HomeMy WebLinkAbout1830DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
35.06 -1 -7
BOX 16
Us mll
CA.006232'
Yorktown 'Medical Laboratory, Inc. LAB
;
321 Kear Street Date:Taken.
Time: ItAtT1
Yorktown Heights, N. Y. 10598 Date; Rc d: 7 S .fit I
Time :.:
(914) 245.3203 Date`'.Reported:
Director: Albert H. Padovani M. T. (ASCP) Collected By.:' "T(( Ivi
Iol <
Referred By:
T- r -1 Sample Location:
TU M
-t /ra
tC•Iter� m
S'�,lu c •S r ?rn L VJ n
CIO rnAncrnt - T s
v 2 !rl f� V . '. Phone N -S"
Phone # - , }{�- -,��Is
L\�Ln k-PjL S, n / I v Repeat ;Test?
Sample - -Type t
( check- one )
LABORATORY REPORT ON THE QUALITY: OF WATER
x .Potable
Non- potable
INORGANIC NON - METALS (mg/ L) ::MICROBIOLOGICAL (CFU /100mL)
STP'IYF
ST? EFF
Acidity ',,GENERAL BACTERIA
_
_ Other:,
Alkalinity
1�
-Plate
Chloride Standard Count,�-�
_
De-tergents, MBAS :.: '.: {CFU /l.OmL)
Sample -Sat us
--
Hardness, Total `'1 ^.
(check each).
Nitrogen, Ammonia � :MEMBRANE FILTRATION TECHNIQUE
Nitrogen, Nitrate
Out_ROi^ra
Phosphate, Total 'Total. Coliform
._._
Sulfate
_ HiiO3
,Sulfide Fecal Coliform
r
HCI
kulfite
H S Oli
>:" < Fecal Streptococcus,
NaO � 4
n OA
`tQOST. PR' AABLE' NUMBER TECHNIQUE
Na2S2(3
>
Copper
--
Iron Totals Co,11,T o.r Index
Lead h =:
!_ Man ganese Fecal' Colif6rm Index
Inc6minc
Mercury 5,
Sodium ;;:KEY FORT':TERMINOLOGY ,'
�C LE .h °C
_
Zinc 'CFU C_I'ony Forming;` Units
GT.:�: °C
Applicable,)
pH. LE ,2
;QISCELLA,TEOUS LT Less`::Than -(�)`
.Pn GE 9
GT Greater Than ( >)
-pH GE 12
t)H ( units) "' TPiTC Td&t` Numerous To 'Count
"Other
Color (units) .';CON' �C4nf,luent(:TP1TC)
,__
Odor (TON) NR Pt n reactive
Turbidity (NTU)
` ;{ REMARKS` COM'�IENTS (For Lab Use)
RLAP110323
J
THESE RESULTS INDICATE .THAT 'THE WATER aAMPLE WAS) . (.WASN!T_).; (N /A,� .
,.., .
SAT.ISFAC OR'Y' SANITARY QU=ALITY - ACCORDIN - T0' THE 'NEW YORK STATE
- DRINKING WATER
STANDARDS, FOR THE- PARAMETER S'.TESTED,T THE TIME OF',COLLECTION.
THESE RESULTS INDICATE THAT THE WATER SAMPLE (DID) (DIDN'T)
N MEET THE
SATISFACTORY CHEMICAL QUALITY STAND ARD$`'OF`'THE NEW YORK STATE
DRINKING WATER
CODES, FOR THE PARAMETER& TESTED, AT`TAE TIME..OF COLLECTION.
WELL COMPLETION REPORT
DEPARTMENT OF ITEALTK
Division Of Environmental Health Services
Office Use only
r� PUTNAM COUNTY DEPARTMENT OF REALTIi
STREET ADDRESS: TAX GRID Nt1Ar8Eit;
WELL LOCATION
WELL OWNER NA IDPUBLIC
USE OF WELL
9 RESIDENTIAL
O PUBLIC SUPPLY O AIR /COND. /HEAT PUMP
p ABANDONED`
1- primary
O BUSINESS
O FARM O TEST /OBSERVATION
O OTHER (specify)
2 - secondary
O INDUSTRIAL
O INSTITUTIONAL O STAND -BY
O
MOUNT OF USE
YIELD SOUGHT
,�` i.
� gpm.lNO. PEOPLE SERVED ..�-a� /EST. OF DAILY USAGE -"
REASON FOR
NEW SUPPLY
O PROVIDE ADDITIONAL SUPPLY
O TEST /OBSERVATION •.t..`
- DRILLING
TOREPLACE EXISTING SUPPLY DEEPEN EXISTING WELL
DEPTH DATA I WET OEPThI S
"
L.
- ft STATIC WATER LEVE(. L DATE MEI4SUREb 4 ���
DRILLING
EQUIPMENT
O ROTARY Or COMPRESSED AIR PERCUSSION O DUG
O WELL t OINT O CABLE PERCUSSION O OTHER- (sW1fyl:
WELL TYPE O SCREENED O OPEN END CASING 3'OPEN HOLE -IN BEDROCK O OTHER .;
TOTAL LENGTH
CASING LENG'TH.BELOW GRADE
DETAILS DIAMETER
WEIGHT PER FOOT
SCREEN DIAMETER On)
DETAILS FIRST
SECOND
GRAVEL PACK o YE GRAVEL
V. SIZE
WELL YIELD TEST j It detailed pumping
MFTNC&. O PUMPED a tests were done is in
ACOMPRESSEO AIR ; formation attached?
O.BAIt D Cl OTHER ; O YES O NO
WELL OEPtH OUMTION DRAWOOWN YIELD
IL hr. min. it pCm.
dows-
WATEN O CLEAR TEMP.
pOAUTY O CLOUDY HARDNESS
O COLORED ANALYZED? 0 YES O NO
ANALYSIS ATTACHED? O YES O NO
PUMP INFORMATION
TYPE CAPACITY
MAKER DEPTH' ^
Mon VOLTAGE .=•1tP
1ti MATERIALS: STEEL O PLASTIC • Ci OTHER
ft. JOINTS: O WELDED ffTHREADED 13 OTHER`
In. SEAL: CEMENT GROUT O BENTONITE 13 OM
Ib. /It. DRIVE SHOE: YES ONO UNER:OYES.,
'SLOT SIZE LENGTH (n) DEPTH TO SCREEN (M OEYELOPED?
Oyu 001'.
r�
DIAMETER TOP f30D'ION 'r!
OF PACK ® MI. DEPTH ..r..,,.L DMftNAdwi.
f more detailed formation descriptions or stave M".
WELL LOG are available. please attach. .:
Orr'" FRom WlfK wen
SURFACE Bar• mA• t�01gU11oN OESCNI/TfINI
R1e1K
It.
STORAGE TANKS TYPE
•. ._... -_ _.._ __ . _
CAPACITY ..- GAL..- eta
WELL ORR.IER NAME Ai J /1. ¢_.. 1 _9L.
le 67 2_1
RXZ—Kr t _ 5, WOM
STORAGE TANKS TYPE
•. ._... -_ _.._ __ . _
CAPACITY ..- GAL..- eta
WELL ORR.IER NAME Ai J /1. ¢_.. 1 _9L.
le 67 2_1
mwv�_Ir C
FDIAL S�'I`= ' LaSPD'CI'IGN Date , CJ
GP 5::,:)I T LL S T LOT
CWNER
ELI, G DISCS ?-TL PRE? �'
CL
E'S ar= 1CG z=,j as GT ar-.crcve- Dl =�s I I
b_ Fill sew =cn - Date of plaC° -ri-z 2t I
2:1
LGTH L��I:_ aVG.DPI'��
C., tZatu_ a_ 1 soil mr- 5=i=ed ICI- I
I I
C. �tcn.e, br' -i5i,, eLC. r Cra =t om,- !) � f_ui area.
i_:�Il Wale_'" C^l'ra T e,- cl-- c _ I {
I=. SL:+u?G= oDIS.CS ?� S',cTDl I i I
JL�C s_ze - 1,00 1r2�`�
ins i l _ : I.e el
fCL'rGrt_cn
; � �c ^_G
- G. riG OQ � Cc.QS r C1e - S'-CLt W, L_^� 1^ 1 =L. C_
e. DIS_ TIC-N SCE
1. P� Ct _ °L= aL saT.e e! cCr - hc_ ���� _ I I I
2. PYGt= = : be C`N frCS=
�a 3 M' ., 2 f cr i C i sl cC - i �' - 'tic°'' CCX a':Q t= �T'.CCeS
v�._Ci� 1L'L.i - GrCCa
c`t0• ar —z rTCC:�:: Ti =ss.r
+ T T e G —rd, ^G ' tc`D Ln
1
Sic- CL L.e :c ! accE-- ,zaDl° 1 �_7 1 G °�_� GL.
6. 10 =_ f =mi urcce -i il-e - 2� L=___ ZCLrCcLiC ^O I {
:.
7. D� - L _ C 1 3C
S. RCG: C1cH'w fCr e,mai s -cn,
1 3/4
�• C
Of Craw._ /
7i
cf C avell in t'E ^G1 I { r4 V— C-<'-VC -"'
ll ,
P4 _ E:C:s C CCU I
h. P�� Y c^ c�5TjsS
_ C° DCLL
1. Si =e cf L C-laTi: e &cimaEe I I I
3. p a- r-1, vi _ =,,=-1 /aua'O
a, Po easily 2CCessible Tanrcie I
5. Fi- s t box baf -lc� I i
6. Cycle witnessed by Ee 1 tri De I
�t_,at f lew r cycle
ri. HCUS� I i
a. H.Cuse 1 r aoorcved plans.
LilC�" C%
V. TIN= 1'rCQPS 1 -r.s ` I I
a. We1i 1Cc -tea as per aLDrove^_
' b. Distance free SDS area rae. =sdr a f`-
C. Casirs 18" above grade. I
S ralns e arcu-nd Well acceo. ;:b e. I / I
C . 11rtGCa d Ci I I
DTI. CVERPI:L wGp-xif"iti?t-P
a. BCYes rGC?r1V GiCllt I �l
b. P11 �1rec F�,t ally baG ll'1 en
1 ; ras flush wit-1 inside of bcx I I CI
=
C.
i 1 1 cr l CCP_tc1iL stones < an irl CicIIcL° -'-
e. , l - rL._.i r arain install ea according to plan �-
- f 11 rotectw & c�:.to st.Wa� *-c -:ur =e
C1 i_ i n Arai n ;utz
G. FCOt� ;c Crc1rS G�1SC_ ^�Qe aWav frCRt S %�S arc
h. Sur=ac= Water rotectucn adea=- e I I
i. Frrc cn control rcvi deb- .on s'_coe= � =r t�.an 153
:�3
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIROWiNrAL HEALTH SERVICES
Joseph Tuminello
Owner or Purchaser of Building
Building Constructed by
Old Route 22
Location — Street
Patterson
Municipality
Single Family Residence
Building Type
69 4 6.4
Section Block Lot
Applehill Development
Subdivision Name
8
Subdivision Lot #
GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL'SYSTEM
I represent that -I bin 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 the 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 Environmental 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 23 day of May 1988
Genera Contractor (Owner) - Signature
Corporation Name (if Corp.) fib�om Lne-, Pa*6T/1
Address
rev. 9/85
mk
Signature
Tittle
Corporation Name (if Corp.)
Address'
PUS. DIAM COUTT'IY DEPARTICNT OF ILIPALTH
DIVISION OF ENVIRONMENTAL IMLTH SERVICES
COUNTY OFFICE BUILDING- "WilvLB1, N. Y. 10512
DESIGII DATA SBEE T- SEPARATE SEWAGE DISPUSAL SYSTEM FILE N 0.
Address-OU:!, 22
Located at (Street SPVZU MCA L-AUJS Sec. C,-� 131001c
On c-ate nearest cros3 allre—etT
M u r 'i c i Pc, L 1 i t 2tershed
SOIL PERCOLATION TEST DATA REQUIRE ED '1'0 BE " Ij TRIMITTED WITH APPLICATIONS
1010
Number CLOCK TI,',4E
PERCOLATION
PEItCLATION
MY,— Elo.pse
Time
n—om Ground Sui, face
in Inches Soil Rate
St'arL--stop Min.
Start
Stop
Drop in Min./in drop
Inches
�,,,
I C s
n
Inches
_8A, -1_2:gpmZAS
22' z
4
e9% 2.1'
2
Ira - S
20' 4
Q_ _2 I L lz�_-Ze CL-&x F__ I - --
Notes: 1) Tests to be repeated at san—, depth until appj-
rates -are -obtained %at-,,-each-- perc--O.Ia,tion test -holb"._, -Ali,
ddta-to-be submitted
for review. '
2) Depth measurements to be mde from top of hole.
TEST PIT DATA REPI UIRED TO BE SUPWIT.PED WITH APPLICATION
DESCRIPTION OF SOILS 1!NCOUN'.VE1;ED IN TEST HOLES
DEPTH HOLE N0. 8 HOLE NO.
G. L. _ToPSO ►,
6"
12"
18"
211 "
301 CLAX o--O /
36"
11211
4811
5411 _.
60"
7?"
78"
81111
BOLE NO.
INDICATE L � �,L AT WHICH C�ROUTID WATER IS T;NCOUN`i'I3RI?D
INDICATE LEVEL TO WIIICII WATER LEVEL RISES AFTER BEING ENCOUNTERED
T'STS WOE BY �1M&S�e Date.
DESIGN
Soil bate Used 1'- Miii /1 "Drop: S.D. Usable Area Provided
11o. of Bedrooms �, Septic Tank Capacity �����`=�'�j'.:
Y oo Gals. ,���r���
Absorption Area Provided By ?,o L. P. x21t" w K Q�� �;,Lrencl
]'lamel�ic�►�rJ �. Fa4laiL�E.��2�. i�'iE nature- (,7 -oL
Address SEA `�' `' `� >'
TIIIS
SPACE FOR USE
BY EEAINH DEPARTMW
ONLY:
Soil
Rate Approved__
Sq. Pt /Cal.
Checked by Date
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
APPLICATION TO CONSTRUCT A WATER WELL
PCHD PERMIT
i
#
WELL LOCATION
Street Address
Old Route 22
Town Villa City Tax id Number
Patterson,
WELL OWNER
Name
Loft Corporation
Address
Pump House Road, Brewster, NO
Private
O Public
USE OF WELL
1 - primary
2- secondary
& RESIDENTIAL 0 PUBLIC SUPPLY 0 AIR /COND /HEAT PUMP
O BUSINESS 0 FARM O TEST /OBSERVATION
O INDUSTRIAL U INSTITUTIONAL 0 STAND -BY
0 ABANDONED
0 OTHER (specify;
O
AMOUNT OF USE
YIELD SOUGHT 5
gpm /# PEOPLE SERVED 5 /EST. OF DAILY USAGE 600 gal
REASON FOR
DRILLING
NEW SUPPLY
O REPLACE EXISTING
OPROVIDE ADDITIONAL SUPPLY
SUPPLY 0 DEEPEN EXISTING 'WELL
OTEST /OBSERVATION
DETAILED
REASON FOR
DRILLING
New Single ami y esidence
WELL TYPE
DRILLED
DRIVEN
ODUG
GRAVEL
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES X NO
IF WELL Ig LOCATED IN A REALTY SUBDIVISION; -NAME OF SUBDIVISION:
Apple Hill Development Lot No.
WATER WELL CONTRACTOR: Name Henry Boyd Address: Rt 52 Carmel, NY 10512
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE:
YES X NO
NAME OF PUBLIC WATER SUPPLY: N/A TOWN /VIL /CITY
- DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: N/A
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
4 -7 -87 ❑ ON REAR OF THIS APPLICATION 0 SEP SHEET
(date) (signature)
PERMIT
TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above is, granted under the
provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and
provided that within thirty (30) days of the completion of water well construction,
the applicant shall:
1. Pump the well until the water is clear.
2. Disinfect the well in accordance with the requirements of the Putnam
County Health Department attached to this permit.
3. Submit a Well Completion Report on a form provi ed y /theyPutnam County
Health Depa..Issue__
Date of Expiration: 19 Pbrmit Issuing Official
Permit is Non - Transferrable
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services
J
AFFIDAVIT - CORPORATE OWNER APPLICATION
FOR PERMIT APPLICATION SUBMITTED TO
PUTNAM COUNTY HEALTH DEPARTMENT
TO: Commissioner of Health
In the matter of application for:
APPENDIX L
represent that I am an //officer or employee of the corporation and am authorized
to act for C e2
having offices at
(Name of Ccir+ oration)
U
,J%� (7i
Whose officers are:
President: 1 ` /�_ i-
Vice - President:
Secretary:
Game and Address)
(Name and Address)
(Name and Address)._.......
Treasurer:
and Address)
and that I am and will be individually responsible for any and all acts of the
corporation with respect to the approval requested and all subsequent acts relating
thereto.
Sworn to before me this :I day Signed:
c
of 19 pj � Title
Notary Public
ANNE M. MAHONEY,
Notary Public, State of New York
Qualified in Putnam County
Commission Expires March 30, 19.9 9
Corvcrate Seal
8/84
of Owner)
�� GOMMEN''rS
IF trench provided
required �
60 ft. max
- -- Parelle3_ -f
X,
REVIEW SHEET - CONSTRUCTION PERMIT t,
DATE REVIEWED:
BY: ' f
(Street Location)
YES NO,. DOCUMENTS
Permit Application
Corporate Resolution
Plans - Three sets
Engineers Authorization
Design Data'Sheet (DDS)
Deep Hole Log
Consistent Perc Results
Perc Hole Depth
s/s
SUBDIVISION
Perc
(3) Fill p
cd �—
House Plans - Two sets
Well permit; PWS letter
Variance Request
Legal. Subdivision
Subdivision Approval Checked
Ex- approval SSDS Adj. Lots Checked
Wetland (Town /DEC Permit R & D)
Data On DDS Plans & Permit Same
REQUIRED DETAITS ON PLANS
Sewage System Plan - (north arrow)
Cewacae Svstem Hvdraulic Profile - �G:
'i
�I
ity Flow
Fill Profile &�Du nsions - Voi`L
�ll o�J Bc�xTrench,/Ga zE `details '
Y; . `P_._
Septic Tank - Size, `Detail ..:.
c Well Detail, Service Line if over
Construction Notes
Design Data: perc and deep results. 3
Two-Foot Contours Existing & Proposed
Driveway & Slopes Cut
Footing /Gutter,Curtain Drains (discharge OK) '
Perc & Deep Holes Located
Representative of primary and expansion
Expansion Area;shown;gravity flow,suff. size
r' If Pumped Pit & D Box Shown & Detailed
y
House - No. of Bedrooms
Wells &.SSDS's w /in 200 ft. of Proposed Systems
Property Metes & Bounds
House Setback Necessary (Tight lot)
House Sewer - 1 /4 " /ft. 4 "0; Type pipe
" No Bends; Max. Bends 45° w /cleanout j
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
10,' to P.L.., Driveway, Large Trees,Top of fil'
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake (inc, expan
15' to Drains - Curtain, Leader, Footing
.: 351to catch basin,stormdrain,piped watercours.'
Ld10' to Water Line (pits -201)
50' intermittent drainage course
Septic Tanks
` 10' from Foundation; 50' to well
Well to PL
I
ZRJ"CT"{ 0" Tam c"(1)
SEPTIC LOC-rIC)Ky PLAN
ACA LE ° = c),
Lpproved an noted for conforc
tppllcalzle Hulec and Re _-aatl
L�utnaei County Real h D, arts,
i ±t¢natnre .5 Tit..e
OWNER OF RECORD
LOFT HOMES
PUMP HOUSE ROAD
BREWSTER, N.Y. 10509
I c TAnI K
t +
i
r
M -c n :; Q CO -4 0-
> r" i4
rr, ID
rb
rp r) ;Q
(11 Lh
>
LA
if; Z:
rr, (r,
G RI M
'j
0 rr
" , Y'A
114,
r
4 on -j b, 0 -41 v
zo
--j :c
p
71
U3
Im
r
rr
n-V
L 19, f Ra L - -----
= .
.4y -7
r- A/ Zc) jq
---- -- - ----
.9v
r, b
4tr
U)
v Jr,
CP