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HomeMy WebLinkAbout0448DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13.07 -1 -14 BOX 6 00257 1.6 IL. 1 09 , 00257 NG I EER `MUST DEPARTMENT :OF' PUTNAM .CO.UNTY HEALTH P. R& I DE Division of Environmental Himith Servia�ea, Carmel; N. Y. 10512 P E MI I T l 9—'2,90 CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE ' DISPOSAL SYSTEM Pi4TT ER Sr. t`i Town or village N Q � G.2 w L/e>k Located at PA ^, SOf41,lET , Tax, Map . ' Block• Owner JOHN �6- GGY FERRIS/ Formerly Tax Tax Map Lot } /- subd. Lott-# Address S� a L�,SS Separate Sewerage System built by JoiAw r aRgi iI -.�� 90A S �PAr IEA'SC lW y Consisting of 6a1. Septic Tank and —SPA .A Z/ N%/I.C% I–IteNc• -0 Z' o' Other .requirements Water Supply: Public Supply From Drilled By ALZOa6ZT: Y &T'T Private Supply `N, Address �AMI Y QE�1QEt`ILC Building Type - No, of Bedrooms Date Permit Issued c Has Erosion Control Been Completed? • Y e Has garbage grinder been installed? w . 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 of which are attached), and in accordance with the standards,.rules and regulations; in accordance with the filed plan, and the permit issued by the Putnam County Department Of Health. P.E. ZR.A.- 40. 26008 Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate_' sewerage system shall become null and void as soon as a public sanitary 'sewer becomes available and the approval of the private water supply shall becom -I and void when a'publ a pp)y becomes availabN.; Such approvals are subject to modification or change when, in-the Judgment of the om si16ner of Health, ch revoca o , ca on Or'cIN nge Is eeesury. Date �--- �� By. Title Rev. 6/85 WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3(71 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 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 OWNER NAME � -�.`` V � as ADDRESS : � �`�v' �:�� it LOCATION OF WELL (No. 8 Street) (Town) (Lot Number) PROPOSED USE OF WELL DOMESTIC ❑ SUPPLY BUSINESS ❑ ESTABLISHMENT El INDUSTRIAL ❑ FARM CONDITIONING El CONDITIONING ❑ TEST WELL ❑ OTHER (.Specify) DRILLING EQUIPMENT ❑ ROTARY COMPRESSED AIR PERCUSSION CABLE ❑ PERCUSSION OTHER ❑ (Specify) CASING DETAILS LENGTH (feet) ri U DIAMETER (inches) WEIGHT �, PER FOOT 1 '7 /� THREADED ❑ WELDED I E SHOE z YES ❑NO jnq C�STrTG YES NO YIELD TEST ❑ BAILED ❑ PUMPED HOURS COMPRESSED AIR ; G.P.M. �V YIELD (Q.P.M.) V WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) JG t� DURING YIELD TEST (feet) .� _, �v Depth of Completed Well in feet below Land surface: '30o 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. to FEETl!�� /FEET If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED DATE OF REPORT WELL DRILLER (Signature) / 'sf C -•.. tzc- / -/ ti PUrNAM COUN'T'Y DEPARTMEIQT OF HEALTH DIVISION OF ENVIROi�TAL HEALTH SERVICES .K Am -�- PL U Y FC2 Z i S Owner or Purchaser of Building �Nty FERMIS Building Constructed by �i4if�1 gyp. � `� Nt�1ET LA . Location - Street - TT�2So 't`l Municipality 1, FAKI L-Y Building Type 1 -7 -7 Section Block Lot SS R�pk y 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 system, or any repairs made by me to such system, except where bhe. 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 Environinental 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 D6c - 1985 Signature / Title C3N^/Nr- 2 + GENER/ct L- Col-VTRkc General Contractor (Owner) - Signature Corporation Name (if Corp.) Address rev. 9/85 mk Corporation Name (if Corp.) Yorktown Medical Laboratory, Inc. 321 Kear Street . Yorktown Heights, N. Y. 10598 (914) 245 -3203 Director: Albert H. Padovarli M. T. (ASCP) Z6 L LOCATIONS: ❑ 321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245 -3203. 201 BUTTONWOOD AVE.. PEEKSKILL. N.Y. 10566 737 -8777 495 MAIN ST., MT. KISCO. N.Y. 10549 666-3335 ❑ STONELEIGH AVE. (NEAR HOSPITAL), CARMEL, N. Y. 10512. 278.9330 rn DATE TAKEN: .13.s DATE RECEIVED: —� DATE 'REPORTED: SAMPLE SOURC Lab i �leis REFERRED BY:' Collector • �i LABORATORY REPORT mg /L ❑ ACIDITY ........................... ............................... ❑ ALUMINUM ......... ................... ............................... O ALKALINITY i P= ...... A= ........................ ❑ ANTIMONY .... ............................... ........................ BACTERIA, TOTAL /mL ... . ........... .......:........... ❑ ARSENIC .................................... ............................... ❑ BOD, 5 DAY ......................:.... ............................... ❑ BARIUM ....................................... ............................... OBROMIDE ............................ ............................... ❑ BERYLLIUM ................. ................... .............. ❑ CARBON DIOXIDE, FREE ........ ............................... ❑ BISMUTH ............. ......... ............................... ❑ CHLORIDE ............................ ............................... ❑ BORON . ........................................ ..........:.................... ❑ CHLORINE ............................................................ O CADMIUM .................................... ............................... ❑ COD .............. ❑ CALCIUM .....................:.............. ..:............................ ❑ COLOR ................. ............................... ❑ CHROMIUM (tot.) ❑ CYANIDE ............................ .............................:. ❑ CHROMIUM (hexavalent) .................... ............................... ❑ DETERGENT, ANIONIC ............ ............................... ❑ COBALT ...................... .......... ............................... ❑ FLUORIDE ............................ ............................... ❑ COPPER ...................:................ ............................... ❑ HARDNESS ............................ ............................... ❑ COLD ........................................ ................:.............. O MPN COLI FORM COUNT/ 100 ml ............................... ❑ IRON ........................................ ............................... M TCOLIFORMCOUNT /100ml ..:0 ................... ❑ LEAD ........................................ ............................... CONFIRMATORY TEST ............ ............................... ❑ LITHIUM .............................................................. ❑ NITROGEN, AMMONIA ........... .......................:....... ❑ MAGNESIUM ................................ ............................... ❑ NITROGEN, KJELDAHL ............ ............................... ❑ MANGANESE ................................ ............................... ❑ NITROGEN, NITRATE ............ ............................... ❑ MERCURY .................................... ............................... O NITROGEN, ORGANIC ............ ............................... ❑ NICKEL ........................................ ............................... ❑ ODOR (units) • ............... ............................... ❑ PALLADIUM ......................................... :............. ........ ❑ OIL & GREASE ........................ ............................... ❑ POTASSIUM ................................ ............................... ❑ pH (Ull i t 3) ...................... ............................... ❑ RHODIUM .................................... ............................... ❑ PHENOL ................................ ............................... ❑ SELENIUM .................................... ............................... ❑ PHOSPHATE (ortho) ................ ............................... ❑ SILICON .................................... ............................... OPHOSPHATE (condensed) ............ ............................... ❑ SILVER ........................................ ............................... ❑ PHOSPHATE (total) ................ ... .I..............:............ ❑ SODIUM ........................................ ............................... ❑.SOLIDS, SETTLEABLE, ml /1_ .... ............................... ❑ TIT! ............................................ ............................... ❑ SOLIDS, SUSPENDED ............. ............................... ❑ ZINC ............................................ ............................... ❑ SOLIDS, DISSOLVED ............. .......... ................:..... ❑ .................................................... ............................... ❑ SOLIDS, TOTAL ..................... ............................... ❑ .............. p • SOLIDS. VOLATILE ................. ............................... REMARKS. k. -6 7.1t .,� ..... �1.1.1� ........... • SPECIFIC CONDUCTANCE ( uhm0 S / cm) ............... .................................................... ............................... ❑ SULFATE ............................. ............................... ❑ .................................................... ............................... ❑ SULFIDE ............................. ............................... ❑ .................................................... ............................... ❑ SULFITE ............................. ............................... ❑ .................................................... ............................... ❑ SURFACTANTS ..................... ............................... ❑ .................................................... ............................... ❑ TURBIDITY ( NTU) ............... ............................... ❑ .................................................... ............................... THESE RESULTS INDICATE THAT THE WATER WASV OF A SATISFACTORY SANITARY QUALITY WHEN THE SAMPLE WAS COLLECTED. THESE RESULTS INDICATE THAT THE WATER DID MEET THE SATISFACTORY CHEM- ICAL QUALITY OF THE NEW YORK STATE ADMINISTRATIVE RULES & REGULATIONS, DRINKING WATER STANDARDS (PART 72) FOR THE PARAMETERS TESTED "OK, H �AT, E YAS COLLECTED. N/A = not applicable Alhn:♦ 4 ►A T IKCPD z ...... :'�-�.,-"l:.,.i-'P.UTN-AM, COUNTY: DEPARTMENT OF�HEALTI ­Div -1th X* , qMentq.. Eiivirq I' Hi a isioh of N `§EW E'DISPOSAL, SYSTEM `z C6k'&RUCTION,.��PERMI.Y;FO.R'4 -P� Sonnet A _4,; '' Rafitarc Tax. Ma Located. a. S # C -R6 f . Subdivision ner/odr ess J61M LPeggy Ferri s /3 Mal AV 42- Qnl y ;6- Byi! ding krea.. D NotlF:�k� 01 , — .­ _ be-i' 'c UB'edrobm's-` Design �*F T),T) ..!�iiYaritii sewerage - S'jsteryi �16 conisist...,,61' -1,,000 a 1`,�Aein IN, 14 To .,Ve, dete h6(i.,-, To bet constructed. Y,­ Address 7 -:Water Supply Public Supply From _7 _V� l'o." he:,,det-e A iiprwaie to be�,,,dril led �by X - Addi.iiis7,!" ' Other Requirements that .-L. am wholly and cornOletely- responsible- for the .5"ign-and Aqcjti ' _1ee,,jbove.det M cribed will 154ic' oins6uct!kici 'a" s shown on the � approved :-,a . �y County D epartrribnt: of,.,H"Itfi;. ;and that on completion thereof .,,a,:x' Certificate: ,o Constructip ';be submittety to' 'the '5"partnpr�!,, In a 'written; guarantee will be furnished the-oynq; h.1 -part of sa pr,�od,.p bo�oj ,;place in good opbiati�q, c6nditidn,ariy id',,si%vagb:disp6 f, 2 y 4qcq. of ,the,, approval ,.,"of the Ceftif icate' of, �Construction,, C will be-16cate'd as­ Shown '66 the approved plan and with �the stand of. "ep!, �Z. 'j-hiate 7 Signed r, -n t A Pp R 0 V E Ci,-Fb'R :dOA_SY A U C T�,.'l ON: TT. h I s:,a p or 6va I'expires one ypar'f i9iTi thp.",,date'. issued unless_ constr'da 4 revocable for cause :.pr 'may. f Hea b 6 amended nd e d �6 r m 6 d i f ie d wm'M' e -n* sidired n ecessa P P.Lr e e I r it..' A'- d '-'- b ,dome MAN-.. roved disposal tj0T,., Me s�qe permit -3, R tRev 9 1 13 n Town or, Y il lage bio�ck;,. ReVisiorV val ­ 7. Wilt Ri�q.imd L en x wide. r & J) that the separate sewage., ciisPOUV system ndards,-ruies and regulations of the Putnam 1tjjfjct'6iy',to,the commissioner of "ealthWilk L r 'assigns �by-. the that said btilldeiw' if its s - Immediate ly following Li the date of 't,he'issu-. described above ; dorule! and ,.regulationsi . of. she Putnam' P.E. x . R.A. N-T Y LiceKse No. 2'6008 . of Ahe bUil ng'has'- been- undertaken -iand "is n:: Any change'or alteration'of construction Ily. 0 °7 iflii, 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 -)nHIN r--=-j2P- 1SAddress 3 M 3ti2C— WSTEr� F3N N RVP + Block 7 Lot "7 Located at (Street � f L4 Sec: �lndicate neares cross street) Municipality Qi- --\TC Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run No. Start -Stop Elapse Time Min. Depth to'Water From Ground Surface Start Stop Inches Inches water Level in Inches Soil.Rate Drop in Min. /in drop Inches 1903-9,21 18 19 2 Ole 1 -9s3. 3964 - Ana P_ ? .,9 4166 1 -- /c-48 P_ ^7 5 1 907 -018 3940 2,7 3 4 16v6 /045 P-7 r 3 51041 -• "111'1=: :.Z7 19 2� 3 2 3 �pn n ®. HEALTH Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to beo.made from top of hole. 44. k TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OT' SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE N0. HOLE NO. HOLE NO. G.L. 6" 121" - 18" 24" 3011 36.. LOAM 42" 48" 54 60" 66" 7211 7811 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE' BY Dest-PE-1 iQcnTFCLD E'ty , =,� - T\ Date DESIGN' Soil Rate Used0 -/0 MirVl Drop: S.D. Usable Area Provided 6�c� S No. of Bedrooms Septic Tank Capacity /fc;?O Gals. - /Vk —<-.4C0AJRY Absorption Area Provided By 3Z L. F. x24" 3 S enc . Name N Signature � /CZ.52 � <2-A Address �7 /=,4� iZT SEAL R-1 L /11..1/ 1PJr OQ THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: �,rqE ST�l'` Soil Rate Approved Sq. Ft /Cal. 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