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Home My WebLink About3740DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.19 -2 -4 BOX 29 ON IN MN NN r '_ T MEN INNER M 03740 7', T 'L��,� ,t _� t 2., A NAM" COUNTY* DEPARTMENT f'- HEALTH ', 4e t"C' *24— !IMP 4WI4 '4"HA4M;.0 W_ 2 Vb _"CONSTRUCTION17 MPLIAW ERTIFICATE OF Ct..,FOR,,,""S.EWAG.E.DISPOSAL SYSTEM Magi T 4 Hlock p 14 OWneI "k i'Lly W Separate Sewerage System -built /46 y C J "V t6hilsting -of-- �00 0. "Other requ roman.. 4,- M % Oar, ��i's Ir. �, ;7� �,,_qbIiC;SUPPIY;,,Fro A .�,Prj4ate', u pi rilled-.By- 3, Address r 77 , -SwIdI69 Type , j, Date lit sided A:' 7:. that' thii"sysifiliQ n -j6laris . of-, th�� completed work. -( .,--,copies 1, ceitify� S g q a�7 -Ni��I_cd a Ctj�d eattache q.,preinises b_ h, the, 0*4�1- issued by -the jo�g.�d.id' �- of which ii anc' WI tC+A":,A Putnam County ':Department 147 "'J RA: "P 9F pate WIPNAL C I, P --A f License Wo..� q unsanitary �Any ;pjrsqp,,�,pScupV rig, prej so, jiai,*�, ob" !MpltjV-_.take Iu46h,aajonZjS mf�l ba;n#6its&y. it f separate SeWirao 6iidifibrii resulting 66m,-iiiih�fu 0 ;as soon as. &-pubii� Aji.iiy46`w`er", mes i6rnft -SVO WDI , 0 , i,,- ; 'Such. op'p"l are yo id avilli6hi ir4 t6 oll� n-itiIA, a 7— A iupj ill t6--46oiii0iciot, th'. h ha-!-! -.-:,-in e' jy �grnen -, .0 'the ,,Co' of � ,Health' , i (fiIjition or'ehangs is nacesmary. 7 bil P, Date a a k, X� 9781: Rev. J.L : iJ 15 CA 1.f Owner_ or Purchaser-of Building Municipa .ity. . BuilAing Constructed by Section Location - Street Block` 2 ter 1JtCE _ Building Type Lot GUARANTY OF SEPARATE SEWAGE-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 guaranty to the owner, his succes- sors, 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 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 occu- pant of the building utilizing the system. The undersigned further agrees to accept as conclusive the de- termination of the Director of the Division of Environmental Health Ser- vices 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 _:. .. ac:t:. o.f --the oecupant.:_:.of...the __bL;?- lding- -ut li zing.. Dated this Zv day of /Q 19 ?3 Signatu Tit1 W, 'G= If corporTlon, e name and address) ,,°a- i/_Pr"ve - - - - - - - - - - - - - - - - - - - - - - - - - -d_/A -�' -a- (- - - THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health RECEI JA fV 2 0 -984 PU'f`NAM CC) T H1 Y_%f [DEPT. OF HEAL-11H WELL COMPLETION REPORT 3/71 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY OFFICE BUILDING- CARMEL, NEW YORK This report is to be completed by well driller and submitted to County Health Department together with laboratory report of ,. >. _ ;_casaEtssl.:cif,i+uat :s mple iV :ajotater;in of satisfFetory baete�iei= �ualrty� bi= ese�t a i #mete =of= cots §t Licti i pl aFicc #s issued: REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NAME Louis.Calicchia ADDRESS Cor. Wood St & Provost, Putnam Valley LOCATION OF WELL (No. & Street) (Town) (Lot Number) COr. Wood St. & Provost Putnam Valley PROPOSED USE OF WELL BUSINESS DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL 1:1 SUPP Y El INDUSTRIAL ❑ CONDITIONING El (Specify) ER DRILLING EQUIPMENT COMPRESSED CABLE El ROTARY 93 AIR PERCUSSION ❑ PERCUSSION OTHER ❑ (Specify) CASING DETAILS LENGTH (feet) 124 DIAMETER (inches) 6 WEIGHT PER FOOT 19 C� THREADED ❑ WELDED D E S O YES ❑ NO CASING YES MUTED?- � NO YIELD TEST ❑ HOURS G.P.A. BAILED ❑ PUMPED COMPRESSED AIR YIELD (G.P.M.) 15 WATER LEVEL MEASURE FROM LAND SURFACE -- STATIC(Specifyfeet) DURING YIELD TEST fleet) i Total Drawdown Depth of Completed Well in feet below Land surface= 205 SCREEN MAKE LENGTH OPEN TO AQUIFER (feet) DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: Diameter of well including gravel pack (inches): GRAVEL SIZE (Inches) FROM (feet) TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET 0 90 Clay Overburden `� 90 205 Ledge If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE F t' lye T �• �°� �� T� UN DEPT. 0� DATE WELL COMPLETED 12 -5 -83 DATE OF REPORT 12 -9 -83 WELL DRILLER (Signature) il'UKAI U11N.MCUIUAL LAbUAA I U R I IN L:. LOCATIONS: P,O, Box 99 321 Kear Street Yorktown Heights, N.Y. 1OS98� � 321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245•3203 g ❑ 201 BUTTONWOOD AVE.. PEEKSKILL, N.Y. 10566 737.8777 245.3203 _ O 495 MAIN ST„ MT. KISCO, N.Y. 10549 666-333.5 :. •. , ... ., r�L^ b,• �:,` r3NE' EEJC' rf--:` r4$ °'iNcAR=HC�SPITA��1; <.•A��;',�U N:'Y:si'051.2_i,7,,,.., r. L LOUIS CALICCHIA RFD A, BOX. 281, PROVOST PLACE MAHOPAC, NEW YORK 10541 528 -0014 I LABORATORY REPORT mg /L ❑ ACIDITY .................. ............................... ❑ ALKALINITY .................: ...... ...... { -: )dBACTERIA,TOTAL /mL .... ................. C7BOD, 5 DAY ................... ............................... ❑ BROMIDE .......... ......... ..... ........... :.............. ❑ CARBON DIOXIDE, FREE .............................. O CHLORIDE ❑ CHLORINE ................... ............................... ❑ COD ........................... ............................... ❑ COLOR ....................... ............................... ❑ CYANIDE ................... ............................... ❑ DETERGENT, ANIONIC ... ............................... ❑ FLUORIDE ................................... .............. ❑ HARDNESS ................... ..............:................ ❑ MPN COLIFORM COUNT/ 100 ml foo TT COLIFORM COUNT/ 100 ml ,d,,,,,,,,,,,,,,,, ' ❑ CONFIRMATORY TEST . - ❑ NITHOGEN, AMMONIA' ...................... ❑ NITROGEN, KJELDAHL ........................ .I....... ❑ NITROGEN, NITRATE ........... ' ❑ NITROGEN, ORGANIC .................... I.............. ❑ DOOR .............:......... ............................... ❑ OIL d GREASE .............................................. ❑ PH ........................... ............................... ❑ PHENOL. ....................... .............. .................. ❑ PHOSPHATE (ortho) ....... .........................:..... ❑ PHOSPHATE (condensed) ..tea ❑ PHOSPHATE (total),`,�yq ❑ SOLIDS, SETTLEABLE, mI /L ��- ®ice ❑ SOLIDS, SUSPENDED ❑ SOLIDS, DISSOLVED ...............4.p.f4� „, i�) ' ❑ SOLIDS. TOTAL 5l4....... 4� O SOLIDS, VOLATILE .................... ❑ SPECIFIC CONDUCTANCE ......,�.+.��,,t ; =) ' ❑ SULFATE . .................................................. ❑ SULFIDE .................... ............................... ❑ SULFITE .................... .........................:..... ❑ SURFACTANTS ............ ............................... ❑ TURBIDIT . .......... ............................... AT RF'RT 11 PAnnVANT Al T (A1;C1)) LAB # DATETAKEN: 12/29/83 (T:45 A.M. ) DATE RECEIVED: 12/29/83 9 A.M. ) DATE REPORTED-10?- SAMPLE SOURCE:I' 1191119RAIn DY:. COLLECTED BY: L. CALICCHIA ❑ ALUMINUM ................................ ............................... ❑ ANTIMONY ................................ ............................... ❑ ARSENIC .................................... ............................... ❑ BARIUM ....................................... ............................... ❑ BERYLLIUM ................................ ............................... ❑ BISMUTH. ................................... ............................... ❑ BORON ........................ ............ ............................... ❑ CADMIUM .................................... ............................... CALCIUM.................................... ............................... ❑ CHROMIUM (tot.) ........:................... ............................... ❑ CHROMIUM (hexavalent) .................... ............................... ❑ COBALT .................................... ............................... ❑ COPPER .................................... ............................... ❑ COLD ........................................ ............................... ❑ IRON ........................................ ............................... ❑ LEAD ........................................ ............................... 0,-,LITHIUM ..... i ❑ MAGNESIUM .. ............................... .......... ............... - ❑ MANGANESE ................................ ............................... OMERCURY .. ............................. ............................... ❑ NICKEL ........................................ ............................... ❑ PALLADIUM ............................................................... ❑ POTASSIUM ................................ ............................... ❑ RHODIUM .................................... ............................... ❑ SELENIUM ............................................ I....................... ❑ SILICON ........:........................... ............................... . OSILVER ......................................... ............................... ❑ SODIUM .... ............................... . ............................... ❑ TIN ............................................ ............................... ❑ 7INC ............................................ ............................... .................. ................................................................. O................. ....... ............................... REMARKS: .......A.. L.T..H...O..U..G..H... C OIRRM..Q.RGA1,11, ... ARE NOT .PRESEN. T,, W3..WQ.V.T 'T,r p RECOMMEND STERILIZATIQ,11�,.Q,� „TEL „Wj,�, ........... ❑ BECAUSE OF THE HI,C�H,•HAQ�RRIAL „QO.uNT ❑ ...... . ............................... .... ........... .I................... ❑ .................................................... .......... .I.................... ❑ .............. .............................................. _.. _ ....... WATER WAS OP A SATISFACTORY SANITARY QUALITY I,91E;1 14ATER DID/ MCET TIrE SATISFACTORY CHEMICAL QUALITY LES & RECULATIONS, DRINKING WATER STAIIDARD S (I''ART 72) OF Eg V Yorktown Medical Laboratory, Inc. ALAGRT 11. PADOVANI M.T. (ASCP) JAN 10 1984 < <c— +v.:... -w 4an -..+.. w.n.r s- �- -oe•• :.T ." .-sC.Y �sr UiPVAM COUNTs P.O. Box 99 201 Buttonwood Avcnue 495 Main Strcc ?EPT. OF HE,�t cigh Avcnuc 321 Kcar Strcct (Corncr of 202, across from Hospital) (Across from Lloyds) (Corner of Drc%wMe Road) Yorktown Fkiglits, N.Y. 10598 Peekskill, N.Y. 10566 Mount Kisco, N.Y. 10549 Gumcl, N.Y.10512 (914) 2453203 (914) 737 -8777 (914) 666.3335 (914) 278 -9330. Wells or springs which have been altered, repaired, newly constructed or accidently polluted should be thoroughly cleaned and disinfected before a sample is collected for a bacterial examination.. The side walls of the basin or pipe, the exterior surfaces of the pump cylinder and drop pipe, and the walls and roof' above the water line where a basin is provided, should be scrubbed with a stiff bristled brush as far as this is possible and washed down with a. strong chlorine solution. A satisfactory solution for this purpose can be prepared by dissolving sodium hypochlorite (laundry bleach such as Chlorox:,Rose- X,Dazzle, etc.,containing 5490 available chlorine) in the proportion of one pint to twenty five gallons of water. After cleaning, the well or spring should be disinfected as follows: 1. Mix two quarts of laundry bleach -in ten gallons of water and pour this solution into.the well. or spring while it is being pumped. Running the adPr_�int l _tine. pra_s�z��:_'e .rlrc�ps .zn .the. presS��rP tank will. -cause -the, pump- -. to start. Run water from all the taps in the house, one after the other, until the water at each tap has a strong odor of chlorine. It will.be necessary to open the valve or plug in the top of the pressure tank, if provided, in order to permit the strong chlorine solution to come into contact with the entire inside of the tank. Air must be readmitted and the tank opening closed when pumping is again started.. This procedure will sterilize the entire distribution system. 2. After this, dissolve two quarts of laundry bleach in t-en gallons of water and pour solution into the well or spring. Allow well or spring to stand idle from twelvE? to twenty four hours and then run water to waste away from grass and shrubbery until the taste and odor of chlorine disappears or is very faint. Several days should elapse between this treatment and the collection of another sample.for bacterial analysis in order to insure that a representative sample.free from chlorine is secured. Until the water supply is shown to be safe, all drinking water should be boiled. More information about wells and their disinfection can be obtained from the following pamphlet available from the Superintendent of Documents,: U.S. Government Printing Office, Washington 25, D.C. "Individual Water Supply Systems" - Public Health Service Publication #24 (25¢) � - -W,.- PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. DESIGN DATA SHEETT - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner T3/(.1� D �� Address I)A,,.Jt,. , /J Located at (Street ,QV p<Z1r Sec. 6-S Z Block Lot . l �4n ica-e nearest cross street) Municipality PL-1WA-01, ,QC.� -t- Watershed /J SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS hole Number CLOCK TITT' PERCOLATION PERCOLATION Run. E17a,pse Depth to Water Water Level .No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop lncne� lncne� 11V1 1 1 i S i fl I Z 210 2 `� ~ 3q Z I 2 Z3 3 ? 5 10 31 1 9 - � 2 2A 3 5� . .'O 2 Z Z 1 4 5 1 ti�� 34 t c� Z,Z (o 2..__g ''�- 59 Z 1 I Z� 3 Sl - 1010 � I 2 � � • � �. ! 3 � _ 5 EC JUL 2 61983 PUTNAM 0 'viy Notes: 1) Tests to 'be repeated at same depth until �A�ual soil rates are obtained at each percolation test hole. to ubmitted for review. 2) Depth measurements to be made from top of hole. TEST DEPTH HOLE PTT :DATA REQUIRED TO BE SUBMITTEDW ':, ITH APPLICATION� DESCRIPTION OF' SOILS E I .ENCOUNTERED N TEST HOLES NO. :: HOLE NO. HOIAZ. 'NO. 6" 1211 s A, N Ci C L-C?AM 1811 2411 3011 3611 42" 4811 5411 6011 6611 7211 78" 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LE.VEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY V- rs&mm ASSOC, . Date Izes 11 Rate Used 6� -7 Min/l"Drop: S.D. Usable Area Provided 00o No. of Bedrooms 3 Septic Tank capacity I C)OO Gals Type." A61qofjey Absorption Area Provided By -0.7nDL.F.x24" width trench. ' Address SEAL WILLIAM A. KEANE AssocIATES, P.C.- A PROFESSIONAL CORPORATION THIS SPACE FOR USE BY HEINH DEPARTMENT ONLY: .. Soil Rate Approved_ Sq. Ft/Gal. Checked by Date rZ i u i- z u" 198. 3 PuYt-JAM COUiMTY U f. OF ki-Hd.'T-H FIITNA1 l 000NTY FY')': RT1 TNT 01' 111'.,T,TN : - • L�T;1;=T'SNgN' G F' .��'V'I Rc '�.: F t'TA -1 I Ei\ 11:1` �F� fi 'TCES 1 Date Re: Property of> 1 �.� .•.. -, n Located at •: f�- Section Block FoR Lot =` A. E ... 4 ASSOCIATES PC `` Gentlemen: � . . i A PIS FF.ESSIONAL �OIRPORATION This letter is to authorize -�01 a duly licensed professional engineer or registered architect (Indicate) to apply fog a Construction Permit ':for a separate sewag_ system; co Y serve the above noted property in accordance with the standards, rules CY or regulations as promula'ated by the Commissioner of the Putnam Coun—ty i Department of Health, and to s gn_all necessary papers on behalf in connection with this matter and to: supervise the construction of said s },stem or systems in conformity with the provisions of Article 145 or .14z,_:_. du-c t- a�;•- w - =the Pu-blie _�c�1th :La,a,� °asia�tbfe `Patr►am-'I && nay Sa;� C- p ". tary Code. FOR Very truly you s t WILLIAM A. KEANE _�— ►fi ASSOCIATES, P.C: Signed A PROFESSIONAL CORPORATION Owner of Property C Oil i;t01 si;>>ec' Address F.F.., //3 JAA(.7rH A7v(- Telephone )Address Jul Telephone 1 t -PUT NAM 0F k -EALTR E E �;., 4r 6