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Home My WebLink About0607DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23. -2 -14 BOX 7 LIN :i J . r . IN .` .' . IL 00607 0 ?_oio¢r'l- $ l- S1-Yr7 Pl -I)VA" Owner or Purchaser of Building .5 PL. F)I , /N 0• ING. Building Constructed by JNcMAMUS ?-4( , Location - Street' Municipality. -3BCDILoaM , S/ha)_£ F4;o lLf , FRAME Building Type 73 Section Block 7- Lot M Ate, to Subdivisionq Name Subdv, Lot # GUARANTEE 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 guarantee to the owner, his success - ors, 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 determin- ation of the Director of the Division of Environmental Health Services 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 day of 5e /. 19 F�� Signature � ' Title Corpora ion Name i corp. A dress 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 Yorktown medical Laborato*ry, Inc L 0 CATION � :�� Y � ;N 7�� ❑ 321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245-321J 321 Kcar Street ❑ 201 BUTTONNlOOD AVE :, PEEKSKILL, N.Y. 1056& 737-8777 Yorktown Heights, N. Y. 10598 ❑ 495 MAIN ST., MT. KISCO, N.Y. 10549 6M3335 (914) 245 -3263 TONELEIGH AVE. QqE4R HOSPITAL), CARMEL N. Y 10512 278 9330 Director: Albert H. Padovani M. T. (ASCP) DATE TAKEN: + Q - �— —I DATE RECEIVED: - �� j/f�) I(/ DATE REPORTED: , SAMPLE SOURCE: Lab` I� r -j REFERRED BY: L_ ! f Collector: �C�r��'► LABORATORY REPORT mg /L ❑ ACIDITY ............................ ............................... ❑ ALUMINUM ................................ ............................... ❑ ALKALINITY i — — ❑ ANTIMONY PBACTERIA, TOTAL /mL .............a) ....................... ❑ ARSENIC .................................... ............................... OD, 5 DAY ........................................................... ❑ BARIUM ....................................... ............................... • BROMIDE ............................ ............................... ❑ BERYLLIUM ................................ ............................... • CARBON DIOXIDE, FREE ........ ............................... ❑ BISMUTH .................................... ............................... ❑ CHLORIDE ................................................... :....... ❑ BORON ........................................ ............................... ❑ CHLORINE ............................ ............................... ❑ CADMIUM .................................... ............................... ❑ COD .................................... ............................... ❑ CALCIUM .................................... ............................... ❑ COLOR (units ) ................. ............................... ❑ CHROMIUM (tot.) ............................ ............................... ❑.CYANIDE ............................ ............................... ❑ CHROMIUM (hexavalent) .................... ............................... ❑ DETERGENT, ANIONIC ............ ............................... ❑ COBALT ................ .................... ............................... ❑ FLUORIDE ........ ❑ COPPER ........................... .................... ............................... .......... ............................... ❑ HARDNESS ............................ ............................... ❑ COLD ........................................ ............................... ❑ MPN COLIFORM COUNT/ 100 ml ......,.�..*.�..................... ❑ IRON ........................................ ............................... TC 1'COLIFORMCOUNT /100 ml ..'10........ .... ❑ LEAD ........................................ ............................... CONFIRMATORY TEST ............ ............................... ❑ LITHIUM .................................... ............................... ❑ NITROGEN, AMMONIA ............ ............................... ❑ MAGNESIUM ................................ ............................... ❑ NITROGEN, KJELDAHL ............ ............................... ❑ MANGANESE ................................ ............................... ❑ NITROGEN, NITRATE ............ ............................... ❑ MERCURY .................................... ............................... ❑ NITROGEN, ORGANIC ............ ............................... ❑ NICKEL ........................................ ............................... ❑ ODOR (units') • .......... .................................... ❑ PALLADIUM ................................ ............................... ❑ OIL.& GREASE ........................ ............................... ❑ POTASSIUM ..........................:. .... ............................... ❑ pH ( U 211 t S ) ...................... ............................ .... ❑ RHODIUM .................................... ............................... ❑ PHENOL ................................ ............................... ❑ SELENIUM .................................... ............................... ❑ PHOSPHATE (ortho) ................ ............................... ❑ SILICON .................................... ............................... ❑ PHOSPHATE (condensed) ............ ............................... ❑ SILVER ........................................ ............................... ❑ PHOSPHATE (total) ............... ............................... 11 SODIUM ........................................ ............................... C1 SOLIDS, SETTLEABLE, ml /L .... ............................... ❑ TIN ............................................ .....................:......... ❑ SOLIDS. SUSPENDED ............. ............................... ❑ ZINC ........................... ............................... ................. ❑ SOLIDS, DISSOLVED ............................................ ❑ .................................................... ............................... ❑ SOLIDS, TOTAL ..................... ............................... ❑ .................................................... ............................... ❑ SOLIDS, VOLATILE ................. .........:..................... ❑ REMARKS:..................................... ............................... ❑ SPECIFIC CONDUCTANCE (uhmo s /cm) ............... ❑ .................................................... ........................:...... ❑ SULFATE ............................. ............................... ❑ . ............................... ❑ SULFIDE .............................. ............................... ❑ .................................................... ............................... ❑ SULFITE ............................. ............................... ❑ ..................................................... ......................... ...':.. ❑ SURFACTANTS ..................... ............................... ❑ .................................................... ..... :......................... ❑ TURBIDITY ( NTU)............................................... ❑ .......... ........................ ............................... ...... THESE RESULTS INDICATE THAT THE WATER WAS 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 WH THE SAMPLE WAS COLLECTED. N/A = not applicable t Albert H. Padovani M.T. (ASCP), Director WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3171 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 Robert Mann ADDRESS McManus Road Patterson, N.Y. LOCATION OF WELL (No. 8 Street) (Town) (Lot Number) McManus Rd.. Patterson, N.Y. Tax Map # 73 -1 -23 PROPOSED USE OF WELL BUSINESS ® DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL ❑ SUPPLY F1 INDUSTRIAL AIR El CONDITIONING (Specify) DRILLING EQUIPMENT COMPRESSED CABLE El OTHER ❑ ROTARY D AIR PERCUSSION ❑ PERCUSSION (Specify) CASING DETAILS LENGTH (feet) 21 DIAMETER(Incho 6 WEIGHT PER FOOT 19 ®THREADED ❑ WELDED O YES NO CASING 91QUTED? YES NO YIELD TEST HOURS G.P.M. ❑ BAILED El PUMPED LN COMPRESSED AIR YIELD (G.P.M.) 2 WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Speclfy feet) DURING YIELD TEST (feet) Depth of Completed Well in feet below Land surface: 605 — SCREEN MAKE LENGTH OPEN TO AQUIFER (lee!) 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 0 605 gneiss, feldspar, & some quartz If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED 6 -6 -85 DATE OF REPORT 8 -21 -85 Val Artes!an WELL DRILLER (Signature) R. D. 5 -Route / / UarrilClr Co., to 52 10512 8.- 6" I I I I I (3) 5° DIA. KNOCKOUT INLETS SEPTIC TIES A B C D E 1 ,F675132 41 140.5141 1021 95.5 18.5 73 86 8.- 6" I I I I I (3) 5° DIA. KNOCKOUT INLETS r �6� ZTlTT711L S[`1'E rrisPECTIOr: ° - Ye.� No Comments ,Properry lines or corners found . . . ... . . . Can estimate house location . . . . ... , Will drivoway need cut . . . .. . . . . . . . . Nnzst trees be removed -note these Is deep hole representative. of entire. SDS area Additional deep holes nseded. Sufficient SDS area available consIdcr:i_ng �O driveway cut, house location, separation , distances, etc. DEEP HOLL' DATA Depth Water rl.evation: Rock elevation: Soils s d e. s cr:i. ;_)t i on Date. PIJ �- A L SIZ'- -E IPSP]3CTIO ?i 'Insp. by: House located where - shown on -approved plan SDS located where approved . . . . . . . . . .. : J e.ngth of trench measured Width of trench ave tie — Slope of tile.line and trench. acceptable , Room allowed for expansion trenches Over 50 ft. from swainip,watercourse Natural soil not . stripped or SDS area -. w-u-iecessarily graded :... : . 10 Pt. maintained -from prop.line and 20 ft. from house Separation of trench from house, well -- et c . - Toll ows - p] -a.n - - -- - - =- - -- - ==- - -- = - -- - -- - hiunber of bedrooms checks Stone:, brush, sttiurps, rubble, etc -. greater. than 15 ft. from nearest trench , 15 Pt. of peripheral soil horizontally from trench. ... . . . . Junction boxes properly set Could surface run off from driveway, roads, _ ground surface, etc . channel near SDS .. , ta.rea Does lot draina f,e app o ar 0. K. in area of SDS _ FINAL MADING OF SITE ACCEPTABLE All other wells and SDS closer 200' ' shown or- reference made ! � Property boundaries (metes and bounds - clearly ow ��L sc;aDiV is tom `_j ✓ ��LYy scap . _ ✓ ►'�iPEV , q-PPR, - rJv SEPARATION DISTANCES SPECIFIED ON PLkN !10' to P. L. 201/ to Foundation ivalls i0o to Dearest well 1.00` to stream, march, lake, etc. incl : expans 5' to Curtain drain 0' to water line (pits -20 5' to storm drain 0' ' to larse trees 01 from. f0tlndation to soptic tank 5' to p.ipo fi,om leader drain & , foot;inz:, drain A. To cftTc4v gRSi1J ' �jaO -fie. ✓D•_ r.cx go-to F'2 crt p;,� �R�M�, ��' r��NC•� c�c�ha� � ��` �E 6 # �'(� / J i� � Ta c p IMcets Std . Remarks , es No DOCUIG.'TITS ' House plans O.K. 40 i Design data sheet ✓ p o(4 . Peres presoaked?-; I i -in. 30" perc test depth Const. results for 3 runs ; D. Hole log; O.K. is Corporate Affidavit for otho than individual i Authorization for engineer iPtter from Water Supply if applicable If variance requested -such noted-on plans & apps, ti e.- DETAILS ` �if change -is proposed,) Exist�ng contours shown show new contours) / Slopes for driveway cuts, etc. shown •i Water service line location Footing drain, etc. location I ,� Top slope, bottom slope of fill Percolation.tests and deep test pmt location i I Septic tank size and conformance to std. ✓ j 3 B.R. housa min ir;um House setback shown Distribution box ftg. below-frost / All water within 50 ft . of, .PL shown Plan and profile SDS �.. _ f ..... . . All other wells and SDS closer 200' ' shown or- reference made ! � Property boundaries (metes and bounds - clearly ow ��L sc;aDiV is tom `_j ✓ ��LYy scap . _ ✓ ►'�iPEV , q-PPR, - rJv SEPARATION DISTANCES SPECIFIED ON PLkN !10' to P. L. 201/ to Foundation ivalls i0o to Dearest well 1.00` to stream, march, lake, etc. incl : expans 5' to Curtain drain 0' to water line (pits -20 5' to storm drain 0' ' to larse trees 01 from. f0tlndation to soptic tank 5' to p.ipo fi,om leader drain & , foot;inz:, drain A. To cftTc4v gRSi1J ' �jaO -fie. ✓D•_ r.cx go-to F'2 crt p;,� �R�M�, ��' r��NC•� c�c�ha� � ��` �E 6 # �'(� / J i� � Ta c p 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 ,Eo.6e. -� Address 40e0av ST YomiGggso NY, � Located at ( Street4dicate „rie� ha/e Qq Sec. 73 Block Lot 2 3 ne,arest cross s ree Municipality. /�2 f}-er -Soil Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run apse Depth to a er Water ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches 1 1 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. 4-:.61 4'o 4- 3 1 8 2,1 3 2 LI 3 4 Zl 2 5 2' 3 9- 4-:37 g1 4'Sa 9- V3 1 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 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. r HOLE NO. HOLE NO. G.L. T2EE TTEf� 6" 7a P s o 12" S , L T Y 18" 24" 30" 3611 422" .. 48" 5 4 If 60" 66" 72 84 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WTTER LEVEL RISES AFTER BEING ENCOUNTE TESTS MADE_ BY To rg,r it ��i91�D , P. ,. Date �,3 DESIGN Soil Rate Used e-/Z> Dtn/l "Drop: S. D. Usable . Area Provided No. of Bedrooms -3 Septic Tank Capacity ?00 Gals. Type Pr- Q -e,2s-F coNe- Absorption Area Provided By 3 �o L. F.x24" 7 zo s _ idth trench. .(� Y r l Oc��hOra�n! Name a tih ✓. /�� P. • lgna Address sT L '" a M T k- n Iq / o S 49 O °• ose�� THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: '0ApFFSS1�N�`* Soil Rate Approved Sq. Ft /Gal. Checked by Date in NOTE : LOT / R.O.B. FILL WILL BE PLACED AS SHOWN ON THE PLANS 60— 90 DAYS PRIOR. TO THE INSTALLATION OF THE FIELDS AND THE. REMAINDER OF THE SEPTIC 'SYSTEM., 7%O