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00759
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L 0 W E N TH A
WELL, COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH
3/71 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
M. L. LOWENTHAL
ADDRESS
ROUTE
LOCATION
OF WELL
(No. ti Street) (Town) (Lot Number)
ROUTE 164 BREWSTER
PROPOSED
USE OF
WELL
ESS
® DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
11 SUPPLY El INDUSTRIAL ❑ CONDITIONING El OPHER)
DRILLING
PMENT
EQUIPMENT
® ROTARY ❑ AIR PERCUSSION ❑ PERCUSSION OPH if )
CASING
DETAILS
LENGTH (feet)
20
DIAMETER (inches)
S
WEIGHT PER FOOT
® THREADED El WELDED
1 E SHOE
YES El NO
CASINGY
YES
LJ NO
YIELD
TEST
HOURS G.P.M.
❑ BAILED ® PUMPED ❑ COMPRESSED AIR 30
YIELD (G.P.M.)
30
WATER
LEVEL
MEASURE FROM LAND SURFACE— STATIC(Specify feet)
DURING YIELD TEST fleet)
!!±
pth of Completed Well
feet below Land surface: 1
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 fleet)
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION
Sketch exact location of well with distances, to at least
two permanent landmarks.
FEET to FEET
Drilling in overburden -
clay and boulders
Hit rock at ten feet
Drilling in rock - settin
PO
Drilling in rock -
;a
If yield.was tested at different depths during drilling, list below ro
FEET
GALLONS PER MINUTE
DATE WELL COMPLETED
June 1 5 ' 71
DATE OF REPORT
Aug 24, ' 7�-
WELL DRILLER (Signature)
v, y
anc„
- _Buildin9"TYPe, I
Has Erosion Control .Been Completed? v n0,
'I, certify 'that A he systems) as listed serving the above premises were`construi
._attached) -; and in accordance with .the :stand" s,` rules'and,regulations, 01.
Date July 19, :,1971
a Cergfled by
Burgess & ehr
°' Address
Any person occupymgF•premises served by;the above systems) shall promp
icon It Ions :resuating "from wch :usage - Approve ' of the'separate'sewer`as
available; ind the approval of the'private;water'supply; shall become null -a,
subject to - modification :or change when; m the,'judgment 0 tthe Comm
Y
0
.: 4/29/71' '
of Bedrooms Date Permit Issued
ad essentially as shown on the plans of the completed work,(copies of which, are
S filed, =;and `the 'perniit,'issued _by 'the Putnam.County Department of Health.
X
License. No:
9a- • 4
y take such action as may be necessary to? secure the;correction of any unsanitary
sy40rm,a'sh4 i1'6 ecorrie n ull and�yoid as`so-on as' a public sanitary - 'sewer becomes
i void.-when a public .water _supply becomes%aJailable. Such approvals are
sinner of Health, such revocation, modification or _change 'is necessary,
1 v= ` Tit18' �v
m, Lowe -lyf fi
BREWSTER LABORATORIES
Box 224 - BR.EWSTER, N. Y.
WATER ANALYSIS REPORT
SAMPLE NO.. 2429
SOURCE: h hL Lowenthal hose bIbb . 6 well supply
Rowe 164-
Paitersonj N. Y.
COLLECTED: August. 24j 1971
BY: P. F: Bea t Sons, Inc
BACTERIOLOGICAL EXAM NATION
. Coliform Count, MF Method 0 per 100 ml.
This result
indicates the
source of
the sample was
of satisfactory sanitary
quality when
the sample
was collected.
August 260 19 71
Roy Bickwit P. E.
Direct
Or
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division .o "'f Enyi o mental .'Heahh 'Services Carmel "N Y. '10512
rf r
CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM
Town of `Fatt.erson
li Town or. Village
Northerly s �c�e Rte 216 aprox 130Q ft 15 r 1
P Located at, Section Block
;. 2J. J-
Subdivision -pot a part O R .SUbd 1 V� S 6n Lot' " 8 (T &x _Map) fob 32
IvIax L. Lowe -nthal Patterson, T1. X.
Owner Address
+^ +_
uild;n9 TYPe anch Lot Area'
13 c
R
"Number of Bedrooms } Total, - Habitable Space 1 Square Feet
1 S F
00 '24,-Q. i
t
'Separate Sewerage System.to consist of a teal Septic Tank -lineal feet X 36 width trench` .•I
Coual?lin Rr- ewster
To' constructed by Address 9
Water Supply. Public Supply,'From
X =� Beal
„ *Pri, - iSupply !fo be drilled by, -•
• -- ..Address.,
Brevrster, N'. Y. 10509
Other Requirements Dry we'll optional
M' 'represent that Iarri wholly and co%npletely responsible for the design `and "location of "the 'proposed system(s); 3) that- the se" parate sewage, disposal system
i
I atiove describe'tl 'will'-be construcfetl':as shown on the approved amendment there to and,in accordance.with ' the.standairds, rules an regulations o e u nam
County -Department of Health, _and that on completion thereof.a "Cerfificate..of. Construction Compliance" satisfactory to the Commissioner of Health will
i'be submitted do fhe Departmenti` and a wrdten guarantee will be.furnish_ed the owner hissuccessois heirs or assigns by the builder; that',said builder will
r`place in,. good. operating Condition, any part of .said sewage disposal system during ;the period of two (2) years imme6 atelY. `;.following ?the date of the issu
A
of °ahe approval of.tthe Certificate of:' Construction ;Compliance rof iahe original, system; or any "repair9 thereto; 2)'that the drilled well described;abo4e
i,.will „be located as.shoivn on the,agproved plan and that said well will be,nstalled in accordance° with the 'standards rules and regula i� ons : 'of; the Putnam
;County Department of Health
April 26, 19,71 �tt
Date Signed;
Bur,ess <Behr ::128. Cxle "n zd= Aue ; armel ¢ ILK "
Address lY icense M.
{APPROVED FOR` CONSTRUCTION This approval expires cone year from the date issued unless construction of the bwldinghas been undertaken :end is
1 revocable.fi r cause or may be amended or niodifiatl when considered hecessa y by the Commissioner of'Health Any change or alteration of..construction.
requires a- newL�ermi t Approved, for disposal of ;,domesUiC3ait1 .yiiewage; a rivate ;water supply only
�: G I
+
Date
. ey � � ,'Title � '•
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL. HEALT141.SERVICES:
DESIGNhATA .SHEET - SEPARATE. SEWAGE DISPOSAL SYSTEM FILE N0.
215J °2-i.32
Owner Max. pa t�y e .r..s. o.. n, i ?, Y.:
;
r
a _ Nor er y e 8
) Coueh .Road.
Located at - (Street West 'of Sec. 15 Block - - Lot
I
i
(Indicate nearest ross street)
t
Municipality Townof Patterson Watershed New York City.
'
SOIL PERCOLATION TEST DATA REQUIRED•TO BE SUBMITTED WITH APPLICATION
1
.
Hole.
Number CLOCK TIME ": 'PERCOLATION "
PERCOLATION
Run Elapse. Depth to Water Water Level
No: Ground .Surface in Inches
Drop in
Soil Rate
Min/in.drop
Start Stop Min. Start ,' Stop
Inches Inches Inches
h
,. , .;
_.... ,.
..:....l.. g� .., .l2 a.56: U z8 .. _....... 19 _. _ ._ .... 1 ..
.�� ;3
.. 13 Min
i
' 19 09 132 :12056:..1,
13 it
3. , 1:...1 10 1; 37 27 ... :.... , l.g.. 20 2 ....
1L ►�
,
5
?) 56 1h 1�
1.
2... ] 2 .56 .. 1: 2L 2 :8 _ 18 .: _ 20 2
14
:..�
4
0
3
i
:
Notess
i
1) Tests to be repeated at same depth until approximately equal soil
rates are ob
,
tained,'at each percolation test hole. All data to. be submitted for - review. `.
<
�;
2) Depth measurements to be made from .top of hole.
t
VerrIco/ ei
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a. r wt TS�J RS i, "St.G �;G A C•ER A
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AS-aUILT LA N
/VOTE TN /5 15 TO CERTIFY TA4AT-T"E .SEWAGE,
SYSTEM WAS CONSTRUCTED -PUCTED A5 INDICATED. ON
AND THAT TJL/jE SYSTEM WAS INSPECTED BY A4,C BEFORE -' 7
v WAS COVERED OVER_.TPF_ 5Y_5TEM.WA5 CON5TPUCTEO
IN. A.CCOQ-bANCF_ WIT14 ALL TUE RULES AND,PCGULA TION's.
OF THE P41TNAM COUNTY DEPAPTmL:Ivr OF NC-A I- T14-,
NOT j /a-
EXCEPTIONS TO t!IF_ ABOVE, IFAN,Y NOTED BELOW.
NO N.0 'VV el- L .NOT 43 U/Z.;
vo.
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OF., .WAGE -D AL
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U00 -13 APPROVAL
-PPRO
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10
SEP2.1§71'
of HEALTH
4._5 . ve
700
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