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HomeMy WebLinkAbout0330DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -2 -29 BOX 4 00139 ' .. ' ` '�-. fit JLL f i ti 'j i 7 Ir 1' F ' '. � I'' ` 1 46 00139 P:UTNAM COUNTY DEPARTMEl -s, WELL COMPLETION REPORT 3171 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 peter O'Hara ADDRESS Cross Road Patterson, N.Y. LOCATION OF WELL (No. a Street) (Town) (Lot umber) Cross Road Patterson PROPOSED USE OF WELL BUSINESS ® DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL El SUPPLY El INDUSTRIAL ❑ AIR ❑OTHER CONDITIONING (Specify) DRILLING EQUIPMENT ��yy CABLE THER ❑ ROTARY t2i A R P RCUSSION El PERCUSSION ❑ (Specify) CASING DETAILS LENGTH (lest) 21 DIAMETER (inches) 6 WEIGHT PER FOOT 19 R1 THREADED ❑ WELDED YES NO CAS Ki YES NO YIELD TEST HOURS G.P.M. El BAILED ❑ PUMPED COMPRESSED AIR 1 2 YIELD (G.P.M.) 15 WATER LEVEL MEASURE FROM LAND SURFACE — STATIC(Spsclty feet) 30' DURING YIELD TEST [test) total drawdown Depth of Completed Well 125 in feet below land surface: SCREEN DETAILS MAKE LENGTH OPEN TO AQUIFER (feet) SLOT DIAMETER (Inches IF GRAVEL PACKED: Diameter of well Including grovel park (Ineheo): 1GRAVEL SIZE (Inc rya M loot TO (toot) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of wall with distances, to at least two permanent landmarks. FEET to FEET 0 2 Overburden I�Q� Ir pUTf��M {�a pEpT,. of EA1 - Boyd Artesian Well .Ca.. Inc. 2 125 White Limestone If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE'iQ� _71 DATE WELL COMPLETED 5 -8 -85 DATE OF REPORT. 11 -8 -85 TWELL DRILLER (Signature) Rt. 52 Carmel N.Y. Yorktown Medical Laboratory, Inc. LOCATIONS: o° ❑ 321 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245.3203 321 KCar Street ❑ 201 BUTTONWOOD AVE.. PEEKSKILL, N.Y. 10566 737.8777 Yorktown Heights, N. Y. 10598 O 495 MAIN ST., MT. KISCO. N.Y. 10549 666.3335 (914) 245 -3203 O STONELEIGH AVE. (NEAR HOSPITAL), CARM EL. N.Y. 10512 278 -9330 Director: Albert H. Padovani GATE TAKEN T. (ASCP) �/ _ F DATE RECEIVED: C DATE REPORTED: SAMPLE SOURCE: i Lab REFERRED BY. L ! '�`'✓ _j Collector:- 4 ��CeilOt_ LABORATORY REPORT mg /L ❑ ACIDITY ❑ ALUMINUM ❑ ALKALINITY i P- ................ A= ..................... ❑ ANTIMONY .. ................................ ................:.............. ACTERIA, TOTAL /mL .................. �.......................... ❑ ARSENIC . ................ .................... ............................... BOD, 5 DAY ............................ ............................... ❑ BARIUM ...................................... ............................... ❑ BROMIDE ........................... ............................... ❑ BERYLLIUM ............................................................... C3 CARBON DIOXIDE, FREE ........ ............................... ❑ BISMUTH .................................... ............................... ❑ CHLORIDE ................................................. :.......... ❑ BORON ........................................ ............................... ❑ CHLORINE ...........................: ............................... ❑ CADMIUM .................................... ............................... ❑ COD .................................... ............................... ❑ CALCIUM .................................... ............................... ❑ COLOR' (un i t S ) ................. ............................... ❑ CHROMIUM ( tot.) ........................................... :............... ❑ CYANIDE ............................ ............................... ❑ CHROMIUM (hexavalent) .................... ............................... ❑ DETERGENT, ANIONIC ............ ............................... - ❑ COBALT ....................... ............................... ......... ❑ FLUORIDE ............................ ............................... ❑ COPPER .................................... ............................... ❑ HARDNESS ............................ ............................... ❑ COLD .................... ............................... ................ MPN COLIFORM COUNT/ 100 ml ❑IRON COL1�0 M CO;�T/ iGG nd� • ..... C3 LEAD ...................................................... .... ... .... ...... ❑ CONFIRMATORY TEST ............ ............................... ❑ LITHIUM .................................... ............................... ❑ NITROGEN. AMMONIA ............ ............................... O MAGNESIUM ................................ ............................... ❑ NITROGEN, KJELDAHL ...................... :.................... ❑ MANGANESE ................................ ..............................: ❑ NITROGEN, NITRATE ............ ............................... ❑ MERCURY .................................... ............................... ❑ NITROGEN, ORGANIC ............ ..............................: ❑ NICKEL' ..................:..................... ............................... ❑ ODOR (Units) ................ ............................... ❑ PALLADIUM ............................... ............................... ❑ OIL & GREASE ........................ ............................... ❑ POTASSIUM ................................ ............................... ❑ pH ( UllitS) ...................... ............................... ❑ RHODIUM .................................... ........................:...... ❑ PHENOL ................................. ............................... ❑ SELENIUM .................................... ............................... ❑ PHOSPHATE (ortho) ................ . ...............:............... ❑ SILICON .................................... ............................... ❑ PHOSPHATE (condensed) ............ ............................... ❑ SILVER ........................................ ............................... ❑ PHOSPHATE (total) ................ ..................:............ ❑ SODIUM . ........................................ ............................... ❑ SOLIDS. SETTLEABLE, ml /L . ............................... ❑ TIN .......... ............................... grm4o �..P� .. ❑ ZINC '� "I ❑SOLIDS. SUSPENDED ............. ............................... .;.�... ❑ SOLIDS. DISSOLVED ............. ............................... ❑ ............................................... ............:.:................ 11 SOLIDS. TOTAL ...................... ............................... ❑ ........................ ............................... : ........... ❑ SOLIDS, VOLATILE ................ ............................... ❑ REMARKS:.......... .........................�'�.4i �.......................... • SPECIFIC CONDUCTANCE (uhmo s / c m) ............... ❑ ............................ .............................., L Ty. • SULFATE ❑ .............................................. PUTN... r �� `,�... ❑ SULFIDE ............................. ............................... ❑ ............................................... EPT:..'� ... �............. .... ❑ SULFITE ............................. ............................... ❑ ...........................................:........ ............................... ❑ SURFACTANTS ..................... ............................... ❑ ...............................................:.... ............................... ❑ TURBIDITY ( NTU) ............... ............................... ❑ .........................................:.......... ............................... THESE RESULTS INDICATE THAT THE WATER WAS 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 4lhort N PaAi ; M T IACr.1 fl:........ BRUCE R. FOLEY Public Health Director Daniel Severance 21 Cross Rd. Patterson, NY DEPARTMENT . OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Dear Mr. Severance: August 1, 2002 Re: Addition- Severance- 21 Cross Rd. No Increases in Number of Bedrooms (T) Patterson Tax # 13 -2 -29 I have received and reviewed the plans for the proposed addition to the above - mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp form this Department dated August 1 2002. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at Three without prior approval by this department. 2. The area of the existing sewage disposal system, and its expansion area, must be maintained. 3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Patterson . If you have any questions, please contact me at your convenience. Veri-tRily'yours William Hedges WH:kg Senior Public Health Sanitarian CC:BI i -4. T� DEPARTMENT OF HEALTH Division . Of Environmental Health Services 4 Geneva' Road, Brewster, New York 10509 (914) 278 -6130 BRUCE R._FOLVY. A g Aeting Puhile Health Putnam,- County Dept. of Heait�, 4 reneva Road 3:ewster, NY 205C9 Re: �'�'�Ct?✓ Residence Tax Mlap"12 . Town • Crentiemen: AcceTain�, to record; maintained by the Town,- the abcve noted dwelling zs . in cornpliance v,ith ToN` eoc+e and the total number of bedreorn5 on record i5 .� This info- imation has been obtained torn: CIrRTIFICAT� Or OCCUPANCY: A SESSORS RF;CORD: OTHER uilding Lector .y . a.. ..... :t . DEPAR T NiEIv I OF IMALTH Dlvision of Environmental Health Serwees 4 Genava Road Brewster, New York 1050 Tel. (914) 278 - 6130 Fax (914) 278 - 7921 153=4340 ' ' 1 • r MMMMMMMWMMd BRUCE R. FOLEY Public Heckh Direvcr STREET �-�' %/ ._TOWi�i �vIAP# DESCR21 TION OF ADDITION NUMBER OF EMSTING BEDROOMS � PROPOSED # OF BEDROOyLSb (FROM CERT. OF OCC"LiPA\CY OR CERTIFICATION FROM SUILD NC INSPECTOR) *:Anv addition v.hich is considered a bedroom requires formal approval of plans (Con-truetion permit) prepared by a -roftssional Engineer or Registered Architect in accordance with aoplieabie. sections of tthe Puraam Cocnty Sarlite.ty Code. Please submit this fcrmn Wd the folowing to Putnam County Health Dapt., 4 Geneva Rd., Brewster, t`Y 10509, Phone M -F? 30. 1. Certified check or money order for $100.00 �2. Sktnches of existing floor plan (drawn to scale, all living area Including basement) " Non - professional skete'nrs are acceptable ,/3,T rvm sets of proposed floor plan (drawn to scare, with name, street, aad tai: r_:ap T) * Non- p:ofcsssionai sket -hes are acceptable ✓4. Copy of s Ney s owin; well and septic location, to the best of your knowledge. Include date of installation if KP.G'. ,,n. Label all wells and septic systems within 200 feet of the property line. Contact this office wi7.h any questions. 5. Copy of Cent. of Occupancy from Town or Certification fron? Building Dept. with legal bedroom court of dwelling. OFFf :E_ USE Commew.s rib 99 c APPRAISAL SERVICES COMPANY 1200 Stony Brook Ct, Newburgh, NY 12550 �R He- 10 /1 Pressed _Zvi MAP /SKETCH ADDENDUM � Fr'•enC� F er►{ � K It 1 x x An. File No, S8 nn � o�R OW S S �R K llllll�ll •c 'A"l A-r c ,a J ral /.kJJ.. e PUTNAM COUNTY4- DEPARTMENT W B =11 �SevPrance, c: rcy.5 5 /3 _ z -a� Z7 HOUSE PLANS APPROVED FOR BED50O ?1 COUNT ONLY; �EDRO�JM•S Sipatuxe & Title y. tf - I APPRAISAL SERVICES COMPANY 1200 Stony Brook Ct, Newburgh, NY 12550 File No. 5854 MAP /SKETCH ADDENDUM t9 r- erg k b w 0, s Y wL �R B � r .c I.— I r� A F- K F oW s • e/R 11111 {►II c C 1 .SO � �e z7' Subject: Lot #48 Cross RA, Paucrsnn,NY, Burrower: Severance, Paula M. /Daniel J., Client: Financial Access hott� h y kr 4 > .� z 'rc{ ..rjt 1�: J "rid':. , + 1. fI r'. A.I Ci '� ' �' r 1' a �.tltlr'!„i• S_ , 11 - ` t' F., t .. ; c. .t Fes...' •Jt -mil'` r•:...jt , {:, F- '^ yA,� .1 0.1 l +, a� i , }. ° +r:, �•7�t" A .j R f *l y. . fl' ,<' tS; 11 q r: k. ' y `*•� z. il. ..y t ., s ti rr '>r• ' {Pf 4-'A--,-,K , .JJ �'S �N wr t 1I� .rd f --rF °z> _�,.� `�.�V j' a ' ' r y. A .Y' 3 ` Y' J .r y t r ­.....V._,­., J o /' v . 1. 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'.. ......j * , ­ ... _ .. . .�, ..;L.. .1 - �m _ .. .�.�-_-,,,-,.,!,."i�;.;��,-,�%,.%.t"t,.,!"; .1" -.� �:f". '­,­ . - .", - _:­ _ . - . . * , - •-, . c ...... .'L .. . . . ,:I . . I-. I' -t, � � � -I.. ., _ 'L . I . .,.� - - v � . '.�_...'.. , ,ti-,Y,i,'X,,­,�-:., ".". ..". � - , '.�_ . L .l.r..�,"....'.- �. . :% -:!-��.��- " !..:. .�. I I .. . "i i _11* 'A , , if", . , , . : , , �,` %V't-, " _ � ­ Allru'Y Alvo� * 1:�-'- ":, - .,%, t: -, 4.�.*��...4.�_- -,".. - • .� 7� il� , - Ift lohk� .� T ­ 8 It p.T n.."�,.....n,-,,.,�.-i5.,F,,,�.,.-,.,i;,- -_� tl i,.! .; P DEPART # H1LTH UTNAM. COUNTY F Permit, �:'S: Q Division of . Enwronmental. Health. Servrces Carmel N ';Y f�512 CONST . UCTION PERMIT FOR 'SEWAGE . DISPOSAL .SYSTEM %� own or I ga e Located et��� s ✓�! `��:�✓ %%�� Tax Map %� clock Lot : %J'r Subdivision � -'' - Renewal Revision Q�. owner /Address :: '• i Date Of Prev ❑ous Approval Building Type f �1%O Lot Area ��� ^G" Fill Section -only ❑ Number of Bedrooms - Design Flow G /P /D �oO M t?N P c H, D Noti Eication. Regpire8 k a Separate Sewerage< System; to consist- of / OCOG Gal Septic Tan . ` , and �� , -� d. �... o! To be constructed by Water Supply Public Supply ".From 1 si x Pjvate Supply tc be jddrilletl bey F L ­4 Other Requirements ('represent that 1 am wholly and completely responsible for the design and location of the proposed systems) ,l) ,that ,the separate sewage dis sal- system ; f' above d'esenbed will be constructed as showrron the approvedamentlment there, hereto and ;in-aceortlanee with_the standards ;rules an 'r u a ons o e u nam County °Department of gHealth -arttl that on completion thereof a "Certificate of Construction ;Compliance satisfactory' to tAe.tOmmissioner of,HeaIthwill= r. `'be submitted, to '.the Department- -.and a wntten'" guarantee "will'be. famished -the owner his wteessots, heirsoi assigns bythe- builder; that saki builder will !,•place ,in good operating Condition .any., part of, said sewage tlisposai system ' during -the period of two:(2) yea% s- imrriediately'foliowin9'thedate ot:the issu; once pf' -the approval of the Certificate of';Consiru-ction <Compllance; of 'the originalsystem ,or any repairs, thereto `2) that ihe. drilled well described above- i, will be' local: 4 as shown on^the approved plan and that said well will be•lnstalled "•in acftiCdan a jtt� pe f Bards, -rules .and roqu a ons -'of the .Putnam county. •Dspartmeot of Health a iii � L Date ( Signed_' P E R. _ Andress E . • 4.7))1 License No. APPROVED FOR .CONSTRUCTION This approval expires ne yea from th �., issued u ss conitruc ion' of the building,hai been undertaken antl'.'.is , r. revocable for cause'or mays be amended ormotlified when co sid red ec ry' bj/ e:;COrn ssionec of ealth: Any .change•Q!��eration of'construction requires -'a„ w per A v - disposal of domestI e ar' Date 9 r Re,,. .9 -e1 R FESSIONAL CO ORATIQN 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 �I7em5y_ 0 4A vs A Address - RL2 511 Located at (Street 3R 4kJ'� Coss CeA: Sec. 1 Block Lot �Tndicate nearer cross street) Municipality Watershed (A, C, . SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION . apse Depth to Water a er ve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop 3 5 Inches Inches lncnes 1 gco _ 2 2 21 i` 3 7 3 4 5 iDc�— IOZ� 2 1 ,-1 iDd� Zi r ZI 3 2 3 5 1 _ 2 3 5� Notes: 1) Tuts to be repeated at same depth until aroximatelyy equal soil rates are obtained at each percolation test hole. All pp 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. f HOLE NO. Z HOLE NO. G. L. 6" 12" 18" 24" 30" 36" 42" 48" 5411 60" 66" 7211 78'f 84" G I M ) VGt-D T-- INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED /'JO warZ'"R. INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY SCE -: �j Goc- Date / L4 DESIGN Soil Rate Used__W7___Min/l "Drop: S.D. Usable Area Provided 56)-� - No. of Bedrooms Septic Tank Capacity I 'DQC-) Gals. Type M&E>cwJ Absorption Area Provided By _L. F. x24 3b"� ===., i tre`ch.. Address ULl /`9 ICEANE SVGINEERS, r'�.C• A PROVESSIONAL Cr-?RP0'R, AT1ON THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by Date