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Home My WebLink About1543DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -4 -40 BOX 14 01543 � '. r ■ T L'. '� ' � .1 � ■ .. T. lei; i6 m ='i ma Wall +L 01543 V BREWSTER LABORATORIES Box 224 - BREWSTER, N.Y. (914) 225 -2072 SAMPLE NO. 5594 SOURCE: J. Salantino Well Bullet Hole Road Patterson, New York COLLECTED: November 3, 1984 BY: P. F. Beal & Sons, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method Q per 100 ml. This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. November 8, 1984 WELL COMPLETION REPORT 3/71 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK This report is too 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 complance is issued.. . POAT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION . ' OWNER NAME ADDRESS LOCATION OF WELL (NO. d treat) (To.") (Lo6t Nu b r) PROPOSED USE OF WELL BUSINESS DOMESTIC ❑ ESTABLISHMENT F] SUPPLY El INDUSTRIAL ❑ FARM ❑ CONDITIONING ❑ TEST WELL El OTPN ER 4fy) DRILLING EQUIPMENT 1 ❑ ROTARY COMPRESSED Lp,,AIR PERCUSSION CABLE ❑ PERCUSSION OTHER ❑ (Specify) CASING DETAILS LENGTH (feet) ) DIAMETER ( Inches) WEIGHT PER FOOT 5Q, THREADED ❑ WELDED D I S O YES ❑ NO 5 RrYES 7 NO TEST ❑ BAILED ❑ PUMPED V, COMPRESSED AIR HOURS �. G.P.A. YIELD (G.P.M.) 6 WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) DURING YIELD TEST [feet) / Depth of Completed Well in feet below Land surface: ,� / IJ 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 (teat) TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET ( If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED I DATE OF REPORT WELL DRILLER (Signature) _t'7 / t� • l� �d ysi� �71-aj�2 Owner or Purchaser of Building _ :Bualdang:.•ConstructZ) _tt -by - - Location - Street All Municipality Building Type Section _.. ,... Block r ..... _. _......,.r. _.._.�.. .. .. �. Lot Subdivision 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 o Signatur- Title itle C po ati Name if corp.) �^ Addr s 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 1 VRRI Unitl MLUll,rtL Lr%UUI%r%IUl ►1 III tO. P.O. Box 99 321 Kear Street Yorktown Heights, N.Y. 10598 245.3203 LOCATIONS: ❑ 321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245.3203 ❑ 201 BUTTONWOOD AVE.. PEEKSKILL. N.Y. 10566 731.8777 ❑ 495 MAIN ST., MT. KISCO. N.Y. 10549 666.3335 Rx. :...: ._.._ _._❑_S - ONELEIGH AVE. (NEAR HOSPITAL). CARMEL. N._Y_,10 12. 278•.9; ._. LABORATORY REPORT mg /L ❑ ACIDITY .................. ............................... ❑ ALUMINUM ❑ ALKALINITY ....................+ ....................... ❑ ANTIMONY tACTERIA, TOTAL /mL ......� .................... ❑ ARSENIC -BOO. 5 DAY .................................................. ❑ BARIUM .. LAB # DATE TAKEN, � /4 4, DATE RECEIVED: e-K DATE REPORTED: SAMPLE SOURCE:_ia Gk", REFERRED BY: COLLECTED BY: ��-- 76 3 ❑ BROMIDE ................... ............................... ❑ BERYLLIUM ................................ ............................... ❑ CARBON DIOXIDE, FREE .............................. .❑ BISMUTH .................................... ............................... ❑ CHLORIDE ................... ............................... ❑ BORON ........................................ ............................... ❑ CHLORINE ................... ............................... ❑ CADMIUM ......... ............................... ........................ ❑ COD .:......................... ............................... ❑ CALCIUM .................................. ............................... • COLOR ...................................................... ❑ CHROMIUM (tot.) ............................... ......................... • CYANIDE ................... ..........................:.... ❑ CHROMIUM (hexavalent) .................... ............................... ❑ DETERGENT, ANIONIC ... ............................... ❑ COBALT .................................... ............................... ❑ FLUORIDE ................... .......................... ...... ❑ COPPER .................................... ............................... ❑ HARDNESS ................... ..............4................ ❑ COLD ........................................ ............................... ❑ N1PN COLIFORM COUNT/ 100 ml ........:�......... ❑ IRON ........................................ ............................... T COLIFORM COUNT/ 100 ml .... .. 0 LEAD ...................................... ............................... ❑ CONFIRMATORY TEST ................................... ❑ LITHIUM .................................... ............................... ❑ NI`TROGEN, AMMONIA ... ............................... ❑ MAGNESIUM :.................. ......... ..... �... ❑ NITROGEN, KJELDAHL ... - ''' ..........................., ❑ "MANGANESE ........ ............................... ❑ NITROGEN. NITRATE ... ............................... ❑ MERCURY .................................... ............................... ❑ NITROGEN. ORGANIC ... ............................... ❑ NICKEL ....................:................... ............................... ❑ ODOR ....................... ............................... ❑ PALLADIUM ................................ ............................... ❑ OIL & GREASE ............... ............................... ❑ POTASSIUM ................................ ............................... ❑ PH ........................... ............................... ❑ RHODIUM .................................... ............................... ❑ PHENOL ....................... ............................... ❑ SELENIUM .................................... ............................... ❑ PHOSPHATE (ortho) ....................................... ❑ SILICON ........ :........................................................... ❑ PHOSPHATE (condensed) ... ............................... ❑ SILVER ........................................ ............................... ❑ PHOSPHATE (total) ....... ............................... ❑ SODIUM ........................................ ............................... ❑ SOLIDS. SETTLEABLE; m1 /L ................... ........ ❑ TIN ............................................ ............................... ❑ SOLIDS. SUSPENDED ... ............................... ❑ ZINC ............................................ ............................... ❑ SOLIDS. DISSOLVED ... ............................... ❑ .................................................... ............................... ❑ SOLIDS. TOTAL ........... ............................... ❑ .................................................... ............................... ❑ SOLIDS. VOLATILE ....... :.............................. ❑ REMAR/ KSS:..................................... ............................... ❑ SPECIFIC CONDUCTANCE ..............:........:...... ❑ ..... .L G....................................................................... ❑ SULFATE .......:........... ............................... ❑ .................................................... ............................... ❑ SULFIDE .................... ............... ................. ❑ .................................................... ............................... ❑ SULFITE .................... ............................... ❑ .................................................... ............................... ❑ 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 SATISFACTORY CI(EIIICAL QUALITY OF NEW YORK STATE ADMINISTRATIVE RULES & RECULA'TIONS, DRINKING WATER STANDARDS (PART 72) FOR THE PARAMETERS TESTED. ALBERT }I, P�DOVANI M,T (ASCP), DIRECTOR: Avision Of aviromental Health Ser vj.co,, AS BUILT conformance ivitb 5oeble RuLl -CM Appm ved as noted for conf -1C, lea �And Regulations of the EP 7 SYSTEM fia C ;ty C.. Xtbr�it.' 4 . - /V CONSTRUCTION; Z-OT -" -1 'Bu N RD. WCHA 0 rNSTAI L C&-. j v B5 7,',INK /000 GAL.;&lA30N,-:3Y SEPT IC 500 L 11V. F7, Z•Z TRENCH NY PIE L V, Y, Q, PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES . COUNTY- OFFICE BUILDING, -CA•RMEL, N : - "Y : - 10512' - -: DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner 'TDAnkz5LA... Q% Address Located at ( Street �;y�- 'T'„ Sec . ]3zock Lot Y ndi.ca e nearest cross street) Municipality �.,� Watershed to-&, e,�Q-o SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME .z:A- PERCOLATION PERCOLATION Run Elapse Depth to Water a er ve No. Time From Ground'Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches J 1 0 iG 1 2 G - /C� 1 2 3 4 5 13.3 ze) l z, /i r 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 be made from top of hole. /0 lo Z Z 5 U- 10 1 2 3 4 5 13.3 ze) l z, /i r 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 be made from top of hole. Soil Rate Used, % 3OMirV1 "Drop: S. D. Usable i?ti :•_ ricl G' No. of Bedrooms Septic Tank Capacity is ; Absorption Area ProvideE Provide By :5236 L.F.x24" ,; ^;_ t e Address SEAL � e °I—V ♦ Sg 84 THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by Date MAR 3 01984. PUTNAM COUNTY DEPT. OF HEALTH TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH ` -^ HOLE NO. - HOLE N0. � HOLE N0. G.L. �L_ �� `—- F'Sc'�Gl 611 Jo 1211 i 1811 2411 3011 '� c 3611 4211 4811 541t 6011 ! i 6611 7211 7811 8+11 r1 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED �2 INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED 4 TESTS MADE-BY - r Date Soil Rate Used, % 3OMirV1 "Drop: S. D. Usable i?ti :•_ ricl G' No. of Bedrooms Septic Tank Capacity is ; Absorption Area ProvideE Provide By :5236 L.F.x24" ,; ^;_ t e Address SEAL � e °I—V ♦ Sg 84 THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by Date MAR 3 01984. PUTNAM COUNTY DEPT. OF HEALTH