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Home My WebLink About0901DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.39 -1 -9 BOX 10 ME I ' ml q Pe ;. 1.6 00901 WELL COMPLETION REPORT STATE OF CONNECTICUT I �r - Do NOT fill in WDB -5 12-69 REV. 9 -71 .,! "`+,f ' WELL DRILLING BOARD -� . �C'• %C.�! f`' � C'J cCJ / GC 1 fZ (� .�' � STATE WELL NO: State Office Building HARTFORD, CONNECTICUT 06115 OTHER NO. OWNER r r . I �r - !�• C .,! "`+,f ' '✓ . % C��J I -� . �C'• %C.�! f`' � C'J cCJ / GC 1 fZ (� .�' � DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with'distances, to at least FEET to FEET two permanent landmarks.. If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE %1--_9 3 41, ELLIS A. TARLTON LABORATORY CONSULTING SANITARY ENGINEERS CHEMISTS & BACTERIOLOGISTS 34 PLEASANT STREET - _ -- - -- - - - - - ---- DANBURY; CONN. -06810 - - - - -- -- - —. 203 -748 -7903 REPORT OF BACTERIOLOGICAL AND CHEMICAL EXAMINATION OF WATER According to Standard Methods of American Public Health Association NAME AND r Source of Sample ADDRESS OF J "Mr John J. Cahill 1,`ater supply, J. Cahill PERSON TO Tivoli Foad RECEIVE 50 Ca�Fron R��d Patterson, 1 , y l REPORT - Brewster, IN W Y rk 1 9 Date of Collection January 31, 1974 COLLECTED BY H 8_ B Data Hydrogen ion h Concentration (ph) 6 6 COLOR 2 TURBIDITY 5 ODOR 2— mineral Dissolved Solids 260 e e Alkalinity as CaCO3 • 46 FLUORIDE (F) Mg /L Nitrite • 001 Mg /L Bicarbonate e Mg /L .00 Alkalinity as CoCOy NITROGEN CONSTITUENTS Nitrate 2.0 Mg /L Carbonate 0 Mg /L Mg /L Ammonia • 000 Mg/L Total Hardness as CaCO3 146 • Mg /L Mg /L AS NITROGEN (N) - - -- -000 -Iran -Iran-as-Fe— _ v.� -- ; e - --- - -hg %l- -- --- --- - - - - -- - Chlorides as as CL 10 1 • Mg /l Manganese as Mn • 00 Mg /L Mg /L Detergent as ASS • 00 Mg /L Sulfate as SO4 23.6 Mg /L Mg /L The arithmetic mean of all standard samples examined per month using the membrane filter technique shall not exceed MEMBRANE FILTER TEST one colony per 100ml. Coliform colonies per standard sample shall not exceed 3/50ml, 4 /100ml, 7/200ml, or 131500ml Coliform Colonies /100M1 in: (a) Two consecutive samples; (b) More than one standard sample when less than 20 are examined per month; or (c) 0 More than five per cent of the samples when 20 or more are examined per month. ® 1. The results of the ,analysis of this sample are satisfactory and meet requirements for a potable water. ❑ 2. The results of the analysis of this sample are satisfactory for a potable water but certain of the chemical or physical constituents are high. These areres follows: ❑ 3. This sample is not satisfactory since it does not meet the bacterial requirements for a potable water. The presence of organisms of the Coliform group in a sample of potable water is undesirable and, while not necessarily indicating the presence of any disease - producing organisms, does indicate that such contamination might survive to the same extent. The presence of organisms of the Coliform group may also indicate that the treatment was not adequate at the time the sample was collected. ❑ 4. This sample is unsatisfactory as a potable water because certain chemical or physical constituents are above acceptable limits. These are as fol- lows: ?lard, verzT highly mineralized water, slightly acid, with good cOMMENTSap.)earance and good sanitart- hist()ry. Certified .. J' /L .d rt...... ir. Gzi..� r ......... a Owner or Purchaser of building 13uilding Constructed by Location. - Street Nh.inicipality , - -- — - --- Section Block f ho uil ing 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.`vhown 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 successors, 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 occupant of the building utilizing the sys +cm. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of..Environmental Health Services 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; - - - - -- -------------- ____ - -- •- - - -- ----------------------- - - - --- ---------- - - - - -- - - - -- 7 Dated this 2 \ day of 19 Signature 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 4 fi .101-lA .. 09. 64118 L Owner or Purchaser of building 4.4 Municipa ity 7 wilding Constructed by Section Location - Street. Block Building. 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 successors, 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 occupant of the building utilizing *he 2,J 1stcm �. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environmental Health Services of the Putnam County Department of Health as to whether or not the- failure of the system to operate was caus.ed by the.will.ful or negligent act of the occupant of the building utilizing the _._. _._system. Dated this 2-1 day of 19 7-3 Signature r 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 ..I represe-nt'fhat 1 am wholly and completely responsible for:the design and, location .of, -the proposed - system(s); 1)* that - the seperatw,sewage disposal system - above descnbeil will be constructed as shown on: the approved amendment there to and In accordance with the standards,. rules . an regulations of, ° e >, u nam County ..Department of s;Health; and that on completionahereof a 'Certificate• of Construction CompUance .satisfactory to the Commissioner of Healthwill be, submitteii _tothe' Department,. and a °.written`.`'guarantee will be`furnisned the owner his�euccessors heirs:or assigns by the builder,`_that se id builder. will r >.g- place in good`operaiing: °condition any part of .said sewage disposal 'system during tFie period ofttwo (2) years immediately following thedata_pf.the issu- .ance'.of.the. approval of ahe:" Certificate_ of;"Construction;Compliahce of the original system -or any repairs thereto 2) that the tlrilled' well descilbed above;' n. - .. , .will be located.as shown on'the,approved plan and -that said well wilfbe installed .in, accordance with, the. 8ndards, rules and = regula i%ns of ,the :Putnam i County.Department of.Health.._ mate 4/9/:%3 sign� P.E X R A Address p 6, Box 3 C )"tlel, NY 1051 License 14 29206`r APPROVED: FOR CONSTRUCTION This approval expires one year, from the date, issued' unless construction of. the building has been undertaken'and is revocable for'cause or may,'be amended ormodified wtieri eonsidered' necessary by, the Commissions[ "of Health Any change or, alteration of'eonstruction requires, a new per It Approved for disposal of domestic sanitary sewage and %or pnvate water •supply .only Date �' BY �'� Title , r' '' �1 •PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION -Of E"PvrjVOT' �T�TAL HEALTH SERVICES - AL COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner /�j�• I �j . c��. �a�� Address d �► Located at ( Street Secs ~�v t BB.11oc19 Lot PAo 8. ,d If 6dicate nearerst cross s re / E Municipality. Watershed efeyA h SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Role Number CLOCK TIME PERCOLATION PERCOLATION Run apse Depth to-Water - water Level No. Time From Ground Surface in Inches Soil Rate Start -Stop 'Min. Start Stop Drop in Min. /in drop Inches Inches Inches I 1 //ff // 311 /a 5 2 3 /308 /340 5 0! 2 11 5 7, Notes: 1) Te':�ts. 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. Y{ 9 t , 1 :y TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES D8PTH HOLE NO. �_ HOLE NO. °' HOLE NO. G.L. '® 6 ,e 12" i8" ®o" 2411 0z 30" 361d�. 42" 4811 54" , 60" 66" 7211 INDICATE TL ll' �WFIH GROUND WATER IS ENCOUNTERED Alamo INDICATE LEVEL TO WJ1ICH WATER 1,EVEL RISES AFTER BEING ENCOUNTERED a TESTS MADE BY . %' Date -11" DESIGN Soil Rate Used ®�llir�/1 "Drop: S.D. Usable Area Provided ° No. of Bedrooms Septic Tank Capacity ®®j) Gals. Type Absorption Area Provided By__261D L.F. x24" _width trench. other � Addies3 R.D.-6, Sox 353 N, PR Carmel, N.Y. .10 512 THIS S ?ACE FOR USE BY HEALTH DE.FARTP,$NT-,ONLY; Soil Rte Approved Sq. Ft /Gal Me Date �9s No. 2920' aA�, ,� °THE STA�� I . PUTNAM COUNTY DEPARTMENT-- OF- HEAL;TH_..__ ..-- . - - - -- DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. 0 /e�,p,6 - 'Address T Located at ( Street Q ae6ae 2 6±"4""' � ''�'�� Lot *40_ 8 aselp Indicate nearess cross street) Municipality Poser, Watershed (,.nom„ SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION. Run apse Depth to Water Water Level No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches / 1 /3¢2 zL 4 �•-i i��3�a 1 �./ yL 2 /3L�S''! 3IYO /f03 4 1 2 Notes: 1) TeAts 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. TEST. YTT DATA_RFQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO.__� G.L. 6" 12" 18" 2411 30 36" 42'r 48" 5411 60" 66" 7211 78" 84" 4- -e wtill, r�- U�tC1uiVD�nIAT 'Et�l�_.E1�l�0UU1Vl�;Ft�,1) INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED AAW :TESTS MADE BY , &"J)ato Ll:iU 1 UlY Soil Rate Used ° ®d Min/1 "Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity 0 ®c.� Gals. Type Absorption Area Provi'd'ed By L.F.x24" width trench. Other A/,a,=,-,, w.r3.g�P.E. Address }snx cF; THIS SPACE FOR USE BY .HEALTH DEPARTMENT ONLY Soil Rate Approved Sq. Ft /Cal. C' Date Building Type F Lot Area"1 2 A` + Putn Valle NfiY 10579__ Number of Bedrooms Th ee Total-11 abi4ab Space Square Feet Y!7\ SeparateSewerage System to consist of" + Gal Septic T k 1180 hnea eet X '�`nCh width,.trench To be, constructetl by Address Water.Supply. Public.Supply'F m ,. � ;':Prroate 'SuPPIy, t • be drills . by ? t - r Other' Requirements I represent that I am wholly antl mpletely sponsible for th and location the proposed systems) `1) that .(the. separate, sewage disposal system. above. described will bpe constructs shown the�approv,ed,ameridment -there and- in accordance with the standards; :rules an- regulations o he-• .0 nam .. County Department of Health, `a'n hat:on ompletion thereof a "Certifi 'of Construction Compliance, satisfactory to the .Commissioner of'Health� wttt . be ,submitted to the Department, an wri en - guarante'e' will be fur ed the owner, his successors hers or assigns by the builder,'that said builder will' place in good - operating _conoition any said sewage d�spo ystem during the period of two (2) .years immediately following the date of the issu ance of the approval of the Certificate= of struction' Comp a of the original system or any repairs, thereto 2) t, hat the drilled_weil described above -,' wilt be located,as'shown ori,the approved plan an hat' id w I lie instailed in'accordance- with: the iandards, ruies and;. regulations' of =the = Putnam r ... County Department of Health.,',, 9 Data 11128/72 . Signed;, P.E X R.A. ft D 6 Bdx 35 e a Yo 105 2 : 29206:: License No Address APPROVED FOR CONSTRUCT.LON This.,approval expires. one yeaWfrom: the date issued unless construction, of the - building fias been undertaken_and is revocable for .cause or inay,be`amended.or modified when consideredJnecessary by' -the Commissioner of ,Health. 'Any change or aiteratwn of,.construction. requires a new' permit: Approved for disposal of domestic sanitary sewage, and /or private water supply only. Y Date��J% it le rye.. .. ..: . ...... . -- 1 W r U r f- a w d W cc U Q U) r..I Lit Z k SANBORN ((unimprdoved) s °2o' -OO'E- /OO.OQ oc / $to fi ROAD,'' /78.16' m__ I to n Nt. °R\.v\�a d c to x \ IT v. \o .4¢ W V' N OV- q a �d \ \ z 9130 0 �\ N N a — I / C4. �i t9 'il 131 -4 W \ 'w o \ a NO m \ ul� 01 R��5z26915 ,d \ I o• I ` SURVEY OF PROPERTY 11 BEING LOTfS 4 /7CANp I79 INCL. LOTS 4140 - 4148 INCL. -% "SIXTH MAP S OFN PUTNAM LAKE" S /TUATF I IN TOWN OF PATTERSON PUTNAM COUNT Y NEw YORK SCALE-;'=40' 4 _ Said map filed March 20, 1931 as plop N °149 E Legend �^ 4 stone wo// r monument found — o I iron pin = e JOHN. H. PRENTISS, P.E. l drill hole i Certified on/y to: Realty Abstract Inc., Putnam County Savings Bonk and The rifle Guarcntee Ca far Title N• "1'Afl -1469. ,re FF. x °-O r n _ 0 Ear a i; r Y'° u. �•, ` rt. _ '. 101q c� ' 1 ,n Y�