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HomeMy WebLinkAbout0026DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 1 -1 -30 BOX 1 t'i , ' 7 T �� r 00026 \�� � � ƒ \: / � � \ opies the pis are Yorktown Medical Laboratory,. Inc.. 321 Kear Street Yorktown Heights, N. Y. 10598 (914).245-3203 Director: Albert H. Padovcni M. T. (ASCP) J LAB. N 1 306 =1 9. Collection Station Used: Carmel Peeksk.ill Mt. Kis /.. _ Nev.City. ..Date Taken: /0100 Date. Received: 10 Date Reported: Collected By: b'. Referred By: _ Sample Source: �� VL '7 LABORATORY REPORT ON BACTERIOLOGICAL QUALITY OF WATER GENERAL BACTERIA Standard Plate Count per 1.0 ml (Agar plate @ 35 0C) MEMBRANE FILTRATION TECHNIQUE (MFT)._ Total Coliform per 100.ml Fecal Coliform per .100 ml _ Fecal Streptococcus per 100 ml MOST PROBABLE NUMBER TECHNIQUE (MPN) Total Coliform: Fecal Coliform: OTHER ANALYSES MPN Index Der 100 ml MPN Index.per 100 ml THESE RESULTS INDICATE,T AT THE WATER SAMPLE. ( � (WAS NOT) (NOT APPLICABLE) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO THE NEW YORK STATE.DRINKING WATER STANDARDS,.FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. —a&4 A 4 C, - /'a 6-,1 Albert H. Padovani, M.T. ASCP), Director. LEGEND RDS - Recommend Disinfect - ing Water Source < - less than TNTC = Too Numerous Too Count WELL COMPLETION REPORT 3/71 _% PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK This report is to be completed by well driller and submitted to County Health. Department together with laboratory report of 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 OWNER NAMES '� ADDR SS e a 3 LOCATION OF WELL o. a Get) own) (o Number) St + 7, ` PROPOSED USE OF WELL BUSINESS 19DOMESTIC ESTABLISHMENT ❑ FARM ❑ TEST WELL ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ ((Specify) DRILLING EQUIPMENT ❑ ROTARY COMPRESSED CABLE OTHER AIR PERCUSSION ❑ PERCUSSION ❑ (Specify) CASING DETAILS LENGTH (feet) a 0 DIAMETER (inches) 7 7/7 HT PER FOOT � THREADED ❑ WELDED O YES NO YES NO YIEL TEST ❑ BAILED ❑ PUMPED HOURS G.P.A. COMPRESSED G.P.J jQ7' S YIELD ( ..� 1- WATER LEVEL MEASURE FROM LAND SURFACE — STATIC(Specifyfeet) / DURING YIELD TEST (feet) j O Depth of Completed Well v in feet below, land surface: '?T SCREEN DETAILS MAKE LENGTH OPEN TO AQUIFER (teat)' 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 well with distances, to at least two permanent landmarks. FLEET to FEET ( 30 Q) -� If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WE�'OM ,2!,ETED VV DATE F REPORT J WELL DRILLER (Signature) . Qwner or Purchaser of Building Building Constructed by Location - Street Municipality Building Type Ter, ti:on Block GUARANTEE 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 r.egulat.ions of the Putnam County Department of Health,:and hereby guarantee to the owner, his success- ors, heirs or assigns, to .place in.good'operating.condition any part of said system constructed by me'which faila:to operate.fo.r 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 determin- ation of the Director of the'Division of Environmental Health Services of the Putnam County Department of Health as to whether or not the.fail- ure of the system to operate was caused by the,willful or. negligent act of the occupant of the. bu,ilding..utiiizing'..the system. Dated this day of 19 Signatur Title Co orati Name if orp. A dr - - - - - - - - - - - - - - - - - - ----- - - - - - - - - - - - - - - THREE (3). COPIES ARE REQUIRED.WITH THREE (3) CQPIES OF FINAL. PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NO_ TICE.OF DATE OF FIRST USE OF SYSTEM.. Division of Environmental Health Services, Putnam County Department of Health y -s. h k pnNAM COUNTY DEPARTMENT OF HEALTH_- DIVISION OF ENVIRONMENTAL. HEALTH SERVICES INDIVIDUAL In1kM SUPPLY SUBSURFACE SOULGE. DISPOSAL SYSTEMS / Z_ FIELD INSPECTION REPORT DATE. INSP. BY: ' (Name of Owner). (Street Location) INITIAL SITE INSPECTION YES NO OODMENI'S . Wetlands on/or proximate to property .............. Property lines or corners found.. .... Can estimate house location ....................... Will driveway need cut....:............... Must trees be removed - note these....._,_ Deep holes representative, of entire.SDS area...... Additional deep holes needed.:... . Sufficient SDS area available.considering driveway cut, house location,,separatlon distances etc.:. Adjacent wells /septics... .:.... Access to prop6sed well locationfor �drillin D.H. - Deep Hole G.W.- Groundwater D. H. 1 . Lot, D.H. 2 'Lot ,z 'D.H.­ 3 Lot . Depth to G.W. Depth to G. W. Depth to G.W. Depth to rock Depth to rock Depth to rock-. 0 ft. 3 ft. 6 ft.. 9 ft. 12 ft 'Soil Description 0 ft. 0 ft. 3 ft. 3 ft. 6 ft. ..6 ft. 9 ft. 9 ft. 12: ft. 12 ft. FINAL SITE INSPECTION INSP. 1 o 'YES. NO,, CA S House SSDS located per °approved..plan.... . Length of trench measured < ' Width of trench average c� Slope of tile line and trench acceptable,..:,..... Roan allowed for expansion trenches.. ..........:.. Over 100 ft. fran watercourse ...................... Natural soil not stripped or SD ' area unnecessarly graded ...................... ....... 10 ft. maintained fran property line and" 20 ft. from house......... :. .. .. Distance well to SSDS (ft.) L� Number of bedrooms checks.....01 Stones, brush, stumps, rubble, etc., greater...r,o than 15 ft. from nearest trench.. ............ 15 ft. of peripheral soil horizontally fran trench ..... ............................... Boxes properly set... ..... ...... .............. Could surface runoff fran driveway, roads, ground surface, etc. , -channel near SDS area.. ��',:..�� Does lot drainage appear OK in area of SDS ..... :./ FINAL GRADNG OF SITE ACCEPTABLE.. .... .�/Z . s ,g �. 4 f'1% - -!' .. f �'..1.•t //O C/$ � ljll Gr�si j/'� Y jr S o -J G dG <' �/ G ✓%. /ilk 0 / Qs- d:. P C� f �C y- . �P7 el to . l J 7or 1 �/ •. y y f �''''', G:.e �. 5 Pram f �.✓ '� � . a .vat �iv! � / . / /'/ i`Gi ,•, d/ GF -° ,. ". i Vilutl'1 VVVI \11 LL'1l11 \i 1.1L:l1\1 Va' ALCUlLAJi.l DIVISION OIL ENV7RONMEN'fAL 11CALT11 SERVICES y COUNIT OFFICE BUILDINU, CAI= -L. N. Y. 10512 D iSIGN DATA S1IEE'i'- SEFARATE SEWAGE DISPOSAL SYSTEM I FJ[LC No. OwnerGerald VanCoughnett Address Harmony Rd. Patterson, NY Located at (Street Mooney Hill Rd Sec• 1 Block •1 Lot 12 lindleate tiearest' cross a ree t1wiicipality, Town of Patterson Watershed' Croton SUIL mincoLA'PION TEST DATA MUMED TO BE SUBMITTED WITH APFLICA' IONS l(ole nT #3 Ilumber CLOCK TIME PERCOLATION PERCOLATION Will Blapse WpUli to a er a e� r Leve Ilo. Time From Ground Surface in Ir c1ies Soil Bate Start -Stop Min. Start Stop, Drop �n Min. /in drop ' Inches Inches Inches 159 - 29 30 21 4 7.5min /in 2 30 - 00 30 21 4 7.5min /in 19 - 49 30 21 2 3/8 12.�in /in Il . 100 30 30 21 3 lUmin /in 2 231 - 01 30 21 3 10min /in c - �� r .7/8 3 � r�. Tlr Oi Votes: 1) 'Pests to be repeated at same depth until aff�+poximatelyy equal soll� rates are obtained at each percglatioti test hole. A11 data to a submitte 4or review. 2) Depth measurements to be made from top of hole. 9 � — 47 �-- 10, i !,.• o�p Ng X96, 12' M.. _ 13 • F �y U�rl' 4i'i 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED N�A INDICATE LEVEL Ta WHICH WATER IE'M RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY:' I.e- DATE: 6 6 DESIGN • Soil Rate Used A0 .. i Min/118. Drop: S.D. Usable Area Provided Soad S�F, No. of Bedrocros . 4' f Septic Tank Capacity /voo gals.. Type nip 2s /11 ''...,777 Absorption Area Provided By' 444 L.F. .x 24" width trench Other .2 !- /L�. R v& D `���%nua�u����ry tE�F NfW Name !/6h%, ' Signatu;'� J Address _/ /✓ sEAt,';°P : i98'0 ** ti� ti r �FESSICNP� THIS SPACE FOR USE BY •HEALTH DEPARZM M ONLY: Soil Rate Approved •scq•ft,/gdl.' Checked by Date 11 D m IM O D Z M 0 5 N N IN57 °00 -18 "E W CD to N / \ 0 rn ,5000' r p .000. f.,E / 1 j I � j Ilj N45 °12 -07 E I I J N I O o ' O 0 4Q0/7' I a / n if it / / /"I / / �// �o� 568.52 cn i+x