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HomeMy WebLinkAbout3698DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.17 -1 -30 BOX 29 fs 1 ` x,l '• t'4"x ya .k;,� a' H a r g �'�- s,.t. a firs a 1 PUTNAM COUNTY DEPARTMENT OF AREAL, M � ' W. ,, 3 y�ston ;of Environmental Health `Services Carmel N Y 10512 _ 4 i �ERTI.IC9TE QF :CONSTRUCTION - CO.MPUANCE ;FOR SEWAGE" DISPOSAL SYSTEM r Located -at," Section Block I i Owner ti Lot .,Job , Separate, Sewerage System built by ' Address = ,. o P Consisting of ,Gat. Septic ' Tank lineal Feet X. dth. trench Other 'requirements t - R c o Watar Supply Public Supply From _ of � i Private ;SuPPIy` Drilled ;ey At1 s - 8wldrig Type ;' -' No of •.Bedrooms - e Permit Issuetl y ��, ENGiry f Has Erosion Co rol Been C mpleted? J. ,I certify `that the'system(f) as listed serving the above premises were constructed essenfiall ray4s Ws s plated, work (cop!es,of which are attached) and "in accordance•'with the standards -iules and° regulations plants filed `and " p rm� " su Y the: unty 'Department of Health: ;uate 4•, Ufied by `P E R A s� Ir i Address icense No A'ray person occupying premises served by,_the above system(s) shall promptly take suc a b to re a correction of:any unsanitary ,1 conditions resulting from such usage A'pprovat ,of the separate sewerage system shall be ;` as a' public sanitary sewer becomes available and the approval of the,,private:watersupplytshall become null aniJ void -when a'`;p t ' comes available. Such = approvals are - sub)ect to modification` or change when', m the- udgment. of the-'C ommissioner of Health; 'suc ,a ogrfication or change is necessary., Data Title 4 PARASITO.l,OGY VIRO;LOGY BACTE,RIALOGY ,. 4 ANCIBIOT�fC -USED s- y* :SOURCE OF MATERIAL ,p REQUEST -Ni h - �e St �T - �'O$1.5��'IIIE:jG.�10E3� COc Y ❑- - = �,. �`' 4 RAEAR. '.❑ CULTURE,, .sioo� . ❑ 5putum F ` a ❑ R6titine ❑ Jose Cl. T B a Lem anal ysa s f Or 01- Throat ❑ Dtphthena 3 3� Cc3�3iib ❑ Spina F utd < : 1Jrtne p Fungus C G C.'tr��£c�j�r3�s3ffEE'A ,'i o �Za6i'� y :;1�J7!$v�k$O t:❑ "O ices 3 ❑ : ,u �itl" �c � G' 'll�QTaT bxk �Yl Pus FrocW ❑ Othe ❑ w s �,0 �f 2l' PUTNAM DIAGNOSTIC LABORATORIES ❑_Ova and,Parasttes $ Y ARMEL, p:,Yral C �TONELEIGH AVENUE � = SENSi ;RESIST' Aeroba%ter ❑= SENSItdY1TY _ = STAPHLOCOCCUS _ p t Chlgranphentc - _ . og TFoft " Q ry m ne6acterture -. ';GoitsttaS;ulphate: :o. >. , _ :r:`i?.- ❑`Hemolytrc:Coag To.;Fo low ; ©f9scher�chia :Qeclomycir ; °' _ ..- ;-_ "❑ °Coag:: Positive p Klebskilla ,;Dihydristreptoinycin - _.. ❑. '' Negative ❑='Raracolo;8act °: Erythrgmycn " �. '" " a" STkEPTOCOCCUS; HEMOLYTIC-' p= Proteusi o•: 3 1 ;• ". a !Neomycin` s r ` -; -? . ❑ ,Alp. a ,, ❑:'Beta, :'�_❑ Gamma - [( Pseudomonas Nitrofuiantom ' ` o - ?' `' ❑ .EnWrococcus` = .Enteric Rathog'ens Oxaatttn a .`❑ Pneumococcus: ❑found Panalba s ❑ Netsserta dam, , : r_ Not - Founds P = P.enicitliri ❑:HeniophMS �: tracycline r TUBERCULOSIS "'SMEAR'` -` s 7-UB_.ERCULOSIS,CUL- TURE3' =j �. yiacetyliileandomycin (� Acid Fast - Not Fourid 7. Neg Fqr Aud Fast F:" �Ampictl in V. ❑Acid Fag*, _ ❑" Pos r =rr: ' - y :❑ Smears Routine Neg ❑ `O & P Not Found ❑Cultures ; ❑ O& P' Pq"sitrve�yFor r 7 �C �sy n C Y r"'1. o�"t'i�" �a .� Lbl2:$ "3C} bd�Ei ic62;i.a es S4. tht 4i c0 ^ C tts - n a p :Eva st nd c s �bf ,purit :,r en c ©l� -ct�do + q ° a Ty-a., e r. .�°s `F 4 a� k. ? b }a e� � t.n d u :. �+. ..: • s r.N - sue, h .: hr oo sec �y B —oc'_: — t- G -� -_ zz Dom_- -� - -- -- � - - --� -- _- •.:� - - - - -- � ---- - - -• mac_-•--- - - ----- J. :._� �- - -� --- �- � --- -- -• - - -�-- - -�� --- :__�--- _•- - -:.-_ _ �� -- — -_ -- - —_ -- _ -- „.DRILL x-ZS LOG I 'L N D ROORT Well at Name of H ffLgn Vc�,” et L4 County of V �_-:T 51, vnex Name of 111a6b ,owner Y Ar --k- "rs k­-* LINF. 0. Address Depth of well 2. DI eter_k'Yield_jo Aa–s—well didinfected'?–,4es ft. in. gpm res Or no X. Amt . of casing - ab-o ve, -gr%6 Wid-JTL� Below round 1 Vo seal in ft packer cement, grout Draw a i-,-, ,.!!...-diagram, in., the .,space,prov ded, below--and ­ show ­'6he-d6pth of s -enetrated, water ;c:_-sing, the w-11. s-al ,' kind and thicknes: of f6rmaj;ions lines 'bearing ormations, diameter of drill holes with d6tted lines and. 'casing s) with. - solid.. lined:. ;(TELL DIAt7jRAM FORMATIONS PEIT.,TRA T 'D. LKS Tiaraeter, in. Depth 'I�ind, thick4ess and Type _of well Ar i X t b6­ 7­ drilling ing m'itlh d' EOA-MY,!:� n wa aring r. Grade Was' well dynamited? "k'y� c TITTING TESTS 25. C) -T , S Details #1 ;Y2 77 #3 Static aater ra level, in -ft, FewT 50-- flow pumping iiig rate in. gpm 75 Pumping level in T40 1,eg ft. below- grade ..Duration� f r lOO­ ­ t,,.st in hrs. :5 --rE `7 OF TI�I ] Cle�pX__, Cloudy urbid Ch 'ec�o R miaended depth of pump in wc>, 1 11, feet below = .trade i3 e, GRIXE, L: 200 , Eff. size Sand mm HlAd.-ecjff�f size Length f screen 0 ft. Diam. of screen in. Typ� e , of scre-en-�- Screen Openings x -j P-1-aw- -a,. sketch of 1the-- property ... , M4--;-, on the back ..of,.,thiS".,sheet locAti6g,�­...;' Dri-11.1 ing start,:-.d A C-11#plet ' TZHE WELL AFD 8..�WAGER DISPOSAL ',-SYS, ' Mo -tiller Well" --V Si ;. ;nature WELL LOCATION SHETCH Draw a sketch showing outline of4rdpe'r­ty'-,= general slope of -roa courses ground-,.location ­�of: structures; ds, ditches, water .wooded. i4rea,s, ..Swamps;- ; — " ' =ponds; r ock .. . 6uAorops -641tid tanks, 'leaching Sy stema-f or'. se iage--o est'holes,.wells and springs. Give directions .0� d_di stance. _t.o-­-ne,,8L-res,t c oratun. .4 YYY .7 ,31 V-) N �F'? FJ_ I Ur Tr space between lines equal to 25, 50 or 100 feet. Make top z t 0 f epag: Yortht end' d- s DIVISION OF ENVIRONMENTAL HE-ALTH, SERVICES Date i�IdV;71 Re: Property of Frank and Marguerite Caputo Located at Partridge Lane Tax Map Designation Lot No.43 on survey eititled, "Section B of Putnam Acres" made by J. Henry Carpenter & Co., completed September 9,1969, and filed in the Putnam County Clerk's Office on November 5, 1969, as Map No. 815A. Gent lemen: -nU vn 14 P 6 tr- 4 - Lo F 4 This letter is to authorize Alex Kolenda a duly licensed professional engineer to apply for a Construction Permit for a separate sewerage syste-m; to serve the above noted property in accordance'with the standards, rules or regulations as promulgated by the Commissioner of the Putnam County. Department of Health, and to sign all necessary papers on my behalf. J.n connection with this matter and to supervise.�.dl systems-in- conforLla"Lty':'T�ith•'-th6--:p ovislons of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sanitary Code. Countersigned: P.E.9R.A.9 #323 340 Elwood Avenue (Seal) HawtbQrne,_.New.York 914 - RC 9-0347 Very truly ymrs, 00, Signed Owner cf Proper 446 Cyrus Place; Bronx, New York Address 212 7 FO 4-1029 Telephone OF '-DIVISTO UZ DESIGN- T;` D I:Z :z S-vS7-7., N T-TLE E loo. zI PlIp r- u C n t7n Ap NNO L c a. te c! a S-- el Bloc:' LOS T 1) E, 3 C" s S tar Stop D- o:) i -,rl 'at u cipa—lit. le& 4� el's'ned SOIT P--rn'-IATT 0\7 S T D T,-� RE r Ll z, T 70 V-�- -,!T T" P P I C A T T LTO 1. e PlIp r- u C n t7n -er e 7. - e NNO '12 i ri: e Fro- Sroun S: J-: St a r t S t Oo S tar Stop D- o:) i i I/ i 7- r C D I ri c s 17.. C,:-. e S 1.. s T. 2 3 S IJ 9Z 140 c2�5 S S �ne D Te s It s to be rep-e=te' -- =4- tamed 2.- —c' o e -c o o S' 0 IA soll Le a r;� O:D Cl L L j 'o e s 1 1).rn d i0 r -1- e i L Lj TEST FTT 0I-',TTTED T,:T PI TC T!O\ -7- D_-, S C T D' T T n, T HOLES i Lis DEPTH kmE NO. •HO-r-:1 N0, 0`1 HOLE NO. G . L 61f 121* TT 24" :mn- Ii J/ to if 36" u, 6 0'. 66" 7 8 84 I K D 1 C A '1 -E' I F VELE :i, A T AC T ui\--ND W AT 7� I- %. I.S ENCOU, 71) TNCD,TCAT-'' T, z, r 1-j T C,' -RITSES AFTE.R.:.87Tx-,- L.\COUTT"RED T Date 7,1 D_ -7!4 0,3 D- S. D. U 60nn 7Z No. 01 ear-03. SE-0 'C _':.:a:, 11", CE D L En/ .5 f 0 th z o.- -ee rovid 3 1�40 AbsorpL- A d L F. x,2 Name Address I L`THF'- -T 0-0 F E -' L P U -A T N f C C N D - E, -0 2. Pol, 1 R3 e p 3 r o,.,- e"" Sq. Ft: /Gal Si a t U 1, e IN AF SEA Checked Date ILI 'r -. ... --,r - r L r. -•_ � -�_ .:r... - ^a:— _ .. - -"'�Y ., .. ��'' �" L/_ i' _ _ _•_ .."s: _r. ref �.... r 1 i - r 4 •v. > IO:MIN, R