NOT] f a satisfactory chemical quality according to the New York State Sanitary Code, for the parameters tested, at of sample collection. i NA = Not Applicable N = Not Present (Negative) SUBMITTED BY - -� P = Present (Positive) SA = See Attachment(s) = Also done because Total Coliform was present Albert H. Padovani, M.T. (ASCP) TNTC = Too Numerous To Count Director > = GT = Greater Than < = LT = Less Than b Vr4 5 �y �� =0.. t •yam a, .e WELL UUrirLLT1VW "rvKi DEPARTMENT OF HEALTH Division'Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET ADDRESS: W TAX GRID NUMBEk VALLEY WELL OWNER NAME. ADDRESS. SCA9115 PBIVATE MR. AICWMA T mnerl PUBLIC USE OF WELL 1. - primary 2 - secondary RESIDENTIAL ❑ PUBLIC SUPPLY 0 AIR /COND. /NEAT PUMP O AB NOONED O BUSINESS ❑ FARM E3 TEST /OBSERVATION 0 OTHER (specify) O INDUSTRIAL 0 INSTITUTIONAL O STAND -BY ❑ MOUNT OF USE YIELD SOUGHT _ gpm. /N0. PEOPLE SERVED EST. OF DAILY USAGE A=til. REASON FOR DRILLING )SC NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O TEST / OBSERVATION 0 REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH ft. STATICVATER LEVEL ft. DATE MEASURED 5718-i[2 DRILLING EQUIPMENT 0 ROTARY• RCOMPRESSED AIR PERCUSSION ❑ DUG 0 WELL POINT O CABLE PERCUSSION 0 OTHER (specify): WELL TYPE 0 SCREENED O OPEN ENO CASING, OPEN HOLE IN BEDROCK O OTHER CASING DETAILS TOTAL LENGTH _cV- ft MATERIALS: IWSTEEL O PLASTIC O OTHER LENGTH.BELOW GRADE a ft. JOINTS: 13 WELDED ,KTHREAOED OOTHER DIAMETER in. SEAL: MtEMENT GROUT O BENTONITE C3 OTHER WEIGHT PER FOOT 1b./It. I DRIVE SHOE.XYES O NO I LINER: O YES RMO SCREEN DETAILS DIAMETER (in) SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (n) DEVELOK07 FIRST o YES oN0 HOURS �.... SECOND GRAVEL PACK O YES O NO GRAVEL DIAMETER SIZE: OF PACX In. TOP OEM K eOTTOra OEM IL WELL YIELD TEST I( detailed pumping METHOD: O PUMPED tests were done is in- COMPRESSED AIR formation attached? O BAILED O OTHER ; O. YES O NO it more detailed formation descriptions ors eve analyses WELL LOG are available. please attach. DEPTH FROM SURFACE Water stir. ing Well 04. meter FORMATION KSCRrPT0N c* ft. WELL DEPTH ft. DURATION hr. min.' ORAWDOWN h. YIELD qCm. Surqu AL gcd I I MATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE II MATER "ry CAPACITY DEPTH - VOLTAGE HP WELL DRILLER NAME - ,a,� O f DATE f . le ST 1 Al ylcU-1y - PUTNAM COUN'T'Y DEPART OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Ila/ Owner or Purchaser of Building Building Constructed by Locat' Street Municipality Building Type Section, Block Lot Subdivision Name 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 "Certificate of Construction Compliance" for the sewage disposal systan; 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 system. 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 system. Dated this % day of 19 Signature Title General Contractor (Owner) - Signature Corporation Name (if Corp.) R- - rev. 9/85 mk Corporation Name (if Corp.) ess C TA * PUTNAM COUNTY HEALT H 'DEPA RTMENT 1•la' GOiMBRfl rr DIVISION OF`ENVIRONMENTAL HEALTH SERVICES Ak z John M. Siirunons; M. D. Deputy Commissionei:of Health - FIELD ACTIVITY RE FORT = Sheet j'. of INSPECTION NAME Ru5!!J x Orig. Routine ~ Orig. Complain ADDRESS BARbC -2 srRC -f PuT1;IRM° VAS —_ Orig. Request No. Street Municipality (T)4(V)(.C) Gompl'iance .Y ' '' .,' - , . Y. ...' ; Complaint Comp MAILING ADDRESS Final P.O. Box Post' Office '-Zip. Code „' Group Illness Construction TELEPHONE ti ' ✓ Reinspection. PERSON:' IN. CHARGE- _ .: - Field, Sampling Only OR INTERVIEWED Field Conference '.: Name-and Title Other : :'DATE 0 1$ . $10 :TYPE FACILITY _ q5 TIME.ARRI.VED �J.-'. ;. TIME LEFT IL Explain- FINDINGS,: tlovsE ts` 'ML[_" VaDFtZ E NT�:ua7 WNAhn F1 At, ITje�t ; S iIC '!'Aar- Wk. Be 'AS' T" nro6 Na ASSa2P"RoN �EtDS ` wE SPot<Fe�pr 'i1RFu N DETAILS C3EE- REYip-q 'FbR. A F[kA L " I N S PFcit� "N .` ` iV FAR " W1 KT..$ TIM �, L:F i� id IN 'P G. H D' ' A'tV D I� GO�[TACt- itT f 4t. NEi�65 . v Y a _ "PECTOR• ' INS C- f�Vi2e�('M`C�RRTAt.. NEWlN AIDS TELEPHONE: Signature.and ltle PERSON IN' CHARGE'- OR ;INTERVIEWED:' �J °acknowledge - receipt of a copy. of this ,­ SIGNATURE:,, Field Activity Report. ...: _T:ITLE ln: `of'A Budding Type 4r-,f-- CIP17 'Lot, Ar N Design Number of Flow G/.P/D 2 f Sejiaiitil��ew6rage System �t '0 To be,coAstructed by 'Water St.jpply: Priyate Sqpp.ly,ao,,6e drilled_ . -7� Address.., Othei •Requireme his I represent that I`,anj':wholly 4nd..eoiii'pletely iisoonSibief o • .:above d­e scribe d will .b--e c6A struc ed' asshown on t e'approy County:' - Department ,of Health, that on1complition i ,,:6e,,Su&,mitfed to.. the.'Departmeni.:-incl a;,Wrlfteh '9U;aiant ­N will be located as-.'shobkh 'th pn e.appi Date -Ada 'APPROVED FOR CONSTRQCTIO requires a.-new permit.,. 'Appcovp Date e j 7 .I­_L,- � ftV­q'8j # N_T7V`IiEPARTME .:HEA H �0­ ql,,050 �, r-:.it -' - . -- &­V-1 ), '. - -H# fih IUD CC Vi Carmel N Y_ 10592 l M, L 9'6T, E l M Town or­V !10, k� C illage Tax c ';Silbd; Wt Renewal :R_eviifon Date; Of Previous.,Approvaji rilr,Section 6fil Y ❑ W P.-q. H. O.'•otification Requir;d G 777777.,:,`�, a i� Septic Ta a and % Commissioner of Heilthwill builder, that 'seid� bu-ilde_r will . ol 10 W in 9 the.Cliti'o the , issw- ,grilled well described above P.E.". R.A. ."U'cense,,No. nsii 1 '0. the building,has beeh undertaken,and is 0"! h ,0, A ny c. a ge�C joirtiration of construction pply only d 'Title Y r PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner. ,3 i. A. U,- l �j ti�4ddre s s �j ���,,q�� 1, Located at ( Street* • e,1 Sec. Block Lot J ,/ � nd e nearest cross street). Municipality ,f w OkW7 Y 1.) 11:4 Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run apse Depth to a er Water Level No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Tnches Inches Inches 4 34 zI q�/j- )2,- -___7V -Z-> 4 4 5 2 3 4 5 Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. A11 data to be subriiitted for review. 2) Depth measurements -to be made from top of.hole. 2- 34 zI q�/j- )2,- -___7V -Z-> 4 4 5 2 3 4 5 Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. A11 data to be subriiitted for review. 2) Depth measurements -to be made from top of.hole. w TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G. L. ✓ t> �+ % / Of 12" 18 "cow 24 30.. 3611 42" 48" 54 60" 66" 7211 781f 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED c "�!" e- INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTE7 TESTS MADE BY -� 1/a j) "+ ylcz�i► Date i % DESIGN Soil Rate Used_y_Min/l "Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity /O0 s,, Gals. Type 1 -011 i Absorption Area Provided By Z±-e L.F.x24" 3b width trench. �— j } t Other c \ ei .S �t?n'k F- �V J 1 i fC 'eA� �'AsO° ��.� Name v 5igna r Address l vnj ,• o .Q4 •V•.v 2481 000-0-4? - THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: ��.,,`' °•'•�Pti o� Soil Rate Approved Sq. Ft /Cal. te Checked by a �`` �t Do :1 Tm'& 16 to cerc fir that the :he seraSo df,^ oEai tryst 'br plan, a G=am nluo 's lild cm. ­ad -1 thT nd na. �=�;t tea vas - i i. .. yor. n4 J ., b,,rifbl�o' It ms 0 red A wa- iv', A1-1 �staf;Ao .:M-9,e!k t,� i'�- d aocordanao will aa6l ie�Ulat I ozifl-of the Pu'nam County .D°pfxrtlOnt. 'th a the b-t 6f _' fe'al't' h md e Dc-,partzo, AS BOLT -SEWAGE. DI-SROSAL.,,SYSTE ftt=a uounvy usparTmenz ox. v�p­pw 'Health jUVISIon of jhvironmeptal Beeft 6 r�;ied for.c6nformnce with 6f the JOSEPH' F..SU�LI,VRNP.E. 4plicable ffideS and RsgulstlOne. ..t ktmLm County Healt"pr - ment. x -YORKTOWN -HFjGHTS,.',NEW YORK ro .0 ;i- t .404, k j % I 3 _ 77". of- Yo lov Tm'& 16 to cerc fir that the :he seraSo df,^ oEai tryst 'br plan, a G=am nluo 's lild cm. ­ad -1 thT nd na. �=�;t tea vas - i i. .. yor. n4 J ., b,,rifbl�o' It ms 0 red A wa- iv', A1-1 �staf;Ao .:M-9,e!k t,� i'�- d aocordanao will aa6l ie�Ulat I ozifl-of the Pu'nam County .D°pfxrtlOnt. 'th a the b-t 6f _' fe'al't' h md e Dc-,partzo, AS BOLT -SEWAGE. DI-SROSAL.,,SYSTE ftt=a uounvy usparTmenz ox. v�p­pw 'Health jUVISIon of jhvironmeptal Beeft 6 r�;ied for.c6nformnce with 6f the JOSEPH' F..SU�LI,VRNP.E. 4plicable ffideS and RsgulstlOne. ..t ktmLm County Healt"pr - ment. x -YORKTOWN -HFjGHTS,.',NEW YORK ro .0 ;i- t .404, k