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HomeMy WebLinkAbout0415DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -3 -70 BOX 5 12 1 ., .r T :6 00224 y. Yorktown Medical Laboratory, Inc. 321 Kcar Strcct t- Yorktown Hcights, N. Y. 10598 (914) 245 -3203 Director: Albert H. Padovani M. T. (ASCP) b 3l( 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. 10.549 666 -3335 TONELEIGH AVE. (NEAR HOSPITAL), CARMEL. N. Y. 10512 278.9330 DATE TAKEN: , -a DATE RECEIVED: _ DATE REPORTEO: l "� SAMPLE SOURCE: K&i�C &14 Lab REFERRED BY: Collector: LABORATORY REPORT mg /L ❑ ACIDITY ............................ .....................:......... ❑ ALKALINITY i Y- ................ A = . ..... .. .. ACTERIA, TOTAL /rttL ....... . ..... ............................. CJBOD, 5 DAY ............................ ............................... ❑ BROMIDE ............................ ............................... ❑ CARBON DIOXIDE, FREE ........ ............................... ❑ CHLORIDE ............................ ............................... ❑ CHLORINE ............................ ............................... Ocoo .................................... ............................... ❑COLOR ( units) .................. ............................... ❑ CYANIDE ............................ ............................... ❑ DETERGENT, ANIONIC ............ .................... ....:....... ❑ FLUORIDE ............................ ............:.................. ❑ HARDNESS ............................ ............................... ❑ MPN COLIFORM COUNT/ 100 ml ............................... �j1FT COLIFORM COUNT/ 100 m1 ��•••••••••-- ••••••••••• U CONFIRMATORY TEST ............ ............................... ❑ NITROGEN, AMMONIA ............ ............................... ❑ NITROGEN, KJELOAHL ............ ............................... ❑ NITROGEN, NITRATE ............ ............................... ❑ NITROGEN, ORGANIC ............ ............................... ❑ODOR ( Units) ................ ............................... ❑ OIL& ......... GREASE ........................ .....................: ❑ pH ( Unit3) ...................... ............................... ❑ 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 ... . ... ., ............ ... .I........................... ❑ TURBIDITY ( NTU)............................................... -THESE RESULTS INDICATE THAT THE WA QUALITY WHEN THE SAMPLE WAS COL ❑ ALUMINUM ................................ ............................... ❑ ANTIMONY.. ................................ ............................... ❑ ARSENIC ........... ..................... ............................... ❑ BARIUM ....................................... ............................... ❑ BERYLLIUM ................................ ............................... ❑ BISMUTH .................................... ............................... ❑ BORON ........................................ ............................... ❑ CADMIUM .................................... ............................... ❑ CALCIUM .................................... ............................... ❑ CHROMIUM ( tot.) ............................ ............................... ❑ CHROMIUM (hexavalent) .................... .... ............................ ❑ COBALT .................................... ............................... ❑ COPPER ................................... ............................... ❑ COLD .... .................................. ............................... ❑ IRON ........................................ ............................... ❑ LEAD ........... ............................... ❑ LITHIUM :..... ........... ............................... ❑ MAGNESIUM ....M:n _ ............. ............. ❑ MANGANESE ....... ........... .. y<................ ❑ MERCURY ..... ..... xi`� .................r� <'G rJ. ........ ❑ NICKEL ........................ j.................... . .�r���°7..... ❑ PALLADIUM ... ..... ... ............. .13.... `.... Q POTASSIUM .: .P�y...�... .j..�,{� ❑ RHODIUM ........... :1 -W .......... _1.j ....... �1��e. .....�.j, ......... t� ❑ SELENIUM 1 ....... ❑ SILICON .............. ......:........................ 1. ........ cif... ❑ SILVER ................... ............................... ;a_Ar2`�;....... ❑ SODIUM .................................... ....................4.......... ❑ TIN ................ ............................... ........................ ❑ ZINC ................................... ............................... ..... ❑ ................. ..................... ..... ............................... ❑ .................................................... ............................... ❑ REMARKS.....,.. ... .. 1.. j� ............ ............................... ❑ ...... ......... lV�.....(,..,[ [�............................. O............. •. a... .Ada............................... ❑ .:.> 2� y t..�.......... o .. ►lQ9C.1�1..Q,?�.d..n.t......... ❑ ..............:t. ................................ ............................... ❑ .................................................... ............................... TER WAS C /Q,D OF A SATISFACTORY SANITARY LECTED. �`�' 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 W EN THE SAMPLE WAS COLLECTED. N/A = not applicable Albert R. Paclovani M.T. 1 SCP), Director PET;j 6) Owner or Purchaser of Building Municipality �- SAP ® Building Construoted -by Section .. H , Location Street. Block Building, Type Lo.t GUARANTY-OF SEPARATE SEWAGE SYSTEM 'h represent that .I am wholly and completely responsible for the location, wor1-.%dnship,z material, construction and drainage of the sewage disposal" system .serving', the, above described property, and that it has .-been, c6nstructed.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 construct.ed 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.u.ndersigned 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 the system. 4 Dated this day of?aveot 19106- Signature Title If corporation, give name and address) THREE (3) COPIES ARE REQUIRED .WITH THREE (3) COPIES OF -FINA 4'PLAN3 ,BEFORE CERTIFICATE OF ;CO:-- 1PLETION WILL BE ISSUED. GUARANTOR. IS REQUIRED TO FILE NOTICE OF DATE OF FIR8T USE OF Division. of Environmental Health Services, Putnam .County�'-.'De apZtig�t of Health r•��i, PUTNAMwCO�JNTY DEPARTMENT OF. HEALTH Division of ERVIf011meflidl " Hea/ih Services, -Ca rmel, k' Y. 10512 - f CO STRUCTION. PERMIT, -,FOR SEWAGE "DISPOSAL SYSTEM:'. ,�% pp �2 mown or'vlllage Ate, �,7 ®'r -. - . - 4 _ .Block � Lot LocataiJ ':at Tax Map /76G.�•I^T j /"`;�..G'i 1+`•�f / �j:. Subd.LOt N. r� . ,, Renewal , . Revision .. Subdivision - _❑ Owner %Address { a�+j'• it /�Ca I71 L j / Y1� �i { '�J 'Date;]() Previous "Appioval - �. Buildin `T �i ai t3 E iC7 = Fiii. sec£ioii onl - ❑ 1 9 YPe ; Lot Area zz y. ` Number of Bedrooms Design Flow G /P /D 5e 2"a t P C *H D. Notification Required Separate; Sewerage _System" to 'consist of Gal Septic Tank and �' d,,r� � °%` 7�,g'" To be: constructed: by Cat" t °trJ f� .�6 Address _.S� A?'t= Q.L flw ,rte I�2: lts� r WAter`'Supp1Y:.' "` Publ c 'Supply From "= = _ + * Private Supply` to be ;drilled 'by ° r, < Address r a . ..�: x. i Other`Reouirements 'f it �'. `.�I "t e tJ$°i A®..) - j" - - i [ 1 "represent that I am wholly and completely responsible for the tlesign,and location' o"i "the proposed system(s), 1) .thaf -the separate sewage disposal system above described will ba.cor structed:as. shown- on'.the approyed;amendr lentthere to and; -in 5ccordance,with the standards, rums an, regu ions.o. s u nqm County' Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the'Commissioner'of Healthwill be submitted `fo the Department;: -and a virriften•guarantee -'will 'De.furhIshed th_e owner;:;his "successois;:helrs:or assigns by the .;builder, _that said +bullder will place in good operating condition any part of said sewage disposal system durin ,.,lhe period of tvvo (2) years immediately following thedate of the`lssuw ' ance'.of the - 'approval of the Certificate of"Constructiori Compliance of tlie'original`syste r y =repsirs thereoo; 2) thai'Ahe drilled well described above ' will be locateQ,asshoWn ort.the approved plan and'that said well will be installed in accordant , :vv the standards, rules and, repu a� aTrons of the Putnam County Department of Health EQNE ©PP 6�..` 3 ,e t^p��+ �fc. i Date°f Signed F.r'1tlVI1V1.GrlJ _ p,g, R.A. i Address l "s P�Icense No } APPROVED .FOR CONSTRUCTION: This approval expves °one' yea► from Elie date . unless construction of the 'building: has been undertaken and is : use of be. amended or modified cnsideretl:necsa hrevocablefor-ca w e CO r of Health. Any change'or alteration of "Con traction requires :a n ermd: Approvetl for disposal of "dome is ni ry sew and /or.pri te.'wate supply .only + Date BY Title S I Rev 9 Bl • a Putnam County-, Depextment of }Iealth Division of Environmental.Sanitation AFFIDAVIT '- CORPORATE aINER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH. DEPARTMENT. :TO: Commissioner of Health -•In the.matter of application for • -s D ,v d vci ` .. 2 w r c�c� 2 _� i 5 oS ct f \/S'Y — — — — — — — — — 9 represent that I at an officer or employee of the corporation and am authorized to act for f \ _ -------- _ _ T..� ... (name `of corporation)' having offices at _ _ _ _� ® ®— ®— _ Whose officers are ! Name an Address) ice • (Name and' Andressl CAU C�� ..Secretary, (Name and-Address) u.:L Treasurer,,irT�j,.'/i..� . J '�?!�''": `_C`a ` NW and Address) and that I am and will be individually responsible for any or all acts of the corporati=on with respect to the approval requested and all sub - Sequent acts relating thereto. %�, Sworn to before me this /, day Signed of 191±/ Title�''�t�?^�- V1 Nota Publ e 0 AP � :s ' J , 4 �) \� by . . PUYNAM �t'U 4iy. Corporate Seal T, :aY PUTNAM COUNTY DEPARTNEV OF HEALTH DIVISION OF ENVIRONMITAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner fA722!!AN &P116T OLV/1Gy Address b I77LzWA 4j, Located at ( Street ft� !3 ,( Sec . Block Lot- -indicate � nearest cross street) Municipality 1PA57M�aA,2 C -r 1 Watershed SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED. WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse 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 Inches Inches Inches Notes: 1) Tests to be .repeated at same depth unt1q,appppnoximatel• equal soil. rates are obtained at' each percolationg q� ,3.�o�.Q .7 AT data to- L submitted for review. DP" — u� JTY 2) Depth measurements to be made ff*0PFt&55')bfT;%ole . 10 2 (odO i .2-E aj o 4 5. 2 10e 45. 4 5 2 1O 3 t 410 Notes: 1) Tests to be .repeated at same depth unt1q,appppnoximatel• equal soil. rates are obtained at' each percolationg q� ,3.�o�.Q .7 AT data to- L submitted for review. DP" — u� JTY 2) Depth measurements to be made ff*0PFt&55')bfT;%ole . TEST PIT DATA REQUIF=,. TO -BE L�2'-T- ITH AP TCi,ITION '�--7ST HOLES DESCRIPTIO'N OF Sol L 21 TT�T 'Zf NO. PTH HOLE G. L. 611 D/L A Ic -12" 1811 2411 30:11 Lj� �A 3611 4211 4811 5411 6011 m 7211 HOLE NO. -4 �— Wz' C'(T TZA c 3 &2U12L,SzP7-r-) 4-2. HOLE NO. 78 8411' INDICATE LEVEL At -WHICH GROUND, WATER IS ENCOUNTERED INDICATE LEVEL TO VETCH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY K t--- Axj,p:� te Da DESIGN, Soil Rate Used1l.1s Min/1"Drop: S., D. Usable Area Provided No. of Bedrooms Septic Tank Capacity )QpK Gals. Type A4A40Ajg-g Absorption Area Provided By_�L-F.x24" X< width T—rench. Address, . W! A VIC SEAL 10EANE COPRPELMAM EN61NEtRS, P.C. A PROFESSIONAL CORPORATION THIS SPACE FOR USE BY HEAUM DEPARTMENT ONLY. SoJ.1 Rate Approved Sq. Ft/Gal. Checked by. Date effTl *k f CSR REVI ON- CIM"CK ST : :T / tj& - e OPPELNA 0 - E nAPT" T.`nrmC House plans 0.K. D---sign data sheet Peres presoaked? Ei n., 30" pert test depth Const. results for 3 runs D. Hole log O.K. Corporate Affidavit for other than indivi Authorization for engineer Letter from Water Supply.if applicable If variance requested -such noted on plans apps. D�TAlIS if change-is proposed, ) Existjng contours shown show new- contours) Slopes for driveway cuts, etc. shown 1�ater service lire location Footing drain_, etc. location Top slope, bottom slope of fill Percolation tests and deep test pit location S °Dtic tank size and conformance to std. 3 B.R. house minimum House setback shown Distribution box ftg. below frost All water within 50 ft. of PL shown Meets Std. I i Plan and profile SDS''" f ' All other wells and SDS closer 200' shown*or reference made ! Property boundaries (metes and bounds- clearly shit i 1r�'SEPAR4TIOD1 DISTANCES SPECIFIED ON PLAN 10' to P.L.. ?0" to Foiuzdation walls )0' to Nearest well 3C 'j0' to stream, march, lake, etc. incl.expansion 15' to Curtain drain 1-0' to water line (pits -20 .5' to storm drain ' .01' to larc-c trc s .O' froll] foundation to soptic tank i .1)' to p ipo from leader drain Sc . footing drain S �`ZF �vZ� 1 (c-s - PE dZ� )c ) A�7'W . 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