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BOX 9
IIs
5
.:,Loeafedy
f] W nar
Cohsisting
Other, regi
Water Supply
r X.
Building_ Type, . _ _
Has Erosion Control B,
wnv�ugns
available a
Subject to
Date
h■
i.yaaaia „va ,u.n "uw Y wvaa % W.Ll-
led plan aad the. permit Ageaued by', the
V.
P E._X R A
L'tense No' ?,,9200 --- a.
secure the eorredion ,oi any,ununitary.
i Dublic tanitery ,ewer .becomes
omen avitlabh>. :S�u-c-h ipp
rov a s � ere
�i�Frthsll�' S.1 nec�i/afy
h
- Title,
Robert NiefeI
Owner or -Purchaser oT Building -�'
Robert "ef
Milding Constructedby
East Branch, Road
Location treet
Modu 1 ar
u ng Type
Municipa.ity..
8
Section
Block
14.1
GUARANTY OF SEPARATE SEWAGE SYSTEM
I represent that I am wholly and completely responsible for the
location, workmanship, material, construction and 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-
vio.es._o.f .the ..Putnam.. County. D.epar.tment. 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.
Dated this day of e? k 19'1 r Signatu
Title
If corporation, g ve name
and address)
THREE (3) COPIES ARE REQUIRED. WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMPLETION WILL BE ISSUED.'
GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
Division of Environmental Health Services, Putnam County Department of.Health
DECEIVE®
S E P -1 1982
�+�j NA EOUNTY
DEPT. OF HEALTH
WELL COMPLETION. REPORT PUTNAM COUNTY .DEPARTMENT OF HEALTH .'
3171 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
d E? ! !J �'►! O
Z4
ADDRESS
,3 57 2 ._57` Net-- 1 C 1 n.
LOCATION
OF WELL
St
(No. d Street) (Town) (Lot Number)
East Branch, Road Patterson, New York
PROPOSED
USE OF
WELL
BUSINESS
a DOMESTIC ESTABLISHMENT El FARM TEST WELL
SUPP Y INDUSTRIAL' a AIR ❑. OTHER .
CONDITIONING (Specify)
DRILLING
EQUIPMENT
ROTARY A COMPRESSED CABLE R PERCUSSION PERCUSSION OTHER
a (Specify)
CASING
DETAILS
LENGTH (feet)
61
DIAMETER (inches)
6
WEfuHT PER FOOT
Z'7
a THREADED ❑ WELDED
0 SHOE
X YES ❑ NO
LNG U
YES L_! NO
YIELD
TEST
HOURS G.P.M.
BAILED PUMPED COMPRESSED AIR . i
4 8
YIELD (O:P.M.
1
-
8'
WATER
LEVEL
MEASURE FROM LAND SURFACE = STATIC (Specify feet) DURING YIELD TEST (feet) Depth of Completed Well
20 385 in feet below land surface: 385
MAKE LENGTH uPEN TO AQUIFER (toot)
SCREEN
DETAILS
SLOT SIZE
DIAMETER (inches)
IF GRAVEL
PACKED:
Diameter of well including
gravel pack (Inches):
GRAVEL SIZE (inches) FROM (feet) TO (feet)
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION
Sketch exact location of well W/th distances, to at least
two permanent landmarks.
FEET to FEET
0
50
Hardpan & Boulders
Dg re
s��� RECEIVE[
JUN 81982
PU FNAM COUNT
DEPT, OF HEALTi
50
385
Black & White Granite-
If yield was tested of different depths during drilling, list below
FEET
GALLONS PER MINUTE
250
2
355
4
375
8
385
ail
DATE WELL COMPLETED
5/12/82
DATE OF REPORT
5/25/82
JW DRILLER (Signature)
Robert Pile miii, /President —PULL muu iNu CUe , im.
'L .
0
i-
BREWSTER LABORATORIES
Box 214 BREWSTER, N. Y.
WATER ANALYSIS REPORT
SAMPLE NO. 47 90 Rv 6 P rf c�-- D 1 cc y, �°. 64 C)41 O
SOURCE: Robert ZWiefel Well
East Branch Road
Patterson, NY
COLLECTED: May 12, 1982
BY: Mill Drilling, Inc.
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method
This result
ixdicatts the
sourct , of
the sample was
of satisfactery saxitary
quality whm
At sample
was collected.
May 17, 1982
0 per 100 ml.
Bick or P. E.
Director VECEIVED
JUN 81982
PUTNAM COUNTY
DEPT, Of HEALTH
Owner or.,ur.c aser of Building
Robert Wefel
Building Constructed by
East Branch Road
Location - Street
Section
1
Block
Moo 14.1
Bui ding Type Lot
GUARANTY OF SEPARATE SEWAGE-SYSTEM
I represent that I am wholly and completely responsible for the
location, workmanship, material, construction and 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 the system. -
Dated this 27 day of August 19__8a Signatures ry�
Title
If corporation, give name
and address)
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMPLETION WILL BE ISSUED.
GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
Division of Environmental Health Services, Putnam County Department of Health
RECEIVED
S,EP -1 1982
PUTNAM COUNTY
DEPT. OF HEALTH
g!
Located at East
subdivision`' Robert
Owner •- Robert
tuiltl;ng .Type MQdU1:a
Number of. Bedrooms
Separate - Sewerage - Syster.
ToT be constructed, by,'_
Water Supply
�f1
Ot" Requirement S ". IM
r '`ter
:V a _ -
Y': t
PJTNAM COUNTY DEPARTMENT OF HEALTH' �-
SO 1173
Ohiision of` EnvironmentW(. Heaith .Sertgces, Carm',e! N .Y 1:05.12
FOR SEWAGE 'QjSPO_SA_L SYSTEM s Patterson
Town or. village
�h Read ' 18
`Tax Map -Block
efe1. Lot , #1 got _ 14 1 Job 501973 -
e e1 'Address R D ; 3,.'Eas.t, Branch Rd:
�t
Lot - 'Area• 490-Ml k N =. Patterson'. NY, 12563
�e 60Q Coal 1,1'44
Design FIoW •- Total�laabitable Space - Square .Feet
E 1000 4 500 L sF 24" Width : _Trench
,
ohsist of G'al Sept�c.*Tank .sand -
xa G
�
Supply From
3 r�x." ti �'t.sr x �^'F � u �.,z, x �.s..,t7 p�� it �` � ex's ,� � ,»•N � - i '� ^
completely r "esponsible for the design and loc5tion of tAe proposed system(s) 'Yj that. tfie separate sewage tlifposal system
ted a'shown;on the ap.provetl amendment there;,to and?�naccordance withahe standards rules an .rp.gu a eons o the:-,:, u ream
K t'isfactor to the Commissioner of ?Iealthwili
and`that on "completion thereof a Certificate of Cohstrction Compliance sa y
be`subm.itted to the Department "and a written guarantee will ibe furnished ;the owner his successors;; heirs o►^assighs,by thei6uilder; th5t`said builder, will
C.
-place in good operating cond�t�on,'any part;< of -- said ',sewage`disposiC"'tem�dunng the period; of two °(2) years immediately,followiny he date :of the s ;u=
ance. of` the approval of the Certificate of,tEonstruction Compliance'i of th -' original system or any ►spans ttiereto 2) that the drilled well described above• 1. 1 will be Ibcafed as,shawn on'the approved plari; and that:said, well wdl be ihstalle in accortlance with the sta s rules"-and regula i�`ons, ;of Mw Putnam
County Department'of Health
a-
7/15�ffi1
Date Signed, -_ P E, RA
4 RD 9_ Pater St e1 NY 10512
Address License No
_ ;2920:6 .
,APPROVED FOR',6 NSTR'UCTIOtVe` This approval-,6pnes one year,from the ;date ss'ued unles t on: of the building has been undertaken and 'is
revocable for-cauie. or may be amended or'modified: when considered necessary'by the - .'Comm loner of Ith:.." Any change or-.alteration of :cohstruction
requnes a' Mew permit Approved for disposal of domesti • ani y w an o nv water =�
Data,, Sy Title
0
PUTNAi4-.COUNTY.DEPARTMENT.'OF.HEALTH
-'DIVISION OF ENVIRONMENTAL' HEALTH
C OUNTY.10FFICE BUILDING, CARMEL, N. X. .10512..;",.
... ... ....
'SEP
DESIGN DATA-SEPARATE ARATE
SEWAGE DISPOSAL SYSTEM PILE No.'.
'
Owner ; e&
ddr6ss
T94vm'
Located dt Street4,'V ow _St Block
Lot 4lcate,ne
71'
"
ares ross.stree
Municipality
Watershed Cjijk-6
AM -TEST...MTA..MUIRED
TO BE SUBMITTED. WITH -,:APPLICATIONS
Number...:...._ :._...CLOCK_-_TIME.
.PERCOLATION.... PERCOLATION
Run Mapse
Depth to., Wateri Water ve7
Time
:
From Ground Surfac 6, in,,. Inchesw w Soil Rate
Start Stop --Min.
Start Stop Drop in Min. /in drop..
Inches Inches' Tn�chegq..
tit
E.
.... .. . ........
.2
. . . . . . . . . .
R ECIE
3
My U,*,V, 11" IZIC) I
.. .... .......... ..
C
PVTNAM�, COUNTY
5
DEPT: OF-HEALTH
�*i'6 t b6.'repeated at same depth until
Notes': 1 0�
appro�Kimately equal soil
rates are obtaihed.':s6t. each percolation test hole.
-All data to be submitted
-for,
Dep7thlbeasurements . to be made from top of hole.-
DEPTH
G.L.
6'1
1211
u
TEST PIT DATA REQUIRED TO-BE SUBMITTED.iITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED'IN TEST HOLES
THIS SPACE-'FOR USE' BY HEALTH DEPARTPMT 0 /
i No. 2920°/
Soil Rate°Approved :. Sq: Ft /Gal. ��`` Date
Structure located. tram ;surrey by surveyor note'C beloW(g_-_
Well located by: Surveyors survey•_
Well drillers, report.—
Enginoen'e ma,serementa -0 -- _ —
Ton k, box os, p'ila, gollenoa 9 Iate,roIs Io•co.t-e.d. by:Ccntractor
Al
.Haaw da.Pd*
/r/ /��r✓ie
e� a
Field inspection by: Health . dool -® data AtQ —_
/. ,
y •i,""'s'
,� •�.aa.. Engo poor. ® do4e
fieo ?I
cif
NOTES. 4) SW(ie-ra Ic - I000 Gal. Fee .ca:fiCa.,
1
p
w»
b J La {a+al s S 5^20 r x -A.4 "1✓, x 24" D.
l @A E N stoN'S
A - D
z�• f,�r k �a
A - E __.0 - E a— _?fzg + -- -- $EF
_
A 6 6C'10 _B - G avtSS10
�K- °°�
A ''H °-- Z-2 M -8 ---'B - N ° -- " - -- � p0.`' °Rep � �e
i
.. Ns °¢9'iy "'d°-
/✓6 °�3' s- "/++.:- / ;S'.c7 = N /�' °fi' f1 jy'e-
- r
• 9-9./j'
, 96.97•... Ne °. }7yf "E- S ✓o' -
- _.- _..__- -
SAN ETA RY SYSTEM DESIGN 0z UILT��
d
-
V — — — -- — -= — - — — — — --
-
LOCATION Street _�TGne�3� �l�q �eln5p4y
Town: — A 4;,=,L_ -- County: — �C�a. _— Stato: tJ� ✓— —
SU'BDIVISLON- �'�Wi� t%af- --- - --
--
Map:l-r73.) — — — --
'
Putnam County Department of $ealtfi `` _
Block. — - -_ —__ LOT Na_„_1_,i
— — — — —
Division of Enviroryental .Health Services
-Budder: I. ?t may,
Surveyar --
ed as -o' ^o ^3ormanae with
appli b1e '.r. ations oY the '_
Drawn: R �.
Date ;2 82
Scolei ,g• �;
Job N�0.197
Pu Co ty
Hea th uey �tm
w g.
J O H N H, P'R'E N TCS'S' P E_
•
ignature Ti a Date
CONSULTING ENGINEER
.:_.
RD.R, F-41 R- Sr., CARPAEL NY 10812 —(8141 828 -6170.