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HomeMy WebLinkAbout4548DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.05 -1 -29 BOX 34 l f 7/ 8' PIM. COUNTY DEPARTMENT OF HEALTH Division of .Enwronmenta/ Heath Servrces Carmel .N. Y 10512 �> 3 •.� a �(/�� � GG Gay I CERTIFICATE OF GJ�IST,.�Q- �.��MiPI .Town or.. Village. • Gar- dine:er Road f led M,a �:' 1 1 _ Located at Sect 3 9 Block Owner- �T2:ICILR �:i3Ill��b��'S;f7 - Lot Job { P Gardineer Rd .Putnam:Valey'NY c Separate Sewerage System,_ wlt 'b, by r]dIIL $ Cam E]a5S0' Atldress y .Consisting of� F= ))�� xrx z s S Zr� Gal Septic �Ta.nk N"t� I�neal .Feet X x y width atrench other',requirements D�n►PS �i� C- LS (r1t1_.y - Water Supply. Public Supply From X Private Supply Driped By an 'Address B r er" t t' Ill V e Building Type 1 `$t��T framg No of Bedrooms PSsrriRQ '� _ F� f Ha; Erosion ee Control Bn Completed _Yes 3 { a & I certify that the system(s)_a's listedtservmg the above premises•were constructed _essentially as shown on tw s�ai bt _ N (eopies' of.which are a$tached), :antl in accortlance with the, stangards rules and =,regulations Fplans' filed, and the p @mit _.isiu by Lh o rlbepartment of Health. Date NOVPiY1PhPr x,_1982 Certified by - S• P'E � -- R.A. 1 Northrdr�e `Rod Peekskill Ti 2 8.6 Address. ` g _ s 1 �. . License .No_.:, s 7 _ 9ny person,.occupying premises servetl byathe above;system(sj shallpromptly take 3uch•act�on.as §may be necessary to secure the corrections <of any unsanitary conddanS,reiulting from such usage AppPoval,xof'-these'parate sewerage system, shall become nulland void "ras soon "aS,•a..pubtic sanifary sewer becomes ,available- and the approval of -the private waterssuppl.y,shall'Oecomeinull and' void when a pub. it- becomes available. Suchi' approvals are sub)ect,fo m6iiificat,on or ,change :when,. in the;Judgment of the'.Comitiissioner df' Health; such° [ev tion :' o'" dification'or change',isrnecessary g Date �CY �� < B dle <y This report is to Bldg, Department, water sample indil Well Location TOWN OF.PUTNAM VALLEY WELL DRILLERS LOG AND-REPORT 'W'ELL ' GCXA LBTION-;:,•REPOR1 .'ii'. ;, >--. , t- t;: -..:•. be'completed by well driller and submitted tdO. together with laboratory report of analysis of --ating water is of satisfactory bacterial quality. Tax Map Street Sec, Bl. Lo /t,� Well Owner d� G , g�,' �_ w & - ; y( r Nafde Mailing Address. City or To Tel. # Well Driller �- Name Mailing Addr „ City or Town 1V1t1L Lr-rin Ur VY�LL .�SCJG> r CC L WELL LAG . Depth from Give description of formatioms penetrated, such Ground Surface as: Peat, silt, sand, gravel, clay, hardpan, shale, sandstone, granite, etc. Include size of .. gravel. (diameter.). and, sand, (fine, medium, coarse.), _ -- _. --color-,of material , st-ruciure -j'f;- Loose packed, cement, soft, hard). For example: O ft. to 27 ft. fine, packed, yellow sand; 27 ft. to 134 ft_ nrav nranitP_. Feet to Feet Formation Description CASING DETAILS YIELD TEST WATER LEVEL SCREEN DETAILS. Bailed Measure -from land surface Length Ft. or 7,1- or `.' ' ; • , i< Hrs. Static: Ft. Make: � When Bailed Slot Diameter Inches 'Yield: - GPM or Pum ed Ft Length Ft. Size Kind: �� Diameter In. 1V1t1L Lr-rin Ur VY�LL .�SCJG> r CC L WELL LAG . Depth from Give description of formatioms penetrated, such Ground Surface as: Peat, silt, sand, gravel, clay, hardpan, shale, sandstone, granite, etc. Include size of .. gravel. (diameter.). and, sand, (fine, medium, coarse.), _ -- _. --color-,of material , st-ruciure -j'f;- Loose packed, cement, soft, hard). For example: O ft. to 27 ft. fine, packed, yellow sand; 27 ft. to 134 ft_ nrav nranitP_. Feet to Feet Formation Description !p Nov HEALTH Date Well Completed �% i+ ; ' Date of Report Well Driller Al„i,, -r�'t - Signature BZS 1 -77 )RKTOWN MEDICAL LABORATORY INC. P.O..,Boz 99 321 Kear Street Yorktown Heights, N.Y. 10598 LOCATIONS: X O 321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245.3203 1 BUTTONWOOD AVE., PEEKSKILL, N.Y. 10566 737.8777 666 3335 0 ❑ 495 MAIN ST., M KI T. SCO, 114. Y 10549 _.,._..,... 245-32 3 _ j - j k�E1G AA &- (NEAR HOSPIT.ALI, CARMEL N_.Y, L051 � ` !�-• � � C.�GiG O,i/I COY � ' L f ✓ei f �o /O•/�i �f J LABORATORY REPORT mg /L LAB # DATE TAKEN: DATE RECEIVED: �� 2 DATE REPORTED: SAMPLE SOURCE: REFERRED BY: 04"/ COLLECTED BY • ❑ ACIDITY .................. ............................... O ALUMINUM ................................ ............................... OALKALINITY .... * ............. �..p ....................... ❑ ANTIMONY ................................ ............................... BACTERIA, TOTAL mL ..... I .......................... O ARSENIC ................................... ............................... OBOD, 5 DAY .................................................. O BARIUM ....................................... ............................... OBROMIDE ................... ............................... O BERYLLIUM ................................ ............................... ❑ CARBON DIOXIDE, FREE .............................. ❑ BISMUTH .................................... ............................... OCHLORIDE ................... ............................... ❑ BORON ........................................ ............................... ❑ CHLOR-INE ................... ............................... ❑ CADMIUM ..................................... ............................... OCOO .. ................... ............................... O CALCIUM .................................... ............................... ❑ COLOR .................. ............................... ❑ CHROMIUM ( tot.) ............................ ............................... OCYANIDE ................... ............................... O CHROMIUM (hexavalent) .................... ............................... O DETERGENT, ANIONIC ... ............................... ❑ COBALT ........................................................... OFLUORIDE ................ ............................... O COPPER .................................... ............................... OHARDNESS ................... ..............:................ ❑ COLD ........................................ ............................... O MPN COLIFORM COUNT/ 100 ml ..... ............... O IRON ........................................ ............................... 51*kTT COLIFORM COUNT/ 100 ml � ............... ❑ LEAD ........................................ ............................... ❑ CONFIRMATORY TEST ... ............................... O LITHIUM .......................... .......... ............................... ❑ NITROGEN, AMMONIA .,.........• . ................... O MAGNESIUM .. .... ............................ :........................ ..'., �G:,MANGANESE' ........... :'io. 9 °v r :..:............:..r.....r: :.: :..:.. �, ,-< O NITROGEN, NITRATE ......... ❑ MERCURY ..............:..................... ............................... ONITROGEN, ORGANIC ... ............................... ❑ NICKEL ........................................ ............................... ❑ ODOR ..........:............ ............................... ❑ PALLADIUM ................................ ............................... ❑ OIL & GREASE ............... ............................... ❑ _POTASSIUM ................................ ............................... ❑ pH ........................... ............................... ❑ RHODIUM .................................... ............................... ❑ PHENOL ........................................................ ❑ SELENIUM .................................... ............................... ❑ PHOSPHATE (ortho) . ....... ............................... ❑ SILICON ........:........................... ............................... ❑ PHOSPHATE (conderised) ... ............................... O SILVER .......................................... ............................... ❑ PHOSPHATE (total) ....... ............................... ❑ SODIUM ......................... . ............................... RE.1 ❑ SOLIDS, SETTLEABLE, ml /L .......................... O TIN ......................... � ... ❑ SOLIDS, SUSPENDED ... ............................... ❑ ZINC ...................................................... ... .............. ❑ SOLIDS, DISSOLVED ............. y ❑ .......... .. ........................:...... � ........................... ... ❑ SOLIDS. TOTAL ❑ .......................................... . .V.Y...-.5.��t................. ❑ SOLIDS, VOLATILE ....... ............................... ❑ REMARKS: ...... ...:........... p....... ..............:.......:........ ❑ SPECIFIC CONDUCTANCE. .....:........................ ❑ ..... .............................:. UTiV/4JV(..C� _ _ _�p....:�?f :l16A{ ...... .Y ❑ SULFATE .................. ............................... _❑ .:.... ............................... ... .Tv.......... ...... . O SULFIDE .......... O ........................ ❑ SULFITE ................................ :.................. O .................................................... ............................... ❑ SURFACTANTS ............ ............................... .. ................................................ ............................... ❑ TURBIDIT.. ................ ..............:................ ............. ................. .........................__. ... _ ...... THESE RESULTS INDICATE THAT THE WATER WAS OF A SATISFACTORY SANITARY QUALITY WHEN THE SAMPLE 14AS COLLECTED, THESE RESULTS INDICATE THAT THE WATER DID MEET THE S TISFA RY C,HEMICAL QUALITY OF NEW YORK STATE ADMINISTRATIVE RULES & REGU TI DRIN NG W T STANDARDS T 72) FOR THE PARAMETERS TESTED.,r r ALBERT H. PADOVANI M.T (ASCP), DIRECTOR i _ . James Campobasso 68 Owner or Purcha8er''of Building Section a47'+wa., ,. .. .:. .., .-_._. .'el a r' .. �, L.•vJ' ld .t. _ ..- -_ Building Constructed by Block y g. Gardiner Road � Location Street Lot Putnam Valley (T) Municipality Subdivision Name Building .Type Subdv. Lot # GUARANTEE OF SEPARATE SEWAGE SYSTEM I represent that I,a.m. 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,, .r.ules.and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his success- , or's, heirs or assigns, to place in good operating condition any part of said system.constructed by me which fails to operate fora 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 determin- -• ti a �.�r of 4t�ie- D c :ter -.ef� the -Ii i isic s ef- F�,nazi�r.a�ia er t 1 .T3ea], }�. <Rer.4-i ae.s_ . of the Putnam - County Department of Health�as to whether or not the fail- ure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system.�� Dated this �r day of UWA146e, 19 Z Signature RECEIVED Title NOV a 5 1982 Corporation Name if corp.) PUMAM COUNTY DEPT. OF HEALTH Address THREE (3) COPIES ARE REQUTAE'D 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 y. Division of 'Enw�onmen TION PERMIT -FOR - SEWAGE D.ISPOSA` 's Garde n �Roac e•e l Putnam a Yak of be a. Lot_Area :i owz ,jl'000 � Address 1" 1V or GnrlQge Kr gPPROVED FOR CONSTRUCTION.: This approva6 expires one year froi revocable forcause or maybe amended or modified `when consi nec 4 requires a dew per,'mit Approved for disposal of domestic ARTMENT OF HEALTH'" 7 Services CarmelN t -Y 10512 { Putnam Valley C2 + Town -or V 9eM.�y, Block Lot �' xx 5 R3 � {Barger Stree�,t ''�0`lA `Address - i FL Putnam `Valle, N: Y. -10 �7`q_ 1.200 Total Habita�ble�5pace _ Y SG_uare Feet `j tic Tank antl ^ iw >LF of 2�!%" rnnh i Address Stevenson Ave Peekskill .J :. �a �t Putne �ialle •N:. Y�. 10 "��F s to nrovdPr�v, ty f nyy lion of the propoystems) lj I sed _j, D ` ge disposal system �,to and Ln` accordance with'the standa� ' r o e, u narn t "of. Construction ;Compliance - satisfac h ' t�f Health•will 1 the owner his successors, ;heirs or:s _ h- e , id builder will 2 i during the perioG of two_(2) years i dial ng't �ytgof the issu i original system o► any repairs these tha, we 1 sdribed above k I :,:in accordance with the - standarl s a s tie` Putnam Peekskill w`eNE�9 ;tlate issued unless struction -of the,: bu°if�dlg>1frsO��n unAer'takan and .is �':- Commis er 'of. Healfh Arty change or "alteration of construction ne pr Ater Title q PUTNAM COUNTY DEPARTMENT. OF HEALTH - - DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date Re: Property of James Campobasso Located at Gardineer Road Putnam Valley,- SectionMap 1319 Block Lot 4 Gentlemen: • This letter is to authorize John S. Romeo a duly licensed professional engineer x or registered architect (Indicate) - to apply for a Construction Permit fora separate sewerage system; to serve the above noted property in accordance with the standards, rules or regulations as promulgated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in _connection .with this, mat e-*-:the' 'C7oriatructIo-n`6V ME s system or systems in conformity with the provisions of Article 145 or 147., Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very ou:K! trul y� ul y Signed Owner of Property 3 Countersigned: jq AddreWs, j 1,4 P ..E... I:k.A m— # 0.784 6 S I?- Telephone 1 Northridge Road (Seal) Kfin 0 S. R Address 0 C/:, Peekskill, N.Y. 10566 0 0 =. 0 © 0 737 - 1056 2 846 0 Telephone 0 0 Eq ID 000 000 0 F PUTNAM COUNTY. DEPARTMENT, OF HEALTH. DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUN'T'Y OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE N0. JR3 Owner James Campobasso Address Barger Street9 Putnam Valley, 401A Located at (Street Gardineer Rd SAa. 1319 Block "' Lot. d4ica e nearest cross street) Municipality Putnam Valley (T) Watershed Peekskill 4 SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS oe Number CLOCK TIME PERCOLATION PERCOLATION apse Depth to Water water Level No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches (1) l 10sl5 10:21 6 21.5 22.5 1600 6.00 2 10 :2t 10:29 7' 21.5 22.5 1.00 7.00 � -10:31 10 :38 7 21.5 22.5 1.00 7.00 5 _. (2) 0 10:18 10:23..5 22.5 23.5 1. -00 5.00 2 10:24 10:30 6 22.5 23.5 1.00 6.00 3_ 10-:-34'-,' 10:40 6`­7­- 22.5 = ..23:5 1.00 _. 6.00 1 � 5 DEM OF REAQU Notes: 1) Tests to be repeated at same depth until approximatelyy equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION 4 "� DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. l HOLE NO. 2 HOLE NO. 3 . ._ ... •._. 'LT;. rJ'.. :.�i u. r_a�:yt..M, , . r`> r vc.. r. °+za o_ _ _.. . 6" f 12'" 1 _ F. 1811 21411 30" 3611 4211 4811 54" 6011 6611 7211 7811 8411 INDICATE LEVEL AT WHICH GROUND WATEFR IS. ENCOUNTERED None INDICATE LEVEL TO WHCH WATER LEVEL RISES AFTER BEING ENCOUNTERED None TESTS MADE BY John 6. .Romeo Date April 30, 1981 Soil Rate Used 8 -10 Min/1'.Drop: S:D. Usable Area Provided ' _ 5000 SF + No. of Bedrooms 3 Septic Tank Capacity 1000 Gals. -,-!r2-P,'-Masonry Absorption Area Pro ded By 334 L.F.x24" x 3b'— o o Name John S. Romeo Signature - / H Address 1 Northridge Road SEAL o� o Pp Pk,-,ka..17'_j\j,Y_ 1115(1A. o 27846 0 THIS.'SPACE FOR USE BY HEALTH DEPARTMENT ONLY: ©� ° ®® Soil Rate Approved Sq. Ft /Gal. Checked by Date_