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YORKTOWN MEDICAL LABORATORY INC.
LOCATIONS:
�,�,A����� 37�K�87S��et � '
' - -»�- '��" O 321 usAnsr,vonxrowmHEIGHTS, N.Y. 10598 245-3 203
Yorktown Heights, N.Y. 10� � O��1ammwv�oAvs,pssn�/L�w.�1c� �mn7
. . ] 495 MAIN m/msr,mr K/non. N.Y. �oo�
n 666-3335 245-3203 U. ucAn s
mv1nsz2ra-S
DATE RECEIVED:
REFERRED BY!
L- " -J
' COLLECTED BY: I %T. Colombo
LABORATORY REPORT � 878-962I
� n`u/L
[]ACIDITY ........................................................... []ALUMINUM ..................................
' []ALKALINITY ................... --- --..-''---' []ANTIMONY -_------'---'----�'-'-'--'
,���AoTsn/A.rorAL/m� .--.}..-,----_'--.-.. OAnosw/o _.-._---------.-_-..-.-_--,
[] SOD, n DAY ............................................................ []BARIUM .................. ,_-_.---..---.---.---'....
OBnomms-_-..._....--~--._._..--'�--- OasnrLumw _.-�--~_....----...�-.---._-._
O CARBON omxxos'FREE --._..--..----,.---' Ou/mwur* ---------.---.--..-...--.-'''
[]CHLORIDE ........................................................... O BORON _-.----_..---.-----.-.-.-..--'
OnHLon/ws ............................................................ OCAmm|mw ...-.-_._-.-----...---~--~,-_.
. .
[]COD ......-..---.-----'--'---_-''--- Oo^Lo/um ...-...^~-^----'-'^^~'-----'----' �
. /
[]COLOR .----.-.-.--...-.......-.....,',.,..-. O CHROMIUM hml_.........................................................
[] CYANIDE �. -.-._-----.'---'~.--.`-^.....-. .. O CHROMIUM (h*xy,o*na .. ................................
[] osTsnoswr xm/ow/o ............. [] nooAcr� �_..-~_------_.-__-.-'--.-.^-^`^'
[]pLuonme -------.-.--.--__.-_---_-. []ooppsn -.--.-.-..-...-.--.-.-------����'�'�'�''- -'
OHARDNESS .__..------,-.---.-'-----_-- GOLD -.--_-... ................................................... �
[]wpmoouFOnm COUNT/ 1on^m ............................... []mom ---_.-..--...........i...-......,..^^.-.,-.
ffltMFT cou FORM COUNT/ 1ou"o ..6 ...................... nLsxo --_-.-_----_-----.--.------..-'
[] CONFIRMATORY TEST ............................................ O ur*/mw ,..-^..--'^.--_..-_-_'---~-^----~-'.
Ownrnossw.AMwowm -...------.--..-^--'�.- []MAGNESIUM _..-.,--_-------'-.-..--'-'--^
[] m/rnossm.xusLoA*L ........................................... [] wmms^wsos ...............................................................
NITROGEN, NITRATE ........................................... Omsncunr ...-..-_---...-.-_-------'-----'
[]wnrnossM.ORGANIC ........................................... Om/cnsL ....................................... ,.-----_---''.- --
[] 000n ............................................................... O pALLAo/mw -- . -.......-..-...-.---.-------.
[] OIL mon EASE
................................... -,.---. O�mT��s|mw -.. -..----..----.--,---~^'-^^~
�.- . .. .
. .` � .
[]n* �.....-'--`.....-...-'�'..',�--'..,�-'.� ' []nnoo|mw ................... ..--..-..--.-.-.-,'_-^^-'`
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[]pnswoL ' One�em/mw .......... -~
_---.-.----_.--_..-.�-.-._.-...- ---------.. �
Op*OspnxTE'��ov> -..~.--_-.-,.-....-..-~. []s|uoom .--.-.-.-- �'�����~�----
[] PHOSPHATE (cvvuonmo).,,,,-_..-....---..-_- []SILVER .,...___-.---..............---.-'._--.^.
[] r*osp*ATs<mtaU -^.-~~~'~^~~^'~'^~`--~-�'''~' [] Soo/mw ~----~-'----'-'�'Y'lO�tr-~�^^--
OmOuD� SETTLEABLE, nm/L '.---.--.--.__.. []TIN ,.-..-..-.....-..--'&!��L-,�.&&Y�.-.--..
O SOLIDS, SUSPENDED ............................................ []�/mo ...... ...................... ...............................................
Ik []SOuo�DISSOLVED ......-..-.-,_--... []-.--...--,-.--..-.����::r���. ---
[] SOLIDS, TOTAL .................^........^.. [] ^'^'~^^,~~~~^'^^.''^^^' P����^���'
O SOLIDS, VOLATILE .................................................. El REMARKS ........-..-..-..-......-..^^'-^'^'-^^^ '
OSPECIFIC CONDUCTANCE ......................................... [] -----,._.-..-.-.--..-...-..--.---'...
OsuLpATs..,.......,~....-.....-......-... [] -.-.-.......-...-�.--....-...-~.-'-^~-~
� � ^ ~
[]SULFIDE ............................................................ []~..-........................,..^.^^^'^~^`../^^~
[]SULFITE ............................................................. 0.1 .,.......~^....`^.,.,-.,^....,,,,,^,,,,,~,,._,,,,
[] SURFACTANTS .,~,^.. ^...-.....,..^^...��-l] ^.,.-.,.,^.^.^^..~.-...-...-~-.r^-...^~~^..,_^.,..~,.
[]TURBIDITY ........................................................ C3 ....................................................................................
-
TBCGC RESULTS INDICATE' THAT IBF WATER W&S -0F'A 8AIISFACTDRY SANITARY WHEN
THE SAMPLE \WAS COLI��CTED. * " �
THESE RESULTS INDICATE THAT THE WATER DID MEET THE SATISFACTqRY CHEMICAL QUALITY OF
NEW YORK STATE ADMINISTRATIVE RULES & REGDIJ\�
w�' v y- x '- x ' - v "
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
Nicholas Columbo
ADDRESS
Baldwin Road$
Patterson,
NY
LOCATION
OF WELL
(o. 8 Street)
Baldwin Road
(Town)
Patterson
(Lot Number)
PROPOSED
USE OF
WELL
BUSINESS
❑ DOMESTIC ❑ ESTABLISHMENT
❑ SUPPLY F] INDUSTRIAL
❑ FARM
❑ CONDITIONING
❑ TEST WELL
if )
F] (Specify)
DRILLING EQUIPMENT
COMPRESSED
El ROTARY � AIR PERCUSSION
CABLE
❑ PERCUSSION
❑ OTHER
(Specify)
CASING
DETAILS
LENGTH (feet)
120
DIAMETER (inches)
6
WEIGHT PER FOOT
19
® THREADED ❑ WELDED
rflVESNOE
YES ❑ NO
(�
IXJ
CTiSTFG GIOUTE
YES 0 NO
YIELD
TEST
1rV7 HOURS
❑ BAILED . ❑ PUMPED '[ °I COMPRESSED AIR
G.P.M.
YIELD (G.P.M.)
5.
WATER
LEVEL
MEASURE FROM LAND SURFACE — STATIC (Specify feet)
4T-
DURING YIELD TEST fleet) -
Total drawdown
Depth of Completed Well
in feet below Land surface: 605
SCREEN
MAKE
LENGTH OPEN TO AQUIFER (feet)
DETAILS
SLOT SIZE
DIAMETER (Inches)
IF GRAVEL
PACKED:
Diameter of well including
gravel pack (inches):
GRA EL SIZE (inches) FR M feet) TO (feet)
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION
Sketch exact location of well with distances,
two permanent landmarks.
to at least
FEET to FEET
0
90
clay, overburden
V
00T - 11982
PU 6 NAM COUN"y
H
DEPT. OF HEALTH
90
110
brown limestone
110
&6'
limes ton e(14p��
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE WELL COMPLETED
July 22s 1982
DATE OF REPORT
Aug, 4, 1982
WELL DRILLER (Signature)
t
J.
wn r Purchaser of Building
Building Constructs by
Loca on - Street
(2"'7
Building Type
Municipa ity
d
Block
Lot
GUARANTY OF SEPARATE SEWAGE-SYSTEM
I represent that I am wholly and completely responsible for the .
location, workmanship, material, construction aid 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 Putnam County Department of Health as to whether or not the
failure of the system to operate was caused by the willful or negligent
act of the occupant of the building utilizing thersys e . /1 A n
Dated this day of A, jr 19_QZ, Signature,
Title
(If corporation, give name
and address)
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMP,ETION WILL BE ISSUED.
GUARANTOR IS REQUIRED TO FILE NOTICE, OF DATE OF FIRST USE OF SYSTEM..
Division of Environmental Health Services, Putnam Count Department of Health
CrIV
0 CT ° 119182
Pv E iNAiA (--0U , i
DEPT. OF HEH'L a
c PA
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Putnam County Departm,
Division of-Environmental
r ,
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Putnam County Departm,
Division of-Environmental
0
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 ",e, /A/1k'p AJ Ccomeo Address 1644 DAIW IPaAb.
Located at ( Street � M4',0A/E )1/.J,z.L 21) sea--- /'/ Block cV Lot lv2.1
erica nearest .street)
Municipality. 14'4T12iPSOV Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
gC!
-
a6
Number CLOCK TIME
PERCOLATION
2 1,00 --A OS
PERCOLATION
Run Elapse
Depth to Water
Water Level
��
No.. Time
From Ground Surface
in Inches
Soil Rate
Start -Stop Min.
Start Stop
Drop. in
Min. /in drop
Inches Inches
Inches
141, ,V/-
gC!
4P5
a6
i
_3�
2 1,00 --A OS
5�5�
�✓
6
% �'
��
4
6�
3 x.05 - A-55 - O 426 / So
4
2 MAR 2 41982
3 PUTNAM COUNTY
1. lor _,
4 .. .: .
5 .:. .
Notes: 1) Tests to be repeated at same depth until approximately 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. % HOLE NO. HOLE NO.
G. L.
6"
12"
1'8"
2`t1 "
3011
36"
42"
48"
5411
60"
66"
72"
78"
84"
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED /
/f
TESTS MADE BY i Date 1
DESIGN
Soil Rate Used-44 Mi
On/l "Drop: S.D. Usable Area Provided �OorJ
No. of Bedrooms Septic Tank Capacity, 00 Gals. Type ld,,OOA�n —
Absorption Area Prov ded By ' trench.
Address
1a
�) _r
SEAL
i�
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved Sq. Ft /Gal. Checked by
Ho• oetA0
of NE
Date
�t
i
3
Z
t
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r s
Ah
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