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HomeMy WebLinkAbout0027DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631 - 589 -8100 3. -1 -31 BOX 1 [000m AT oil lill i [000m Any 'person occupying - premises served by the-above 3y am conditions•resulting,.fiom such usage Approval "o, --a se available and 'the approval of the private vuaterdupply. ;hall sutiJact to modification or change, when, in the- juAgmeht- -Date By :promptly .take sucl'L.actlon as may b0.,necesury,to: secure the correction oT any ,unsannary seweralte sy teni shall become null an vol 0! 5666 as 'a publie sanitary sil e-ai ecomes . e.nuliind oid when- a•put►lic er su ply.becomea.ivailabhi: Such approvals are inlssi ei'of Health'. C revocatl' ;:, - change. ecesiary, 11 - F, Title 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 NAME ADDRESS LOCATION OF WELL (No. ti Street) (Town) (lot Number) -1A f _(_, I a 7?' foR 1 �L"rL 5x 41 PROPOSED USE OF WELL BUSINESS DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL PUBLIC AIR OTHER ❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (Specify) DRILLING EQUIPMENT COMPRESSED CABLE OTHER ❑ ROTARY LefNJ AIR PERCUSSION ❑ PERCUSSION ❑ (specify) CASING DETAILS LENGTH (feet) U DIAMETER (inches) WEIGHT PER FOOT (n� LIN THREADED ❑ WELDED E SHOE YES ❑ NO W G�j YES ED4 LJ NO YIELD TEST ❑SAILED ❑PUMPED C COMPRESSED AIR HOURS G.P.M. 5 I YIELD (O.P.M.) t S� t WATER LEVEL MEASURE FROM LAND SURFACE —STATIC (Specify feet) . DURING YIELD TEST feet) j CX Depth of Completed Well !� in feet below land surface: V L4 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 well with distances, to at least two permanent landmarks. FEET to FEET V ':D i ( tir If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL DATE ATE OF_L2EPORT ,!_ C WELL DRILLER (Signature) 0 V Yorktown Medical Laboratory, Inc. 321 Kear Street Yorktown Heights, N. Y. 10598 ' .1 (914) 245 -3203 Director: Albert H. Padovani M. T. (ASCP) rJ V 'k 6-r l LOCATIONS: ❑ 321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 .245 -3203 ❑ 201 BUTTONWOOD AVE., PEEKSKILL, N.Y.'10566 737 -8777 ❑ 495 MAIN ST., MT. KISCO. N.Y. 10549 666 -3335 . ❑ STONELEIGH AVE. (NEAR HOSPITAL), CARMEL, N. Y. 10512 278 -9330 DATE TAKEN: ` _ DATE RECEIVED: DATE REPORTED: SAMPLE SOURCE: Lab f Q REFERRED BY: L ` ���5 �>7�_ y J Collector: LABORATORY REPORT mg /L ❑ ACIDITY ............................ ............................... ❑ ALKALINITY i = ..................••••• XBACTERIA, TOTAL /mL ........................................... BOD, 5 DAY ............................ ............................... ❑ BROMIDE ............................ ............................... ❑ CARBON DIOXIDE, FREE ........ ............................... ❑ CHLORIDE ............................ ............................... ❑ CHLORINE ............................ ............................... ❑ COD .. .............................. ............................... ❑ COLOR ( u n i t s) ................. ............................... ❑.CYANIDE ............................ ............................... ❑ DETERGENT; ANIONIC ............ ............................... ❑ FLUORIDE ............................ ............................... ❑ HARDNESS ............................ ............................... ❑ MPN COLIFORM COUNT/ 100 ml ........... �1t 1'COLIFORMCOUNT /100m1 ............••.. ❑ CONFIRMATORY TEST . ............ ............................... ❑ NITROGEN, AMMONIA ............ ............................... O NITROGEN, KJELDAHL ............ ............................... ❑ NITROGEN, NITRATE ..................... ;..................... ❑ NITROGEN, ORGANIC ............ ............................... ❑ ODOR (units) • ............... ............................... ❑ OIL.& GREASE ........................ ............................... ❑PH ( UIlitS) ...................... ............................... ❑ PHENOL ................................ ............................... ❑ PHOSPHATE (ortho) ................ ............................... ❑ PHOSPHATE (condensed) ............ ............................... ❑ PHOSPHATE (total) ................ ............................... ❑ SOLIDS, SETTLEABLE, ml /L .... ............................... ❑ SOLIDS, SUSPENDED ............. ............................... ❑ SOLIDS, DISSOLVED ............. ............................... ❑ SOLIDS, TOTAL ..................... ............................... ❑ SOLIDS, VOLATILE ................. ............................... ❑ SPECIFIC CONDUCTANCE (uhmo s / cm) ............... ❑ SULFATE ....................... ............................... ❑ SULFIDE ............................. ............................... ❑ SULFITE ............................. ............................... ❑ SURFACTANTS ..................... ............................... ❑ TURBIDITY (NTU ). ............... ............................... ❑ ALUMINUM ................................ ............................... ❑ ANTIMONY ................................ ............................... ❑ ARSENIC .................................... ........•...................... ❑ BARIUM ....................................... ............................... ❑ BERYLLIUM ................................ ............................... ❑ BISMUTH .................................... ............................... ❑ BORON ........................................ ............................... ❑ CADMIUM .................................... ............................... ❑ CALCIUM .................................... ............................... ❑ CHROMIUM (tot.) ............................ ............................... ❑ CHROMIUM (hexavalent) .................... ............................... ❑ COBALT ...........:........................ ............................... ❑ COPPER .................................... ............................... ❑ COLD ...................... ❑ IRON ........................................ ............................... ❑ LEAD ........................................ ............................... ❑ LITHIUM . ................................................... I................ ❑ MAGNESIUM ................................ ............................... ❑ MANGANESE ................................ ............................... ❑ MERCURY .................................... .............................•. ❑ NICKEL ....... ................ ............................... .................. ❑ PALLADIUM ................................ ............................... ❑ POTASSIUM ................................ ............................... ❑ RHODIUM .................................... ............................... ❑ SELENIUM .................................... ............................... ❑ SILICON ....... � ............................. ............................... ❑ SILVER ........................................ ............................... ❑ SODIUM ........................................ ............................... ❑ TIN ............................................ ............................... ❑ ZINC ............................................ ............................... ❑ .... ❑ .................................................... ............................... ❑ REMARKS: ............�..j....... ❑ ................... t�.. ................ ............................... ❑ .................................................... ............................... ❑ ..::.....:......................................................................... ❑ .................................................... ............................... ❑ ................. ............................... ............................... ❑ .................................................... ............................... THESE RESULTS INDICATE THAT THE WATER WAS r,:::�OF A SATISFACTORY SANITARY QUALITY WHEN THE SAMPLE WAS COLLECTED. THESE RESULTS INDICATE THAT THE WATER DID MEET THE SATISFACTORY CHEM- ICAL QUALITY OF THE NEW YORK STATE ADMINISTRATIVE RULES & REGULATIONS, DRINKING WATER STANDARDS (PART 72) FOR THE PARAMETERS TESTED WHEN THE SAMPLE WAS COLLECTED. N/A = not applicable C�L �����►nL -nom -� Albert H. Padovani M.T. (ASCP), Director L ` T -PUTNAM COUNTY DEPARTMENT OF HEALTH Permit N Ofvrsion of Enwionmental Hea/th,'Se�vi'ces, Carmel N Y 10512 r- �,. CONSTRUCTLON. PERMIT FOR $SWAGE DISPOSAL SYSTEM' A/ y y - • Town or: _Village i Located at/l3d4NEy fi /e� ?D., S/qT ,� /E,, Z9.2 Tax Map l alock tAt f2 w Subdivision /llvDivl /L LS"7T ' . y ` �' ❑ ,; / 3aSd'. Lot q Renewal .Revision Owner /Addre:ss TiE edvSirZ- u�T�o'n1 / hjrF"/7'H18�v GL. I t .� I, /r ate Of Prev ous App . D a. �I� ) D i royal _ Building Type S &/T 'dt t`' "�G Lot. Area Fill Section only ❑ Number of.Bediooms ,Design Flow G /P /D 6c-0 P C H.;D Notification. Required Sepirate. Sewerige System to consist .of Gal. Septic Tank and., I}7T To'be..constructed by Zty '•N`�R'� /ate Address Water SLi Ply ":Public 'SLPpiy' {From Eiivate Supply to be dr�lletl by - ';�O ETERM /N61� 1 x- Address , u LL a Other Requirements I- represent that Lam wholly^antl completely responsible forthe tlesign and location of the proposed systems) lj that the separ a sewage;disposat system: above - described will be constructed as shown.on the approved a mendinent'there'4o and 'in accordance with the standards; rules an ;► gu a ions o e. u nam, .11 County Department of Health, and that,on completion thereof a "Certificate. <of Construction_Complance" satisfactory to tha Commission erof'Healthwill tie submitted to the Department,, and' a :written guarantee will be: furnished - he, owner, .his successors; heirs 6r-assigns tiy the builder that said ,builder will place in -good. operating onditioin -- -any part' of saiq- sewage 'disposal'System'during`the. period of >two (2) yearsimmediately' following thedate'of the I ance of the approval of. the Certificate. ot, Construction. Compliance of the original system or any ripairs thereto; 2)'thaf the.drilled well ;described above' ill ,be located as shown on ,the approved 'plan. and that said well will be installed 'n accordance .with t e; stand rds; rules and regu. a ions .':ot' the ,Putnam County Department o(afcHealt,h a !JJ {^ Date Address t� /e (lI �C r7 �— U c Pr 'If 7 n0 License .No v APPROVED. FOR CONSTRUCTION; This approval expires one year from the date issued: instruction of,-the building' been undertaken and is revocable' for cause or may ;be amended or modified when eon ' ereC eeessary.by the Co` is loner of health -:Any,ehange oc'_alteration of, construction. regwres anew permit A`pprovetl :for posal of domesti sa `'te' se a ;and /or pri ate afar supply only ,Date. '517, A By _ - Tale .,Rey. 9-81 5 Notes: 1) T6:sts to be repeated at same depth until approximatelyy equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner JV Construction Address Harmony Hill Rd Located at (Street 4dicate Sec. 1 Block i_1 Lot 17 neares cross street) Municipality Patterson Watershed Croton SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Lot #4 .Hole, Number CLOCK TIME PERCOLATION PERCOLATION Run apse Depth to Water Water Level No. No. Time From Ground Surface in Inches Soil Rate- Min. Start Stop Drop in Min./in-drop Inches Inches Inches 1 1 02 - 32 30 21 23 2 15 2 33 - 03. 30 21 23 2 15 3 04 - 34 30 21 22 7/8, 1 7/8 16 5 2 1 03 - 33 30 21 24 3 10 2_34 -04 30 91 717,/9 9 7f 10'1L 3 05 - 35 30 21 24 3 10 4 5 1 2 3 4 5 Notes: 1) T6:sts to be repeated at same depth until approximatelyy equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. 4 HOLE NO. HOLE NO. G.L. 611 1211 1811 24" 3011 )3611 `t211 4811 5 11 X6011 M. 7211 7811 8411 T.S. Sandy, Loam / rock INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY John Eberle Date 7/1/85 DESIGN Soil Rate Used__jk_Min/1 "Drop:. S.D. Usable Area Provided 5000 t „,et,aoru: �Jr No. of Bedrooms 3 Septic Tank Capac,�,K�l�pp� ° /4!, ,ls . f � ©. _ Absorption Area Pry By�+29 L. F.x24,1•��` X�y,� � C477��TY�vtr+e_ ” %�" I . i /!�n'f'.�'1PY✓�l. Q 11CLU1U I7alQw.Ln Oc wrnellUS Address R.D. 6, Rte. 22 ..�S,L- o A Brewster, N.Y. 10509 ..cscensstt` THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by ��FESS N Date