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HomeMy WebLinkAbout3399DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www. sca n yo u rd o cs . co m 631- 589 -8100 73.08 -1 -43 BOX 27 03399 ., r '� ' ' Z T t 6 '- 9k - Von I 1 '- �I, 1 - *, ' 1 r 03399 u{' X45 3 � S JPEEKSKILL MEDICAL LABORATORY 265 V s E,-si 2' $ .L y 1879 Crompond Rd Maple Terrace Bldg A ._ t Peekskill, New-.Y&i t PE 7 8'777 1 - y - W ' Dr tt COLLECTED t ':' RESULTS YOF EXANIINATIO�WATER ' s 12m3© 71 .� _ OWNER DATE RECEIVED � y BELIE RbHL x 12�3fl 7i .. CITY VILLAGE TOWN & OR NAME OF SUPPLY $`'' �' `��� ' -� - � 1 . { E ': j� +t r r "� cr _ *s�� �� sre �1 �n+• � �SAMPLINGPOINT - - 4 t : s BACTERIA PER ML. {Agar plate count at 35° ) COLIFORM GROUP Wost probable No /100m1) 'RESIDUAL CHI ORINE AS RECORDED AT i y. " b LL' �o ` " A?►? SAMPLING POINT POINT OF TREATMENT ;CHLORIDES' (CI) mg /1 '° NITRATES (as N) mg %1 A.'H PADOVA 'I T,: P)' A- V ZY' f � ^ ! .y 7 i'F ikY K � j � .✓^+� 5 3,f. 8`*� � , y T- �`y. 3 '� R� j i } i � '3 'f ;. R These results indicate thct the water was'a,S' of a satisfactory sanitary quality when the sample was collected: �n� r � a F �` 3 � � � 1 . { E ': j� +t r r "� cr _ *s�� �� sre �1 �n+• � A.'H PADOVA 'I T,: P)' A- V -,. tug f+ 9 �f ` "WELL COMPLETION -REPORT '43/71 PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK RilptQ0 . by yV�ll: dritter'- .,gild,- zubmitted�to- County . <Fiealth.Departmerit:together with laboratory. reporl*of.� .o j 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 1 OWNER NAME CPI v y,Iu h G _A, DRESS (, j ► —�5'1 s'�'t ol �� PULA L LOCATION OF WELL (No. & Street) (Town) of Num er p ( ) A In d�11 PROPOSED USE OF WELL BUSINESS DOMESTIC El ESTAB ISHMENT 0 FARM TEST WELL � ' SUPPLY El INDUSTRIAL ❑AIR ❑ OTHER . CONDITIONING (Specify) DRILLING EQUIPMENT COMPRESSED CABLE OTHER ROTARY F1 AIR PERCUSSION E PERCUSSION El (Specify) CASING DETAILS LENGTH (feet) ;! tlr i DIAMETER (inches) t1/j WEIGHT PER FOOT THREADED 0 WELDED DRIVE SHOE DYES a NO W LYES S CMG OU D7 NO YIELD TEST HOURS ! G.P.M. El BAILED PUMPED X COMPRESSED AIR % �) YIELD (G.P.M.) WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify leaf) f �1' DURING YIELD TEST fleet) Depth of Completed Well ) ,. in feet below Land surface: /! 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 (feet) TO (feet) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of wel h distances, to at least two permanent landmarks. to Fl!E��ET�j }FEET tv �IL_ Caa ` �Q '31 6Ibr ao If yield was tested of different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED DATE OF REPORT f' n WELL DRILLER (Signature) !, �✓� > 01 • o- ''rb - Owne or Purchaser of ding Municipality Building Constructed by Section ir-_A- kA t'aTi— T:> i2.. Location - Street Block R L" C'm I .- 21 Building Type 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- vices _- of....the...:T.atnam_.County- Department of Health as to whether or not the failure of the system to operate was caused by the willful or neglig act of the occupant o he buildi g utilizing th s tem. Dated this P� da of -�-� -- y Signature Title If corpor tion, gl e ame and addr s s) O -7=_ - - - - - - - - - - - - - - - - - - - - - - - - - - - -0 - - - - 14 - - - THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMP.7,ETION 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 ,- \ , �~l 5' YSF'rt.t /' � 1 < tY T NL T t/. W�L._ 1 "ex �yS' .fa•.t&�e� " c'74- t- AZIa"G1 ti..�. -,- +c l w+.. �•,,..'�. "'"a+i�•i t, ,,3 73 L} t: 7 W I' . 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"If.. : '�.+ I 11 "Div WIM-STROCtION" E MVT_-`FoA­S'E1 T R r . si . on --of En'v-ir6hfi?Oiitiil Health Services; ,NAGS �,DISPOSAL SYSTEM '­' F.'­HEALTH K.10512 �O Y Town or ,:y -rWge :,&Ant RA. v A_ Subdivision ` - '- ' 'a ' _ 1- -i,- drilled ` L—o , t ' l* 1, '. e., 4 , ' , .2­-- .A .Owner Address Building T y p p Lot Area 67 N u mber of 6edroom— 0itabIe;Spa Squa rd- ",;F.—_. _ eet Separate Sewerage System .to CoPs s 0 Gal Septic Tank width trench 4 To 66 - constructed by Address Water' Supply: Pu I c P Fro Private Supply 6 be drille d by Address,, -6ther- Requirements I repr esent that am wholly and dono ldtely'respon sib le for. the dbsi§nand 1orat on o e,prRpose that s6pariii sewage disposal' system above described will be- constructed as,s ownqn'thqappro amendment eni tfie�eto and in accordance -with- 66-difidards, rulesand regulations ot77e ufn am County 'Department of::,;Healtli, and that -on -conpletioh thereof � afe C ?mpI '; sifiifict y t6 ,the Cormissidner di-Healthwill be,submitt6 to the.Depart1e 1i and 1aI wlii ' :gdaii� _ lrbi furnished the owner heir's or �yllhelbUildpr;,tha t spic,builderwi _ I . paceAn good operating condition ahy parf -,said "i4i diiposa I system ddh , the: ri (2 w ?IFfollowing-the date'of, the jSSU ante 'of the approvai., of the 'Certificate of Construction., , ompli nce o i-tn@ ori i r a -repaIrs ffibrtto;,2) that he drilledweli described above :will loia ted as pa _a nd ,that.iaid; welj�wjl be Cr li" t e standards regulations A he Puth am County- ',Department of Healtk 7 Date P.E. R.A. , s Lke rise Nor ell 5., one'.r;y ea rf u . nless,�c the 4ate,_issUe.6- i APPROVED FOR C6 NSTRIU&ON: '.This.appr,ovdI expire's.' on ion he -building has been undertaken and is •f T `revoc;61e or,-cause%,or,-mii�r '6-�,,irniand :,`6r!moi riiiia when ioniideriiid neciiissaiy. Commissioner` dk"Iih A-9-ycha"rig ii.or:aIteration of construction 'Sp St. r64'�­ s a ng' w pe r mi t.",- - A viroved for osa :-,cif"� �ire 4-Ic _509 p U sews Y. 4 Ino wy �,2 Date Tale M .PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES. A r... Y_ v.,�. _.__._._.. -- ----"T :-i. � .... -�. , � ,.. :.:a,- .R..,.,:.�,_r,' +,;'c"-a.� -ice:.. �.,.i'. ^- 7,.�'���._.�z.r. ,. r ^-� .- +�'.: -vr�, ;a-.,,,±�.:,•• 3v COUNTY OFFICE BUILDING,V CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SgiAGE ' DISPOSAL SYSTEM FILE NO. 3 Owners f °r� 9;, . Address e s EGG ©Claw �;r`. yALL�y T. _- Located at (Street 72R. Sec ._T/ Block -- -Lot' ndica e nearer cross treet j Municipality�,,�, Watershed Cam' a7o,4i_ SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIP'S PERCOLATION PERCOLATION Run Elapse No. Time Start -Stop Min. ...Depth to Water From Ground Surface Start Stop Inches Inches Water Lev e in Inches Drop in Inches Soil Rate Min. /in drop 21_ , 7 1 /2,' . S''c� /Z•. Ste' A 63 % ' 2/z: s,y / s 411 y 0 �9 3z iG 4 5 1 2 4 Notes: 1) Tests to be repeated at same depth until appproximately equal. Soil rates are obtained at. each percolation test hole. A11 data to be submitted for review. 2 Depth measurements to be made from top of hole. . 4 TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION s r DCRIPTIOIV,_OF SOILS ENCOUNTERED I_N TEST HOLES �.rti::M� f'r. 1,��'[Cb'�. .��ir wivTa. v�•A _.. DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. 611 12" 18" 2`t" 30" 4211 48" 54„ 60" 66" 72" 78" 8411 jo,-a - SoiG I 4�",7 s�-r T,�rfcES of c1.vy INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY /'( <<.!/A�G_ ,.� Date 5�f�i DESIGN Soil_ Rate Used,5?iO Min/l "Drop: S.D. Usable Area Provided j No. of Bedrooms Septic Tank Capacity PE, Gals. Type i�i�scue� Absorption Area Provided .By6� L. F.x24" _width trench. ' Other Fii ure Address SEAL G?.gxi.rE.LT� THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved . Sq. Ft /Gal. Checked by u - PC r� Elate ml t4' •,,;'i�;��l ��: � i Ny:�. :�1' ���� �: 1' �t�. . }.. "�1 .�'a r. 4 f )� I ✓� -aw,.W TAx KV 'G.2 23? u 1\j c 11 - lZr'limmct 7--. -7­- ATik"NS fjF I'l-JE APAP :-MENI M 'IN)v C �jl J J A T, c. E M, OP A 14- T' WTI U ME P OF H EA L TH P rd V IS, OF IMIRONMENTAL HEALTH SERVICES S Ul fdo\ 3J!p 4" M A& N E F ill CA A No 0 ate y ASSOCIAT Es Siao T e-Alsip 014 A- n5o 4LL ESTA-rf;g ?44tA. V Lf-_,( QT 94M 3 t 0 'N X /Y V, Ghka J5 5:� v K p I I K 1 r itv t y G 8,"w -aw,.W TAx KV 'G.2 23? u 1\j c 11 - lZr'limmct J PLOT PLAN 4i; S A's, ?but4 4t air S.•Ec l ol-4 A-A Tit T I A -ci2 kT- 7--. -7­- ATik"NS fjF I'l-JE APAP :-MENI M 'IN)v C �jl J ru- T, c. E M, OP A •_, 50. F AUG2 01971 PJ'7-_'H QP T' J PLOT PLAN 4i; S A's, ?but4 4t air S.•Ec l ol-4 A-A Tit T I A -ci2 kT- ii VON,, A B Cl ON! 7--. -7­- ATik"NS fjF I'l-JE APAP :-MENI M 'IN)v C �jl J ru- N101 BE LIN NSPLXA1r ' ENGINECP AND Ti-!E LOCAL 11FA11,01 IDr-','r.­t :7I41 �i R L E1) E M, OP A •_, 50. F AUG2 01971 PJ'7-_'H QP T' WTI U ME P OF H EA L TH P LAYOUT of SD SYSTEM V IS, OF IMIRONMENTAL HEALTH SERVICES S RE- 1, 1 4" M A& N E F ill G F-0 kGE A. HAUG HN No 0 ate y ASSOCIAT Es Siao T A- n5o 4LL ESTA-rf;g ?44tA. V Lf-_,( QT 94M 3 0 'N Ghka J5 5:� v K p I I K 1 r itv t y G 8,"w ii VON,, A B Cl ON! BE' C, 0 N Sl I°I_;"Tf. L) IN AiX.,1RDANt:[ W, 1 H If, 1_w ES *0 ATik"NS fjF I'l-JE APAP :-MENI ip HEAL:rW APPROVED1,Y5TLM SHAI-L ru- N101 BE LIN NSPLXA1r ' ENGINECP AND Ti-!E LOCAL 11FA11,01 IDr-','r.­t :7I41 �i R L E1) E M, OP A •_, 50. F AUG2 01971 PJ'7-_'H QP F, F T 'r P� N', P, Y, 1. M I F-COT-n WTI U ME P OF H EA L TH P LAYOUT of SD SYSTEM V IS, OF IMIRONMENTAL HEALTH SERVICES S G F-0 kGE A. HAUG HN No 0 ate y ASSOCIAT Es Siao T A- n5o 4LL ESTA-rf;g ?44tA. V Lf-_,( QT 94M 3 0 'N Ghka J5 5:� v