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HomeMy WebLinkAbout1015DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.47 -1 -62 BOX 10 .. ' 1 Ll 1� 1. # . 16' Il I ' T i .' ..7y 1 . ., ` JA � 01015 y c BACTERIOLOGY PARASITOLOGY VIROLOGY 4 .A�� ANTIBIOTIC USED SOURCE OF ,MATERIAL © REQUEST xp CALBO ANN Blood' ;. °A CULTURE u-21 5- ANAW R � 4;' ❑ 5hE ' GI P�EvJ'�YO .. putum; Routrrie p Nose. p pina Fluid ❑Fungus _ .p Urine ❑ "G..,C. p; -eces ❑ ` jl v us Fro ❑ I� 1 PUTNAM DIAGNOSTIC LABORATORIESr ❑ -Ova` and Parasites _ ❑Virgil Studies: 10 MEL, N :Y'. STONELEIGH AVENUE Y CAR S= SENSITIVE R= RESISTANT Ski R I= INTERMEDIATE S- ' I R STAPHLOCOCCUs. OOXYCYCLINE (VISRAMYCINI; UNCOMYCIN Non- -Remo -Coag To; Follow;_ WiT.&RACYCLINE - METHICILL'IN , ❑ Hemelytic,Coag. -To- Follow AMPICILLIN _ NAFCILLIN . .. "'❑ Coags Positive BACtTRACIN ; - *NALI,DIXIC ACID CCUSV H STR PTOCO EMOLYTIC CARBENICILLIN :' NEOMYCIN `` ❑ Alpha ❑ a O Gamma - et B CEPHALOTHIN' FURADANTIN/MACRODANTIN p` Enterococcus CHLORAMPFtENICOL ; ," OXACILLtN: = ' eunioco ❑ _Pn ccus c CLINDAMYCIN �PENICiILIN tteisseria _G Hembphilu COLYMYCIN POLYIIAYXIN _ B l7 A r a obacter .::- ERYTHROMYCIN. _ . STREPTOMYCIN , O _Corynebacterium.- GENTAMICIN TETRACYCLINE 0 Escherichia _ - KANAMYCIN :., YANCOMYCIN O Klebsiella [j;. Paracolo Bact =. 4 MANDEtAMINE :. DACTRIM ❑ Proteus _. ,N Antibiotic "Agent ❑" Pse udomonas CHART `, COPY Enteric Pathogens NO COLIFORM BACILLI ,ISOLATED FROM- SPECIMEN = 5UBM.ITTED. -AT ❑:= Found' ` THE TIME "OFJ EXAMINATION, THE "`WATER" WA5. 0F: GOOD - QUAL'3TY: � ❑ _Not Found cl P. „ f. I 1 • S . L WELL COMPLETION REPORT r 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 -- weal -- driller- -and submitted. -to- County Health -Department- together - with -laboratory - report-of- " T 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 XL I � , J i Q ADDRESS — O ys LOCATION OF WELL S (No. a strebt) (Town) Patterson F.Y. (Lot Number) PROPOSED USE OF WELL ❑D DOMESTIC 11 SUPP Y BUSINESS ❑ ESTABLISHMENT ❑ INDUSTRIAL ❑ FARM ❑ CONDITIONING ❑ TEST WELL ❑ OTHER DRILLING EQUIPMENT ❑ ROTARY COMPRESSED ®A R PERCUSSION CABLE 1:1 P PERCUSSION ❑ Ope if ) CASINO I DETAILS LENGTH (feet) 30 DIAM 6 ;HT PER FOOT 19 THREADED 1:1 WELDED E S X YES El NO CASING E 7 X YES NO YIELD TEST ❑ BAILED HOURS ❑ PUMPED ❑ COMPRESSED AIR Z G.P.M. 8 YIELD (G.P.M.) 8 WATER LEVEL MEASURE FROM LAND SURFACE— STATIC(Specify feet) 10 DURING YIELD TEST [feet) total draWdown Depth of Completed Well in feet below Land surface: j 75 SCREEN DETAILS MAKE LENGTH OPEN TO AQUIFER (feet)' 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 4 overburden L• ko:�I_ n j ` i 4 175 ledge If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE 7171? OMPLETED D E OF i /c EPORT WELL DRILLER (Signature) u G Owner or Purchaser of Building Municipality' Building Constructs by Location - Street Q- �H z �o Building Type Sa Section Block 12 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- vi-c-es - 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 19� Signature r- Title Z17 5d If cor oration, give name and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMP1JETION 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 REVIEW CHECK SHII�,iT Meets Std. Remarks e '—N0 DOCUMENTS House plans O.K. Design data sheet Peres presoaked? Min. 30" perc test depth I I Const. results for 3 runs I I D. Hole log U.K. Corporate Affidavit for other than individual i Authorization for engineer I .Letter from Water Supply if applicable If variance requested -such noted on plans & apps. DETAILS if charge is proposed,,) Existing contours shown show new contours) Slopes for driveway cuts, etc. shown Water service line location Footing drain, etc. location Top slope, bottom slope of fill I Percolation tests and deep test pit location Septic tank size and conformance to std. - 3 B. R. house minimum I I House setback shown ! I i-ic..117w J.!'o. +J .............. Ji1J_ Watie,1' W-LUl :1..11 )V 1 l.. :UJ. 17.0 6i1VWii i iV Plan and profile SDS ( /� All.other• wells and SDS closer 200' shown or reference made - Property boundaries (metes and bounds - clearly shown)' SEPARATION DISTANCES SPECIFIED ON PLAN 10' -to P.L. 20' to Foundation walls L00' to Nearest well 50' to stream, march, la 15' to Curtain drain 10' to water line (p 15' to storm drain 10' to large trees 10' from foundatior to pipe from lE , etc.. � Y i .expansion 20. i ,� I I i'7_�.T� STYE IT-1,SPIECTiOTIT Yes loo Ccmments' Propert�,r 1_in.C'3 or corners foand _ . o . a • r' ostiina.te -house loc' tiotl Will driveway r:ced cut. , • .. _ ' �� Must .tr -es be rernoved -note these e , ", e • , Is deep hole r. cpresenta.tive of ent -r� SDS area AdditiorYal c?eeD 'Holes r_eeCed. . . . . . O . Sufficient SDS a.r-.:a available cons; c?erin driveway cut, house location ,.separati on distances, etc. _ DEEP H0=5 D"M Depth: Water elevation: Rock elevation: - Soils descrintion: Date: FILIAL SITE 'D?SPECTILOIN. Insn. by:-- . House loca red where 'shown on . approved plank .. . w..y•s .,La.'Yr •_yv • • ry i V V.i'N" --. yl'-�.til'- • • • e •_. .• • .... Width of trencri avera -ge . Room of the line -and trenyc -h acceptable e • , Room allo•rea _,or expo nsi on Urenc�As e e • ..Over .50.. ft_. _f rcrn, sma.m -o, ..Tatertb�jsse , . •. - - — _Natural spoil not stri_^p�_Ded or SDS area �.1.nnecessa+=1 I y g''ra'de•..1 e e e a a O e • O • • e - 10 it. tr;-ain -tai red fro:: Dron.line and 20 ft. from house e • . • • Sspa.ration of trench f; ora house, well etc. follows plan . . . • • • • a • a . • O O Number of bedrooms checks . . . • o • • . • a Stones, brush , stur:ps, rubble, e Lc . °renter ' than 15 ft. from nearest trench 15 A. of peripheral soil horizontally from trench • . . . • C .... Junction boxes prope_,1y set Goilld surface run off from driveway, roads, ground surface, etc. cr:a nnel near SDS area . .m.o. • _ Does lot drairsre appear-O.K. in area of SDS FZNU GRADING OF SITE ACCEPTABITE iii PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOS SYSTEM FILE NO.' -))40 o - �i Owner Jy to 0 ��� Address .0 L LOi j O . ve Located at ( Street k �j Ate) CS-3, -Sec. So Block C- Lot Indicate nearest cross street) 1Z. Municipalit IE7 -s a-N) Watershed_ SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Elapse Depth o Water Water ve No. Time From Ground.Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop i Inches Inches Inches 1 I r. `% 2 4— 1 2 t 1''� i t l 2S ►. . do-. �- 5 Notes: 1) Teets 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 be made from top of hole. DEPTH G-. L. 6" 12" 18" 2411 30" 36" 42" 48" 54 6o" 66" 72" 78" 84" TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. NO. s HOLE NO. INDICATE!fJML AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY �/ . Date Soil Rate Used_ -�_Min/l "Drop: S.D. Usable Area Provided t T7-:, cp 0 S� No. of Bedrooms `j Septic Tank Capacity 1 cr-L-) Gals. e _ Absorption Area Provided By = L.F.x24" � 'o� C �hrq enc . ` �5�p Gt Rw- J i G XC Address 2i t' � g THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: �T. L "`� Soil Rate Approved Sq: Ft /Gal. Checked by Date I• - MANHOLE GOVrR -.. PLAN weW q. JUNCTION 8qX FAIN I7 i$ i Wz =— _ 4 „1 {� •FAIN. �. ✓r ` ! n$,, ,,055 tJ %'/ . . or. , `��,• \� /1 ibp - Lt ui L e a. r c i . ✓ d nFIN. A .� ;. CA s m Laces = INV a �, ` ECTION ' sANrTARY TEE i. V. 1' j t �, Qtafinbu. _ TYPLGAi C4NG. �' �RErCA37 CcINC 5 0 «a c SEPTiC TANK e :• 'epu5 PiZS ai $' ` CkC. LEVEL ~^ EARTH 4 T �ti��: • prRpu C�' 7 '.'r ."• .� .4 BACKFILL COIN I 5 ,S �Y -i`P y �. t duel( I�IaTrr.6n�Ipts :a �0' Bi_Ii6.PAPER coveR OR HAY Z, `.sec po_oe. P }5 °•• PFRFORATM jf h �%U•rG a ;; Pi PE L0 N� D�w.cira.M.m A4 i.0 C ft C USHED STvNE' A€9SORPTION TRENCH r i 4 Q�E G• �T U WITH i! . $ NO �j C �U S EATi. 13 O NTFiL CT V i -h. � \DANCOUNTY DEPARTMENT rb tSie�} OF HEALTH STEM'S HALI NOl.'I EIE BACKFILLED UNTIL INSPECTED BY DESIGN JUL19.1974 ENGINEER APdO 7tiE LOCAL HEALTH DEPARTMENT li RkQUItE'0. ( _- -�-•-- 1Af i�- SYSTEM TO CONSIST Or A 900 GALLON SEPTIC TANK SGAeIE - C�ioM,nC} rdiNAM UN DE�P.T:g�f EAETF "'AND FT. QF :a.._:_.FT, TRENCH WITH A MAXIMUM �i vies. r� fR i�GS "PtTC +f • OF iJ.1E ' F'ER FOOT. i - -3. Sa se�gga Pits BDia$.$'Jg�n. �r�e e z V_ \ 1�ho�S�D C� -ride DIMr: 'OIVISIONOF: i7ttPOS,A� SYSTEM GRADES REFERENCIF0 `f0 FINISHED FIRST rrr -•I; I-' pnc. ' a:ke r as ,WVtlmi MTRt HEALVW Std= -FL OOts',.'EI:E\i;47 i.J,V . 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