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HomeMy WebLinkAbout4781DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 91.26 -2 -49 BOX 36 MUM In a All m :` T ' :; I' r J. ' ' - - ` IN L .I AM IN IV; DEPARTMENT OF HEALTH Division of Environmental Health Services PW COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 AFPL' ICA'PION" 't'0 "Ci)NSTRiJC`f- A WA!rVR 1 ELL'' PCHD P IT # WELL LOCATION Stree Addres To V'lla a City Tax. G id Number WELL OWNER Name Mailin Address Aprivate O Public USE OF WELL 1 - primary 2- secondary A RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION 0 INSTITUTIONAL O STAND -BY O ABANDONED ❑OTHER (specify 0 AMOUNT OF USE YIELD SOUGHT_, gpm /# PEOPLE SERVED /EST. OF DAILY USAGE /OCO gal REASON FOR DRILLING QNEW SUPPLY O PROVIDE ADDITIONAL SUPPLY [3 TEST /OBSERVATION >6PLACE EXISTING SUPPLY O DEEPEN EXISTING WELL . DETAILED REASON FOR DRILLING WELL TYPE 5DRILLED ODRIVEN E]DUG GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES �NO WATER WELL CONTRACTOR: Name /�Sddress : r IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /Ylrbf£-i1fY... DISTANCE TO 'PROPERTY FROM. NEAREST' Wa ER MAIN: :...._.. .... .. -.. LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED cl-2gREAR OF THIS APPLICATION bON SEPARA (date) (s ature) 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 prov by the Putnam County Health Department. Date of Issue: 19 } Date of Expiration: 19 ermit Issuing Official, White Permit is Non - Transferrable copy: H.D. File Yellow copy: Building Inspector 2/87 Pink Copy: Owner Orange copy: Well Driller MARV;N O'DE!.t, Inspector 11 PUTNAM TAUT TOWN OF PUTNAM VALLEY BUILDING, ZONING, AND SANITARY DEPARTMENT Robert Morris Dept. of Env. Ifealth 110 Old Route 6 Carmel, N.Y. 10512 Dear Mr. Morris: August 31, 1987 Re: KREIBICH - TM4 /105 -1 -8 Hollowbrook Road TOWN HALL PUTNAM ,VALLEY, N.Y. - 1914) 526 2377 The proposed well shown on sketch drawing submitted conforms to the requirements of separation between any SSD system and, therefore, would be approved by this Department for construction. Upon completion, a copy of well drillers log and water analysis report shall be submitted to the Building Department by the' owner before the well is put in service. MOT: es Very truly yours, //%/`�:_C/1�11--_ - e-�� . MARVIN O'DELL Building Inspector _.. �.. 'd4'1 . _ � .. w.-L' :.f ^. l -rT`P {:�y.�Y, .. ®4-�..�E'y.ri•s -. �4 *��C #W'�y0 .C'_�, �'�.� �_ gip. -•-�. s. Tti ..(^:..t..i �..M � {: �'�...�,. c.Tr�Can• ^_ _..........._.. - -.. -- _.. __.... ....... ......__ ........ ___..._._._.-- ....... .... ... - ........ __....__..._'' -' --..__.............._ .................._..---.._...---..._-- - -- ._ ....... __._ - - -- - -- -- -- - - ._._..._.. - __ _ - .._..-------- -..... d.— � _ _._.._... _...._.._......... __... - _ .._... - -- - -- - ._........ _._ .......... - - -- - -...- - ...— ._........ -- --- I Z .... ........ .... .._ .......... _._._ ...... _...__— ...__. ....._..—_.._._ ._...._.---------- --- --- - -- -- -- -- OoF - 0 Ul N_ .. ...._...,...._.._.._.._........ .._ ..._. ... _ ........ ............ -- ............... _ ..... '--...__.- --- .....__...-- - ----- ..... ..... _ ...... — ............ J .. Q. W J r n Q N ! r Q � 00 _ ! / / __.___. .__._...-- _..._.._.___. _ _...._..._____ .•__ -._... _ __ ._...- _.__._._...— .__.__.._._.. _..._ ._..__.. ...._ ...... ... ._.._.._....._..... - ...... ._ ....... .__...._._._......._ _._._____....- ..__...._._.._ -._ __....__.._.._...._...._......_...__...._...._ ..._.— .. .............. ..._._... _._......._ ..._...,.................__.... J I NORMAN ANDERSON INC. Well• [?r'rflin Sox 152.. PUTNAM VALLEY, NEW YORK 10579 (914) 528 -8698 If il 1: CATE F'EBRUARY..24., -193a- - l NUMBER - v JANUARY 15, 1988 GRET KREI3TCK 3332.. 100 ELEECKER STREET, APT13A 2- 455' C $7. per foot 3185. New york, N. Y. 21' 6" casing - $7. per foot .147. 10012 ---------- --- - - - - -- 3332. - - - - -- -- 1 gallon per minute 11/9/87 TERMS: PLEASE DETACH AND FCTUNN —N FOUR NEMITTANCE BATE - '- CHARGES AND CREDITSr BALANCE PUP1P :. 7052 621 BALANCE, FORWARD, GRUNDFOS 3 14IIP 3 T -DIRE 230V P(Ji�IP INT /BOX 1- 455' @ $7• perfoot $ 3185. -- torque.arrestor 21' 6" casing @ $7. per foot 147. -- 3332.. - z gallon per minute .11/6/87 2- 455' C $7. per foot 3185. -- 21' 6" casing - $7. per foot .147. -- ---------- --- - - - - -- 3332. - - - - -- -- 1 gallon per minute 11/9/87 J�JELI, TOTAL _ 6664. -- PUP1P :. 7052 621 GRUNDFOS 3 14IIP 3 T -DIRE 230V P(Ji�IP INT /BOX 2 pit-less adapters, 2 check valves' torque.arrestor snaked 60' wire (10) 60' hiflex 1601 1" plastic T labor 420' SCH801 couplings 425' re (10 ) .p�y�s o �+ ~ ntY+ 7 NORMAN ANDERSON; INC. _2. ?14647 :Yorktown Medical Laboratory, Inc. LA b _ 321 Kear Street . Date 'Taken: _c;-16 Yorktown Heigh is, N. Y.- 10598 Date Rc' d : (911).245-3203 ., _ _s�t.>.�4�c.ovkPi 17irecto7AI cet .Padovant.if.T (ASCP) Collected By. Referred By. (- -1 SamDle Locatio_ n: NY L J -38 Time : 41 �10'P/1 1-0 Time: 2, rrn el Phone # 1Lj7,5_g25, Phone # `Sample ^:pe, Repeat Test? I (checf -_nee LA3z C ?A7.0R-Y R 0 R T ON T; QUALITY 0 ' WAT�R :iOR�.; :._C '.0:.- '4 ETA LS L) ? ?ICROBTOLOGICAL (CFU /100nL) _ C::_or de.. r Detergents, MBAS Hardness, Tota,1 Nitrogen, Amnonia 'litroge ^., Nitrate P:osphat e , Total Sulfate Sulfide Sulfite G E N AL SACTEaIA: K Standard Plate Count 171- (CFU /1.OmL). MEMBRANE FILTRATION T EC NTQU: ..Total Coliform Fecal Coliform Fecal Streptococcus �'OST PRO3A3L rU :43SR TLC::i1IGUC ?ota'^_e pion - 0���_e CTS Sam.le Sta: 0utzo_ P ,10 3 _ C1 "'2SOL _ 0 aOH Zr.O=+c `ia2S2C3 Co.pce- Ct er. Iron Total Colifor:n Index L-e a d - ManS,alnese Fecal .- Co.l.if- o..—m. - In-dex. hnc•o-' . .. j r.� .�.0 4'Z.y . ✓ - .+v ... _�.. � -_... �.. Yv '- ^i'._ -• .q - ....... r a .... .. - , .� ..c - 5�r�^+'{' .a.s q Sodium KEY FOR T" ?'•fINOLOGY L., L °C Zinc r GT.40C MISCELLANEOUS p✓: (units ) Color (u;its) _~ Odor (TON) Tur.bidity (NTU) N/A = Not Applicable' LT = Less Than ( <) GT = Greater Than (>) TNTC= Too Numerous To Court CON = Confluent ( =TNTC) NR = :ion - reactive REMARKS/C-- CXMENTS ( For Lab Use) pH 2 p" GE g _ p G _ 2 Other. THESE RESULTS INDICATE THAT THE WATER SAMPLE (WAS) (WASN'T) (N /A) OF A SATISFACTORY S'AN'ITARY QUALITY ACCORDING TO T N"' YORK STATE DRINKING WATER STANDARDS, FOR THE.PARAMETERS TESTED, AT THE TIME OF COLLECT . THESE RESULTS INDICATE THAT THE WATER SAMPLE (DID) (DIDN'T) (N /A MEET THE SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK STA - D HKING WATER CODES, FOR TAE PARAME;ZR, S TESTED, AT THE TIME OF COLLECTION. /x/ �!��`,I V 1 1_1 2/86(Rvsd7 /$7) RW Albert H. Padovani, M.T. ASCP), Director "k LAB y _ 2.014/-.47 % �Orktown Medical Laboratory, Inc. — - - -- 321 Kear Street Date Taken: Time: �� > Yorktown Heiph cs YPl. Y. %059;8: A_ to Re d :. �. Ti me. •i � - -_ �r '-. .' r- _ice ': a - 1w .► as ._ v :r ,.�. <r— .. - "�,� .ax= �'-- (914)r245 -3203 Date Reported.0� Director: Albert H. PadovaniAT.(ASCP) . Collected By: gp ► `" k Referred By: 0,nSSn)aR iAgd,a FSample Location: etkh4w, r � OVh L J LABORATORY REPORT ON THE QUALITY OF WATER Phone # — 25 Phone # I — I Sample Type:. Repeat Test? (check one) I`10RJA1 ;7C 'SON- METALS (mw/0 MICROBIOLOGICAL (CFU /100mL) nC_—y Al: alinity Chloride Detergents, MBAS Hardness, Total _ Nitrogen, Ammonia Nitrogen, Nitrate Phosphate, Total Sulfate _ Sulfide Sulfite METALS (mg /L) Copper Iron Lead.. -- Manganese Mercury Sodium Zinc MISCELLANEOUS PH (units) Color (units) Odor (TON) Turbidity (NTU) GENERAL BACTERIA r\ Standard Plate Count (CFU /1.OmL) MEMBRANE FILTRATION TECHNIQUE - Total Coliform (� Fecal Coliform Fecal Streptococcus 140ST PROBABLE NUMBER TECHNIQUE Total Coliform Index F -.•cal Collf.drm Ind -ex' KEY FOR TERMINOLOGY N/A = Not Applicable' LT = Less Than ( < ) GT = Greater Than (>) TNTC= Too Numerous To Count CON = Confluent ( =TNTC) NR = Non - reactive REMARKS /COMMENTS (For Lab Use) Potable _ lion -rotac _ STP _ ST? Other: Sar:p'e Stat.. (check eac ' Out aoin: — HNO3 H C 1 H2SOL NaOH ZnOAc Na2S2O3 Other : Indominc �.LEE 4 °C GT 4 °C _ DH LE 2 _ P" GE 9 _ p:. GL 12 _ Other. THESE RESULTS INDICATE THAT THE WATER SAMPLE (WAS ") (WASN'T) (N /A) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO T N YORK STATE DRINKING hATE� STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. THESE RESULTS INDICATE THAT THE WATER .SAMPLE (DID) (DIDN'T) (N /A} MEET THE SATISFACTORY CHEMICAL QUALITY STANDARDS OF THE NEW YORK STA D NKING WATER CODES, FOR TAE PARAKE;SAS TESTED, AT THE TIME OF COLLECTION. 2 /86(Rvsd7 /87)RWE Albert,H. Padovani, M.T. (ASCP), Director I \j V. This is to certify 0that I have s,r,,,,id , B E N D E V I N 0 9S, LOT_ 8 91,E ?, q 4- � I�P rivylv4YOR0 — toF�ISIE PLA A MT. VERNON. N. Y. PPj+navn %ICL Ilel cauent4j, of AA VW x VI&- ROOM 233 TELEPHONE MO 8-0880 Filed in the P.4nct,•.i County Clerk' s:Offic.e Division of Land Records May VW t a t. zCI as Map 186 6. I have located all existing buildings and lines of.possession and have shown their positions hereon. I hereby certify this survey to "'C.' Survey completed: 10 Ick-I -L on scale of one inch to 20 feet. Map drafted: $A-.& w, 15l 2 N.T.S. liC. 36170 stoke //� /� 2� 111r,2— 5x jo, At , JI/ Ad P 4' A, N en &.i• I/ Ajoo-k U91 Palo CD 5fKP 0 A000 4 0 Guaranteed to..... / C. in accordance with the minimum standard's for title survey's of the New York State Land Title Aasociation. .. _ .:PUTNTv�'.( GOIJNTX4 NF�,�Tu..1?FP�R'.?A�':.k -:: �. �, .,� <. � _ . 4 .. ..- , . .. C- .. r�- •� DIVISION OF ENVIRONKEMAL HEALTH SERVICES John Me Simmons, M.D. Deputy Ccamni.ssioner of Health - FIELD ACTIVITY REPORT - Sheet Q of N � KREM INSPECTION NAME Orig. Routine J. � Ve _ Orig. Complain ADDRESS H® B ro o j�P Origo Request No. Street Town TM No. _ Compliance Complaint Comp, MAILING ADDRESS Final P.O. Box Post Office Zip Code _ Group Illness Construction TELEPHONE PERSON IN CHARGE OR INTERVIEWED Name and Title DATE TYPE FACILITY Reinspection Field, Sampling Only Field Conference Other TIME ARRIVED TIME LEFT .° o ej Explain FINDINGS° e INSPECTOR: TELEPHONE: -r—Signature and Title PERSON IN CHARGE OR IRl'PERVIEGdED: I acknowledge this Field Activity Report. SIGNATURE: 6/86 TITLE: