HomeMy WebLinkAbout2573DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
52. -2 -14
BOX 22
11 oil 1. Ll
or
V I. T
J.4r■ �' q' 'T. '
r r
I'L T7 I or I I I
ilrrr
lal - �t-L. ih I UL
02573
27. C)02058
" Yorktown .Medical Laboratory, Inc. LAB
t
321 Kear Street Date Taken: Time:
Yorktown Heights, N. Y. 10598 Date Rc' d : Time :
- - -. - - -
yl� a'd$ - ite`d .
Director: Albert H. Padovani M. T. (ASCP) Collected By:
Referred By: _
Sample Location:sCiu -�
�JdA/�-Al �EIc -2 Tr.
/ C� w� r✓r¢ /�6 dH7 aP� • Phone, #f
vl/� ``ll N'y. / ar) Phone #f I Sample Type:
L / J Repeat Test? ( check each)
LABORATORY REPORT ON THE QUALITY OF WATER,
INORG-A -NIC- 14ON- METALS MICR- OBIOLOGIC -AL CPU /100mL jr�
_ Acidity
Alkalinity
Chloride
Detergents, MBAS
Hardness, Total
_ Nitrogen, Ammonia
Nitrogen, Nitrate
Phosphate, Total
Sulfate
_ Sulfide
Sulfite
GENERAL BACTERIA
_ Standard Plate Count
(CFU /1.OmL)
MEMBRANE FILTRATION TECHNIQUE
Total Coliform
_ Fecal Coliform
Fecal Streptococcus
METALS (mg /L)
Copper
_ Iron
_ Lead
_ Mercury
Sodium
Zinc
MISCELLANEOUS
PH pH (units)
_ Color (units)
_ Odor (TON)
_ Turbidity (NTU)
MOST PROBABLE NUMBER TECHNIQUE
Total Colifor:u Index
"Faecal Coliform Index "
KEY FOR TERMINOLOGY
CFU =
Colony Forming Units
CON = Confluent (q.v. TNTC)
LT = <.= Less Than
GT r= > = Greater Than
N/A = Not Applicable
S/A = See Attached
TNTC= Too Numerous To Count
REMARKS /COMMENTS (For Lab Use)
Potable
Non- potable
_ STP 'INF
_ STP EFF
Other:
Sample Status:
(check each)
Outgoing
HNO3
HC1
_ H2SO4
NaOH
_ ZnOAc
Na2S203
Other:
Inc oomi'ng .. -
vLE
40C
GT
h °C
_
pH.
LE 2
—
PH
GE 9
PH
GE 12
_ Other:
ELAP No. 10323
THESE RESULTS INDICATE THAT THE WATER SAMPLE Was) (Wasn't) (N /A) OF A
SATISFACTORY SANITARY--QUALITY ACCORDI -NG -TO THE EW ORK STATE PUBLIC DRINKING
WATER CODES, FOR THE PARAMETERS TESTED, AT THE TIME OF SAMPLE CnRIN ION.
THESE RESULTS INDICATE THAT THE WATER SAMPLE (Did) (Didn't) MEET THE
SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK PUBLIC NG WATER
CODES, FOR THE R ETEP� TESTED, AT THE TIME OF SAMPLE COLLECT
LX/ � XN � 2 /86(Rvsd7 /87)RWE
Albert H,, Padovani, M.T. (ASCP), Director
PUTNAM COUNTY DEPARTMENT OF HEALTH
ReV': 3/86 Division of Environmental Health Seevlces, Carmel, PI.Y.10512
EngineerMaetProviae' PV't86:
` P C.H D P ®emit q
.••:CEIRTiFI A OF. ,-AONSTEU,LT1(kV- 4•XIBIPLI.4NCF FOR SEWAGE D[SPDSAL<SYSTEA�i p6 i t ati 'L�a I ey
n
Town oe d e
lacaite�- it Oscawana .Heights Road. T" 35 $loc!< Lot 7.16
John Me�er'Jr.: adgaroff 6
Owner /applicant Name Formerly Subdivision Nam Sabdv. Lot q
Oscawana Heights -..Rtl ,:Put . Va�� 10579
Malling- Address Date Permlt-issued 1 986
separate seweresyetem>;outpy ; .John Mai rt': Jr Aar Os:cawan Heights R "d' Putnam Val Ley NY
Consisting of :' 125 - cauop Septic sank tuna 50.0 LF:.;:Of 24(' Trench
zz ... .
Water Supply :: Pabllc Snpply From : Address
or X: PrlvatesnPPlr.Drlueal iderson Inc .�ddreae`.: 152 Bar.Qer Street
13ouain�:zype 2 story :f name .Has Erosion Contro l Been Completed? o m® Ye ® -.,P) n'am Val�.l ey, N.Y.
'Nu nber of Bedrooms 4 - ae Garbage Grltidee Been histalledg
Other Regniremente None o �t.a'
I "certify that the system;(s) as 'listed serving the,above premises were constructed. 1 0wh9 q�ieepiar'B of the completed work ( copies
of which. are httdchec),'and in aocordance with the standards rules and regulati acc lad :plan,* and the permit issued by the
Putnam County Department Of Health.
Da Jd'n 20;':1990' cert,flea'.by i; ® p.t:._ a.A.
o'
Adtlrass orth • '`d e ad eeksk 11 �.. l 05i§A- NO.' .`27846
® 1
Any : ,person occupying premises servetl by the above systems) shall promptly Yaks such a c. r 0 secure the eorrectlon of ariy,unaanita►y
contlitions. Kesulting from .wch usage Approval of ;'the separate sewerags ystem shall,bocAQie,``NNu• d�ioAld �S`sOOn aC; 'a pub .. s�nttary: fewer becomes
available and the- approval., of the private water supply sftall become null and void when a pupil!° watero pply ®ocomes available. Sueh, approvals are
subject to: modification; or' change ' when in the.)udgment.'of the�Coi.n- miisdoonor of Health ►®voeo4lon; mo614icat{on or cnanlio is necesury.
Date s / ���, y Title
-1
C'
T.TVT T /'AMMT L.TTnM DVnnDT
��l• •�I'
,�•
Y\iJJJL
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUTNAN COUNTY DEPARTMENT ° OF -- HEALTH `
Office Use Only
WELL LOCATIO
EEi ADDRESS: , WN/vl 1 1 Y TAX GRIO NUMBER:
a — 7,/6
WELL OWNER
ME: ADDRESS:
/
6
PSIVATE
P
❑ UBLIC
USE OF WELL
1 - primary
2 - secondary
kR RESIDENTIAL O PUBLIC SUPPLY O AIR /COND.IHEAT PUMP ❑ ABANDONED
O BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify)
p INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑
MOUNT OF USE
YIELD SOUGHT gpm. /N0. PEOPLE SERVED --"—' / EST. OF f)AILY USAGE gal.
REASON FOR
DRILLING
NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O TEST / OBScRVATION
D REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTHO d ft.
STATIC WATER LEVEL -�� ft.
DATE MEASURED
DRILLING
EQUIPMENT:
-O. ROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG
o WELL POINT D CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE
❑ SCREENED O OPEN END CASING ,9:OPEN HOLE IN BEDROCK ❑ OTHER
CASING
DETAILS
TOTAL LENGTH S it
MATERIALS: JaSTEEL ❑ PLASTIC ❑ OTHER
LENGTH.BELOW GRADE eft
JOINTS: O WELDED .10THREADED ❑ OTHER.
DIAMETER in.
SEAL: ❑ CEMENT GROUT ❑ BENTONITE J'OTHER
WEIGHT
PER FOOT %S lb./ft.
I DRIVE SHOE-YES ONO
LINER: ❑ YES,®NO
SCREEN
DETAILS
DIAMETER (in)
SLOT SIZE
LENGTH (ft)
DEPTH TO SCREEN (ft)
DEVELOPED?
FIRST
a YES ONO
SECOND
HOURS
GRAVEL PACK
° YES
❑ NO
GRAVEL T
SIZE:
DIAMETER TOP
OF PACK; in- DEPTH
ft.
BOTTOM
DEPTH It.
WELL YIELD TEST If detailed pumping
METHOD: O PUMPED tests were done is in-
COMPRESSED AIR ,formation attached?
.O BAILEO ❑ OTHER i YES ❑ NO
Y9 �L� LOG 'a'--re detailed formation descriptions or sieve analyses
are available, please attach.
DEPTH FROM
SURFACE
Bear-
ing
Welt
Oia-
meter
FORMATION DESCRIPTION
caoE
ft.
(t
WELL DEPTH
ft.
DURATION
hr. min.
DRAWOOWN
It,
YIELD
gFm.
Surface
�4
'�
ra
WATER O CLEAR TEMP.
QUALITY ❑ CLOUDY HARDNESS
O COLORED ANALYZED? OYES ONO
ANALYSIS ATTACHED? O YES O NO
-F-H
STORAGE TANK: TYPE—.
CAPACITY GAL.
TYPE
PUMP INFORMATYO
MAKER
MODEL
CITY
PTH
HP
WELL DRILLER NAME L OAT
AOOR Y GfDiTt1RE �O
/off
PUTNAM COUNTY DEPART OF HEALTH
DIVISION OF EWIROi rAL HEALTH SERVICES
Jtll'!i1 B��1N:f' Jr.
Owner or Purchaser of Building
John Meier Jr
Building Constructed by
Oscawana i -lei fights Road
Location - Street
Putnam Valley
Municipality
2 story frame
Building Type
35 - 2 - 7.16
Section Block Lot
:1ncA Yadgaroff
Subdivision Name
Subdivision Lot #
GUARANM 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
_ repo zs .made J- ._me._to_ such..s stem, - except where =the• failure to operate -properly-- is' "
Y Y P- P
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.,.gealth 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 20 day of Jan- 19 ' 9G.. `
General Contractor (Owner) - Signature
Corporation Name (if Corp.)
Address
rev. 9/85
mk
Signature
r
Title
Corporation Name (if Corp.)
Mrs
� DISFOSP!j P_RF�
a_
_�
EDS arm lcc ted Es F
b.
Fi11_ ser-ticn - DEte of p
°0 � bar -as , C 1 P� --cL't w lt_R'_n 10
2:1 barrie_' . L=-
C-
soil nct st-icCE
d_
StCr_e, brush, etc., gr =-
e _
. 100 ft. f.r crn wa-e- cours
Dls��CEAL SYSTEM
2 . Pret= cm—� bela frost
tank s -_ - 1,000
b
Ci C t: +nk in-sta 1� 1=
r7.
V.
vi.
C.
d_
e_
f.
a_
FINAL SIM INSPE'C- ON
A G _ DPra
lot u-L:11TC ?n from fc mc icn
I
�I
°0 � bar -as , C 1 P� --cL't w lt_R'_n 10
f z _ c t 45' bard. I
. I
y c
D1S' R= -jTTGND S--,X
cuL e s at- samFa e e ra tier.
- wa -er t-=
I
CtJi�/`(�Q , c%
2 . Pret= cm—� bela frost
i
I . I
. ,_ �,_ LJ
3. r,; n;* a. m 2 ft. crlci r1 soil te7we!-�n bcx ara t=_:c__ =_s
3. Ala----M,
_
i .=ICN Ecx
d p-= ecSi1v ac- -ersT ole rr�hole to crate I !
I I
UE
L- ^= %-i rte= 1- - 0b
L�_�`: irs-- ll�C3�
r1ir,
� J-
2. Dls tans= t0 wc� �r� �l't.c Ir °=5 - (j f =
6.. Cvcle w; `T��s by E =�1tn De artm?_nt. a
3 . kis -1 1 � ac r'r :._' na to plan
a Distance C-nt —Y to canter
5. 51cce of t?"= -:C_"] zCC_nt
6 10 f� L i=-m cr=_.ar ri
lr l
%. DecL-i -cf tra ch < 30 inch
8. Roan ? l l a e f cr E`c -_,F-n c i C,
9- Size of crGVe-1 3/4 - 1?"
10. Deotrl of c=cvZ in trs*:cz 12" nu rr;an
.
L.. Piue ergs =cry I ►
. I
y c
h-.
_....
PUA" ,P CR LCSE SYSTEMS f
1. Size of oL-, G-�: .._.._.. - I 1
+C-Id
CtJi�/`(�Q , c%
2. Cverflaw t=nk - (_ i
I . I
. ,_ �,_ LJ
3. Ala----M,
d p-= ecSi1v ac- -ersT ole rr�hole to crate I !
I I
n
5.. First bcx b =?
6.. Cvcle w; `T��s by E =�1tn De artm?_nt. a
_
e✓ti.rrated- flCrH r:cr e7cle
EiyLr,
cce rer Ecorcv plans -
a- EcLe l y /
L • (/
b.
N rer cf b�xccr._s
a-
k"e? 1 lcc=t as r.Er a- -crcved ol� ^G
b.
Di =mince from 1--'DS ir�=--suraa / b ft. I
C-
C_sinc lb" ahcve crEcie_
Q_
"L'L;aC° d- T- clr =Gc arCLT�G SvZl cC =eni=DlZ. I.
I
C-v— T1, hGR'Kncr =i
a. Eicxes rccerIv c---cu Ea
b.
F11 pi e-s rti a-1.1v bac fill e. I
I
c.
All PLpes flL'_i with inside of bcx t I
d.
F ckfill rraterial cent =-ins stores < 4" in d-7
e.
ca --tai n drain ire- stalled -lle accord-inc to pL =*l
I `}
f.
,-ain train cut=all1 prct =ct= & c?r.to Eti =- ::_wat_c--ur=
n
c,
ccct_rc
h-
SL=-face water rrct c-ticn adeoL;tEt
i_
-=c= -? cn c-nt a L rrcvi ce�i cn sicces c =-7-= __r tt�n
PUTNAM COUNW.. DEPARTMENT OF
OF.ENVIRMMMI, -HEALTH. SERVICES
DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner r.� John Dreier, �Jr. Address 246 Buttonwood l*eniue rPdekskill NY
Located at (Street): Oseawana Heights,' 'Road: 35 gl 2 Lot 7.16
(indicate nearest cross street)
Putnam VAlley Peekskill
Municipality Watershed
4
5
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMIITEED WITH APPLICATIONS
Date
of Pre- Soaking April
15, 1986
Date of Percolation Test
April 16, 1986
HOLE
:3126 3 06 3
30 1
19. 75 2
22.75 3
Na-MER
CLOCK TIME
1 :
PERCOLATION
PERCOLATION
Run
,Elapse
Depth to Water From
Water Level
No.
' Time
Ground Surface
In Inches
Soil Rate
Start -Stop Min.
Start
Stop
Drop In
Min /In Drop.
Inches
Inches
Inches
1
3s22 .3x52 30
20.25
23.00
2.75
10.90
308 4128 30
20.25
2.50
12.00
2
.22.75
435 505 30
20.25
22.75
2050
12.00
3
4
5
:3126 3 06 3
30 1
19. 75 2
22.75 3
3.00 1
10.00
1 :
30 _._ :
: -` l9.75 -.. _.. .
.:__22..25•.. -
---25(x,_.__ .
...... 1
2
3
4
5
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 frau top of hole.
rev. 9/85
14'
_.- IIVDIc"ATE T VEL AT' Gu'EiiOEI C�OUNI7GONM - IS":ENC)OUNTERED "•7
INDICATE LEVEL TO WHICH _WATER LEVEL; RISES AFTER BEING ENOOUNTERED 5' ft
DEEP HOLE. OBSERVATIONS MADE BY:John,' S.. Romeo �. April 15, 1986
DESIGN 000SF+
Soil Rate Used 1115 Min /1" Drop: S. D. Usable Area Provided 5
No. of Bedrooms 4 Septic Tank Capacity 1e50 gals. Type Masonry
Absorption Area Provided By L.F. x 24" width trench ®dcooQQ® 7.
Other ®° SO, Efll�/RI ®'o
0 SW 1 0
Name John S. Romeo Signatur® V
1 Northridge Road " a
Address SEAL o 27816 e°
Peekskill, n. Y. 10566 llf Ali
�Ao� ®�®
THIS SPACE FOR USE BY HEALTH DEPARZMENT ONLY:
Soil Rate Approved sq.ft /gal. Checked by Date
ii\J&l WL
Pero
►W-LA� . .. \WViN.LAJL%J_" LIM 46ALJ..
uVJ.tNa7
Veep
vere
DEPTH
HOLE NO.. 1
HOLE NO. 2
HOLE NO. 3
;T®ps®il ..
Topsoil
Topsoil
Topsoil
Tops011
Topsoll
1'0...
Sand ,silt ,loam,
sa.ndy,silty,loam,
samdy,siltye loam
some Clay,
€ ome c,-Lay
2'
I
1
14'
_.- IIVDIc"ATE T VEL AT' Gu'EiiOEI C�OUNI7GONM - IS":ENC)OUNTERED "•7
INDICATE LEVEL TO WHICH _WATER LEVEL; RISES AFTER BEING ENOOUNTERED 5' ft
DEEP HOLE. OBSERVATIONS MADE BY:John,' S.. Romeo �. April 15, 1986
DESIGN 000SF+
Soil Rate Used 1115 Min /1" Drop: S. D. Usable Area Provided 5
No. of Bedrooms 4 Septic Tank Capacity 1e50 gals. Type Masonry
Absorption Area Provided By L.F. x 24" width trench ®dcooQQ® 7.
Other ®° SO, Efll�/RI ®'o
0 SW 1 0
Name John S. Romeo Signatur® V
1 Northridge Road " a
Address SEAL o 27816 e°
Peekskill, n. Y. 10566 llf Ali
�Ao� ®�®
THIS SPACE FOR USE BY HEALTH DEPARZMENT ONLY:
Soil Rate Approved sq.ft /gal. Checked by Date
r.-
L w.
o r t
� a
.5
d
:ert3fy' t2ri= 'ti^.e
-
� 3 ?vv D�''J � :�? 7" r �!'.! (">ir' � i•': r9 ! r °',. J ''•
:xewa�,e
�s i�ndca3s�c}: orl` Ghs plan
dispAea
and that
;systetq���t
tAe: system'
Pf- ! N 'vv r:_r'taur
:Me"
l �Y s Qr,� apt' ;was- ccave�e,d.
The
, F �L r a 4
1j
� j U a rA L (,: R 7'
2
Ns # y
t •
s
5,... a -�,v? ±Ate::- 1N rhLt !_ }.N..
VIA
Lod A'7to.N }- N.DiCAjL.
j d-,.. •,5' / -T ;
f� J �f! z +�r.Y__.
�pgyf
:J ,� 7
_._ k./! "�_ i
O.. N
_
f
y
r
J S d
N
3
p !�
a rI n
}t
s' r
-- �{'
`. �J F. T
is
ZAP hr
yy
�.
4 ly�� ,±� ^',,4,i_ ..{..• 1 ..n.+, 4 ` lldll i'stU.Fl['LL.'�l•riV�iJ41rLWWI i
r} _r,,.
z i ° ° °" f ! V3,ais o/n�lo"i Env o eniti1' 'Health 'Ser.ves d'o ' a
_._�.�
Woo
otedtifa' conformance; with 3c
.� -. .( ihv-
/
s . ..? PF i'cble:rT{u1os. sid' lations"o ' -:
,lei ;�I�. /P�':�5 �.. �`'T' S. � • :,a.a 8� i
9 i �.: Putnam bounty %ealth De tIDent 1N iL t.'
C IvySEPTIC - -SYS EM ASS
A. .ate. •'ti ..� '.d^ ... C.' .t t .Ar ti -
y . ovd8 bhp rd j 1,¢natttrw R m1 +� eF i
a°
"-BEDROOM! MOUSE ol
' e
f.
-•,. t a }u'g , , � ,., c�'� +u (,� 1, ;, �' _ ,
700 -,00 A ��4�!_ t�. g' t f( i.f � �•'�rG�:O � �: ` ' t 1 J'.. �fn � � .S :I :�`nF 'Y� Y. d� t ;y _ � ,
'S• -`: ft+ (�S.':LT GA TAINK ,.. r }.. : .QF, PU %•t,+T-VA.,rt�Y. -?:
�'` Rid} { i• '°�t _ - t T:.
-e, x a x, :.:s t t �•'' t ' .x^
x 1 r� a t M
Q�
x {�, O ®�� a Y.e i �'� s : }Xrt s,: '� 1
r : a x ORGINA
45
e
:.. ..�x_..... ....�.� .:�_:. �:,: -.` � - _. ....,,. ....... .�Ciw�a� - .- .f.�'c',/e`i�.... +i��f�`Qi. ... •'x..s:, ._ _ _ ; -a:R .. - � f -- -