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HomeMy WebLinkAbout0522DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 15. -1 -43 BOX 6 Cr _ 'I him L I. � I I 111HI.-W %I Ole 00522 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 James Galante ADDRESS Holly Stream Condos, Brewster LOCATION OF WILL (No. a Street) (Town) (Lot umber) Brimstone Road Patterson 4 PROPOSED USE OF WELL BUSINESS DOMESTIC ❑ ESTASLISNMENT ❑ ❑ FARM TEST WELL ❑ SUPPLY ❑ INDUSTRIAL ❑AIR OTHER ❑ CONDITIONING (Specify) DRILLING EQUIPMENT ❑ ROTARY COMPRESSED 3123 A R PERCUSSION ❑ P RCUSSION ❑ (sp*cl y) CASING D ETAILS LENGTH (teat) 42 DIAMETER'(Inches) 6, WEIGHT PER FOOT 19 ® THREADED ❑ WELDED DRIVE SHO X YES NO WAS CASING OnUTED? Fl X YES NO YIELD TEST M. El ❑ PUMPED COMPRESSED AIR HOURS O.P.A. YIELD (O.P. 5 WATER LEVEL MEASURE FROM LAND SURFACE— STATIC(Speclfyf� at) 10 DURING YIELD TEST (fool) i' Total D r awd ow n Depth of Completed well In feet below Land surfacet 705 SCREEN DETAILS MAKE LENGTH OPEN TO AQUIFER (loot) $LOT SIZE DIAMETER Inch ") IF GRAVEL PACKED: Diameter of wall Including gravel pack (Inch"): RA SIZE (Inches) toot O (tool) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of Well with distances, to at leant two permanent landmarks. FEET to FEET 0 6 Clay Overburden ; 6' . 30 Weathered fractured. rock 30 705 Gray granite If ylehdl was tested at different depths during drilling, list below FEET GALLONS PER MINUTE 150 1 250 3 500 5 705 5 DATE WELL COMPLETED 1 -19 -84 DATE OF REPORT 5 -25 -84 WELL GRILLER (Signature) 1X17 Ali Z U ! ORKTOWN MEDICAL LABORATORY INC. PA Box 99 321 Kear Street Yorktown Heights; N.Y. 105h 245.3203 LOCATIONS: G 921 KEAR ST., YORKTOWN HEIGHTS, N.Y. 10598 245.3203 O 201 BUTTONWOOD AVE.. PEEKSKILL. N.Y. 10566 737.8777 ('•'�j�495 MAIN ST., MT. KISCO, N.Y. 10549 666.3335 1/xSTONELEIGH AVE. (NEAR HOSPITAL), CARMEL, N. Y. 10512 278.9: �v L/ L. LABORATORY REPORT mg /L ❑ ACIDITY .................. ............................... ❑ ALKALINITY ......... ...........................,... _-X�BAICTERIA. TOTAL /mL .......... ...................... ❑ BOD. 5 DAY ................... ............................... ❑ BROMIDE ................... ............................... ❑ CARBON DIOXIDE, FREE .............................. OCHLORIDE ..................: ............................... ❑ CHLORINE ................... ............................... ❑ COD .:.................. ....... ............................... ❑ COLOR . ....................... ............................... ❑ CYANIDE ................... ............................... ❑ DETERGENT, ANIONIC ... ............................... ❑ FLUORIDE ................... ............................... ❑ HARDNESS ................... ............................... ❑ N COLIFORM COUNT/ 100 ml ...... ............. ,,�COLIFORM COUNT/ 100 ml y .,,,,,,,,..•., ❑ CONFIRMATORY TEST ........................... :...... ❑ NITROGEN, AMMONIA ... ............................... ❑ NITROGEN, KJELDAHL ... ............................... O NITROGEN, NITRATE ... ............................... ONITROGEN, ORGANIC ... ............................... ❑ ODOR ............................................... ;...... OOIL d GREASE ............... ............................... ❑ PH ........................... ............................... ❑ PHENOL ....................... ............................... ❑ PHOSPHATE (ortho) ....... ............................... ❑ PHOSPHATE (condensed) ....... ........................... ❑ PHOSPHATE (total) ....... ............................... OSOLIDS, SETTLEABLE; mt /L .......................... ❑ SOLIDS, SUSPENDED ... ............................... ❑ SOLIDS, DISSOLVED ... ............................... ❑ SOLIDS, TOTAL ...:........................ ❑ SOLIDS. VOLATILE ....... ............................... ❑SPECIFIC CONDUCTANCE .............................. ❑ SULFATE ................... ............................... ❑ SULFIDE .................... ............................... OSULFITE ..:................. ............................... ❑ SURFACTANTS ............ ............................... ❑ TUASIDIT`. ................................................. THESE RESULTS INDICATE THAT THE WATER THE SAMPLE WAS COLLECTED. THESE RESULTS INDICATE THAT THE WATER NEW YORK STATE ADtIINISTRATIVE RULES & FOR THE PARAMETERS TESTED. LAB # MR DATE TAKEN: DATE RECEIVED:_ DATE REPORTED: SAMPLE SOURCE REFERRED BY: COLLECTED BY: D 022 S —IM ❑ ALUMINUM ............................. ❑ ANTIMONY ..........., ❑ ARSENIC . ..................... ............................... ❑ BARIUM ....................................... ............................... ❑ BERYLLIUM ................................ ........:...................... ❑ BISMUTH .. .. .................... ............. ............................... ❑ BORON ........................................ ............................... ❑ CADMIUM .................................... ............................... ❑ CALCIUM ..................:................. ............................... ❑ CHROMIUM (tot.) ............................ ............................... ❑ CHROMIUM (hexavalent) .................................................... ❑ COBALT .................................... ............................... ❑ COPPER .................................... ............................... ❑ COLD ........................................ ............................... ❑ IRON ........................................ ............................... ❑ LEAD ........................................ ............................... ❑ LITHIUM .................................... ............................... ❑ MAGNESIUM ................................ ............................... ❑ MANGANESE ................................ ............................... ❑ MERCURY .................................... ............................... ❑ NICKEL ......................................... ............................... ❑ PALLADIUM ................................ ............................... ❑ POTASSIUM ................................ ............................... ❑ RHODIUM .................................... ....................:.......... ❑ SELENIUM' .................................... ............................... ❑ SILICON ......... ............................... c.......................... ❑ SILVER ........................................ ....6.......................... ❑ SODIUM ........................................ ............................... ❑ TIN ............................................ ............................... ❑ ZINC ............................................ ............................... ❑ .................................................... ............................... ❑ ....................... ............................... ......................... ❑ REMARKS: .................................................................... ❑ .................................................... ............................... ❑ .................................................... ............................... ❑ .............................. ................... ............................... ❑ .. ............................... ... ........ ............................... ❑ .................................................... ............................... 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R /A/i, ?"� .ri I _ 4p'cia 93 77. _ 4 \7 c ,Z c •r — la.. . 4 � i`y �• a C.• � e- � Y�*',S�i.'. rt ; Q. I / . L. % -`.\ i . tom. � i �� C {Af wf ��°•a t :o�6 - {f i{.. -.max ".F � j 2r/ _fY_. S' /'�• � ♦— A� '� -' 7 i pF 1 l /n Cz Vi, id s," 1 a,5► \ ' '� ( PUtDaM Count t- . £ Division of Envir4 Approved aB noted i �r + , fit' aPDlicable" Pales : ssts to PROJECT ! ♦ ;r L . • a; � ♦ , � � \ �. i 8�1� =C TOUR 1ill.l.'. ! \�<\ ��' \\ \, L DTMFiAJ5il0►J CH Mr v- Ss t A'E 14/i• 66 ,. 1= jf:� • A Iso. BF j:144, ��j r •�: : A "H 162 F3'H` n: 2,32- V. n X7 " /J Notes: l) 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.. o .e Number CLOCK TIME. PERCOLATION PERCOLATION Elapse Depth.to Water Water ve No. Time From•Ground .Surface in Inches Soil-Rate Start -Stop Min. Start Stop - Drop in Min. /in drop Inches Inches Inches 2,32- V. n X7 " /J Notes: l) 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.. i .-; 'r V _ .. r. it •'.P THIS SPACE FOR USE BY HEALTH DEPARTMT ONLY: \�J,' =�5 ►��`:,� Soil Rate,Approved Sq. Ft /Gal. Checked by Date. PUTNAM COUNTY .DEPARTMENT.;.OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL. SYST FILE 'N0. Q .ner` t ge A w K (ga. nle, fErM Address I AQ4w,. �6ydc9S 2 e Z Located at ( Street See. Block Lot /. 34- 6dicate nearer cross street) y PC, ft-em Watershed eiv Municipality o !3 SOIL PERCOLATION TEST DATA REQUIRED TO'BE SUBMITTED WITH APPLICATIONS ...'Hole Number CLOCK TIME PERCOLATION PERCOLATION apse p o Water . a e. r. ve No. Time From Ground Surfce in Indies Soil Rate Start -Stop . Min: Start, Stop Drop in Min.. /in drop Inches Inches Inches of F� q s -213o 1� 5 a .. :232 "3ti 4 2 3 Notes: 1) Tests to.be repeated at same depth until approximately equal soil. rates are obtained at each percolation test hole. All data to e submitted for review. 2) Depth measurements to be made from top of hole. DEPTH G.L. 6" . 12" 24" TEST PIT DATA REQUIRED:TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO. HOLE NO. 36" 54" .6011 1q wq, tN 66'► �L c✓ 721.1. 78,; .8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE 0 WHICH WATER:LEVEL RISES,AFTER BEING ENCOUNTARED TESTS MADE BY d u ( �C, , l.�J L r4-cc- Date DEIGN Soil Rate Used 1 s Mirm/l "Drop: -a.D._Usable Area Provided No. of. Bedrooms . 4- Septic Tank Capacity �Z-�© Ga�.�. -� , pe 6 i Absorption Area Provided Bye O L.F.x2V �jb'� 0� Nfj trenc Name j<Ay�do l O k W,4_ f+4A ►-tgT- bignat .. Addressboctnsb y S 04 y , THIS. SPACE . FOR USE . BY HEALTH DEPARTMENT ONLY: Soil. Rate Approved...._ Sq. Ft /Gal. Checked by Date. a 7rb.UW :,Ras P V_ 4� A It, AN, 717 kg� 1A It i .1 .0 1�4 MAI to p'x Ni Pl