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HomeMy WebLinkAbout4532DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.05 -1 -11 BOX 34 04532 ,■ . , . 04532 Putnam. County Dep "artmen of Ile, j UTINAM COUNTi D1, NT OF 1-1ZAIL11i -DIVISION OF ENVIRONMENTAL HFALTH SrRVICES.' Date June 249 1976 P%e: Property of Fasciale Contracti.ng Inc., Located at FlorencO Road .Putnam Valley Me P 1319 Section Block . Lot 28 Gentlemen: John. S.' Romeo This letter is to authorize a duly licensed professional engineer or registered architect (Indicate) to apply for a.Construct.ion Permit for a separate sewage system;.to serve the above noted property in accordance wit h t) iea.standards, rule.s or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in 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 Pascale Contracting Inc - Address Gallows Hill RD RFD_ Peekskill9 NY 10566 Located at ( Street Florence Rd Sec .�hp 1319B1ock Lot 26 �_Indicate arest cross,s ree Municipality Putnam Valley(T) Watershed Peekskill SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS o e Number CLOCK TIME PERCOLATION PERCOLATION Elapse Depth to Water Water rFveT No. Time From Ground Surface in Inches Soil Rate Start -Stop .,Min. Start Stop Drop in Min. /in drop Inches Inches Inches. (T) 1 5 :Q1 5 -0.10 9 16,25 21.25 3000 3.00 2 5 -012 5022 10 16075 21.75 3.00_ 3.33 3 4 .5 - (2) -0 06 5:-0 20.00 23.00 3.00 2.67_ 2 5x17 5-027 10 19.50 22.50 3000 3.33 3: 4 5 Notes: 1) Te':�ts to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. A11 data to, be submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED TO BE SU$MIT WITH APPLICATION DESCRIPTION OF SOILS tENCOiIr!gTERE IN TEST HOLES DEPTH HOLE NO. 1 HOLE NO. 2 HOLE NO:. 3 Topsoil .. r. _. Topso 1.. .. 6" 107, Topsoil 10" Topsoil 9" Topsoil 12" Brown R.O.B. 18' 1 24" 30" 3611 42" 48" 541, 6o'l 66" 7? 7'811 8`F11 " .Brown R.O.B. INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED None INDICATE LEVEL TO WHIQH YTRR LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Jo nn omeo Date July 3, 1976 �t {r _ 3 Soii Rate ,Used 0-5 Mirj/1 "Drop: ? S.9D. Usable Area Provided •� 5.000 SF + No. of Bedrooms 3 Septic Tank Capacity 1000 Gals. ,hype r•j� .• - Absorption Area Pro idd By.250 L.F.x24" x�, widt p 751W Q d Name John S. Romeo SignaEure : ; Address 1 Northridge Road SEAL _' -•' Fee S N.Y. 1 • • '27846 THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: MEW ��•••...�••�• Soil Rate Approved Sq. Ft /Gal. Checked by_ Dote F. A IL eP CASING DETAILS A YIELD TEST.:, WATER LEVEL -SCREEN DETAILS Length. Ft. Bailed -'(Mdasure or -Pumped Hrs' from Static.: Ft.'. and 4Ukf&d -6). Diameter;��._ Inches jWhen Yield: J/ Gp ' M Bailed or Pum ed Ft Slot Ft.Size Kind: Diameter In. TOTAL DEPTH OF WELL... 4440 Feet' WELL LOG Ground Surface awr t., it-, Pzp coX6 --o tatb*kl vtormations penetrated, such QEWRT, clay, hardpan, u e- sire:' -of- (I ne medium, Z 6 War g'�_ T structure, (L^os� arcked, -0'.`ft?.io Date Well Complete4X�J4. -S t :,ft pt • io_l F�- T `...777.. BZS 1-77 Feet to Feet Formation Description 4 Tj u r I ',t Date Well Complete4X�J4. -S t :,ft pt • io_l F�- T `...777.. BZS 1-77 t 3' 4 1 S PUTNAM >,CO ' Y. DEPARTMENT Of HEALTH Division of Enwonmental Health5ervices Carme% N Y 10512 5 ; +c.?.�.5' m -•. "' CERTIFICATE; OF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPO�`SY.S�f`�I� �4`�+" - ^> Town or 'Village m b �LOCateClfat } er 'Street -8c F]:Orenae Road; }� Nla .. •. _ t _ Section _9 �(� Block :'• owner -- � Pascale Builders Inc: (Pefro Pascale.) _ got. �: '� � � ;� ,ob =` 2� _:: J.rR. valentine2 Separate sewerage System bwlt by Address J. i irLh Consisting -of Gal. Septic -Tank -- ' Imeal Feet X " __ width trench Domestic }tie Only - . Other. requirements - £ nq n P'.• 4 a_. i+x .'�. a. Water..Supply ^`Public +Supply.From _ R 4 Private :Supply Drilled By eT80n 'Driher8 Address3t'�er StreetzPutnam valley; N.Y: �z Raised Ranch, 3 3 Bwld�ng'Type - No Hof Bedrooms MAC. Issued � f11as Erosion Control Been, Completed .,"«»..�. £�. ;S r �• S. � e 'tt 1. certify that the`system(s) as listed serving the above premises were constructed essentially as shown o d*nrork. (copes: of which are attached), and in.accordance with the standards rules and regulations plans Bled and the,permit#i` by arri,y Department of Health. qq 1 f T stir' u• t '...,..ter -G. » j i3 :i" y�.4 i f n- a ♦ A Gate ®7 l x * ` C re trfied by • P E — R A. - - - 1 �Northr3dge Peekskill' N ` 1 Address Linse No `,. .' .F x,3^3 1 -. • ARA Any;per3on occupying premises served byrthe above systems) shall ;promptly take such action as may b s g4 a correction of any unsani a conditions resulting from; such .usage. Approval iof the separatesewerage = system•ahatl become null and a ;public sanitary -sewer becomes: available. and the approval of the °'pnvate. water supply shall become null an' void when a ;publ!c,vy `u Srn available': Such approval`s 'are ' subtect to -1 modification & change' when,, in the'judgmeri4 of the °Coin is a "of ,W such 'r o on, modification.or. change ,is necessary. A �, - t..;'= � i'. 'p :..�. .� a -�.v Y T' r?"'- .q rr � -r•. -� �". rqF^ � ? k �:; �T,., .. � �: a ' t YORKTOWN MEDICAL LABORATORY,INC N,p'M<`; l 1; r' ✓ t" qT k'^ : t� rt <+ .v, y� -.{ 4 r �, 1; t 'a `ysi'�n P 0 Box :99"' 321 Kean t .det 5 rS' 3 ♦u m ac+s w ck ma w •wb a ze, vats spa +✓ e' e» i -�: °'rYoFk:I�it,"N°i 16 . K-1149 _._.,_,.,.. ,.._ ...'. _4 ...� .... DATE,COLLECTED, RESULTS OF.:EXAMINATION OF WATER, 2 3 } OWNER u EI�U r f . f DATE REC ED i �.: z: -. DATEIRERORTED=----i ` r �. 6/29'.77. SAMPLING °POINT , sr w- _a.+rnvsarns..nfl wrTeinvAAU. UKT3.WM AT v i iT BACTERIAPER ML (Agar "plate count at:35 C) GOLIFORM GROUP (Most probable No: %100m1:j RD ES ;TOTAL ppm DETERGENTS II1CJ NITRATES (as'N) mg L IRON, TOTAL mg L WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 : Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK ®: _ 1. Thus,.ue,pwrci ;�s ,tQ be, Q Sled i�py, ;wgq!J i���r�attdfsulimitted. ~. 9,.Countyi blealth= [�teparimeafstogefMef iNith- 'Isi�oratarY� sport of analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION r, ,P ` A OWNER NAM ADDRESS LOCATION OF WELL No. 8 Street) (Town) (Lot Number) �j �• P Q - c �� - � J! •. _ PROPOSED USE OF WELL BUSINESS ® DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL ❑ SUPPLY ❑ INDUSTRIAL El CONDITIONING OPBER) DRILLING EQUIPMENT ❑ ROTARY OMPRESSED CABLE OTHER AIR PERCUSSION El PERCUSSION (Specify) CASING DETAILS LENGTH (feet) DIAMETER (inches) G �f WEIGHT PER FOOT �' 21-THREADED ❑ WELDED ( � VE SHOE !� YES ❑ NCI CASING T JUT D7 ES LI NO YIELD . TEST .Houk G P.M. BAILED ❑ ❑ PUMPED ❑ COMPRESSED AIR YIELD (G.P.M. WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST fleet) Depth of Completed Well in feet below Land surface: A (� 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 9' If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL C PL ED DATE OF REPORT L DR R Ignature) FA Pascale Miders..Ince Putnam Valley (T) weer or Purchaser of ..Buildin 9 Munic pa ity Nal, u n---Construct6d by Section Barger Street & Florence Road m oca ota - Street oe Raised Ranch 28 u ng Type Lot p° GUARANTY OF SEPARATE SE14AGE 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 accor4ance.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 palace 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 thejsystem. 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 act of the ocaup!,�nt� of the ki4il4in the .system Dated this 5 day of JU 19 7'i 31gnatu(��,e� Ti t1e orp ©ration, .g. V® name and address) - - - - - - - - - p- t -THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE XSSUED. GUARANTOR IS RE STIR D TO FILE OT CE QF FTRST ITSF OF SYSTEM. - - - - - - - - - - - - -- - - - - - - - - - - - - - - Division of Environmental Health Services, Putnam County Department of deal th .9 et 7 1 Jl� -7. <: lc "O"A . . . . . . . . 77� 14L e, Al 4� q x '77 We In A L APT, L4 1� si -% js� * 0ti- 06 SvSTEM -MbUgE --'Db9lGNE:d'& SUPERV ISED A 40- 0 0 CO ROMEO AIN' E"l, -:T-,�� ToWl+ OF;�, 7-Y (�O.NSULTMG .ENGI. 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