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HomeMy WebLinkAbout1357DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.78 -1 -71 BOX 13 1 1 Ism S:2 11 Is Is 1111 No 611 Is Is .`0 r I� ' ` I 1, me :6 �■,' T Ir al f r - .� 1 �� T '•• Ti 0 Is 01357 6 PUTNAM ,COUNTY DEPARTMENT OF ••-WELL COMPLETION REPORT 'w`_- 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 aubrnitted to:'£aUnt +#'ealth Depi tment together with laboratory report .61f Einalysis 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 NAME ADDRESS OWNER Peter Wagner 2871 Philip Avenue, Bronx, N.Y. 10465 (No. 6 Street) (Lot Number) . LOCATION (Town) OF WELL Batavia Drive, Putnam Lake, Patterson, N.Y. BUSINESS PROPOSED ® DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL USE OF WELL ❑ OTHER SUPPLY El INDUSTRIAL ❑ CONDITIONING El (specify) DRILLING C ❑ ROTARY ® COMPRESSED C CABLE E OTHER ) EQUIPMENT ❑ R PERCUSSION ❑ PERCUSSION O ) CASING L LENGTH (feet) D DIAMETER (inches) W WEIGHT PER FOOT M ME C CiC$iIVG TE6Y- DETAllS 2 20 6 6 1 17 T THREADED ❑WELDED Y YES ❑ NO Y YES NO YIELD H ❑ BAILED E E], P HOURS G G.P.M. Y YIELD (O.P.M.) PUMPED ® t6 7 7 7 7 . WATER M MEASURE FROM LAND SURFACE —STATIC (Spa clly feet) D DURING YIELD T TEST fleet) D LEVEL 1 10 3 Depth of Completed Well 320 i in feet below Land surface:- 20 MAKE L LENGTH OPEN TO AQUIFER (feet) SCREEN DETAILS S SLOT SIZE D DIAMETER (Inches) G IF GRAVEL Diameter of well including AVEL SIZE (Inches) FROM (feet) TO (feet) PACKED: g'ravol pack (inches): DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch enact location of well with distances, to at least FEET to FEET two permanent landmarks. 0 10 Hare packed clay 10 320 Hard gray granite. 0w ,e "'/V P ( If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE 200 21 W2�� 250 4 Y 310 7 11D/A�TE_OF REPORT WELL DRILLER (Signature) RT�AMM✓/! -Ar"A r•>.M MOM WAWA �A BREWSTER LABORATORIES •$ox 724 =- Ei2;WSZERI ��i: �':. _... - .. . WATER ANALYSIS REPORT SAMPLE NO. 3119 SOURCE: Peter Wagner - new we a Z Dataota Drive Pu nam . Lake p Y 4 COLLECTED: Jan , 4# 19 74 BY: Nil i Dr i l L 49,r> Inc BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. Jan« 5, 19 ?4 d per 100 ml. �o ickwit P. E. Director L L6, C) (OT 65' W'T � L rD i Er E L PdTNAM, k;T A a�PPROrVf E. 3,7C 71974 4 — - We v, Slow Of. 550 GAL Al L rD i T& L L6, C) (OT 65' W'T � L kE-PT'c TwtL 011111111,11, PF 04S \LJ , Loc&TIO- tl 0 -P) E-v./A 6 E- P054 L a ^V -w Ta. Er E L PdTNAM, k;T a�PPROrVf 71974 — - We v, Slow Of. 550 GAL Al L rD i T& kE-PT'c TwtL 011111111,11, PF 04S \LJ , Loc&TIO- tl 0 -P) E-v./A 6 E- P054 L a ^V -w Ta. �G a5mer or lbrchaser -ot' build-. 7 7t luilding Constructed by Ser_tion . �T 161�Q Location - Street Building Type Block Lot GUARANTY OF SEPARATE SENAGE SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material; construction and .drainage of the sec':age disposal syst'em 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 1 \ -V;- ;11`i(a{J J)V. l:I1F! W)- j_I.111.L Ul' 11(- V.L-Ll U13 L du L Vl- LJIC UI.L:U'NaiI L.'. ut _ LA.cc the The undersigned further agrees to-accept as conclusive the determination of the Director of the Division of Environmental Health Services of the Putnam County Depar..trrent of .HP.;33-th as to whether or not the failure of _the..s.ystem to operate was caused by the' willful or negligent act of the occupant of the building utilizing the system.. Dated this L\ day of •19-14 Signatur �e4 Title -cor oration, V, veMalrie and audres __- __----------- _ -__ -_ ------------------------------------------------- THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFI.CATi 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 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVZRONMLTdTALAi,T -H -- SERVICES COUNTY OFFICE BUILDING, CARPEL, N. Y. 10512 DESIGN DATA SEWAGE DISPOSAL SYSTEM FILE NO. Owner Address /z Js Located at (Street 9 f g, 7,1Q q Sn Block 6o2 Lot 0 n lca e neares cross s reef Municipality A4 _r T, & _ -j:0ni Watershed i 5' y SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS H-016 Number CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water -Water Level No. Time From Ground Surface in Inches Soil Rate Start -Stop Mina Start Stop Drop in Min. /in drop Inches Inches Inches j 72 2 /0 3r 7.� 1.3 5 /ms' �7 AV J. 3 to 3 4 5 _. 2 3 4 5 Notes: 1) 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. w_. _ - - - , -- - _ � ,. { :' ` 1 ,. I �. 11— , ; -• ra- .. _ - .. ,. - .i ':� - TE3T FIT. DATA. REQUIRED . TO BE SUi?MTTTF1D WITH AF'PLIGATIO�I. I 11, "'' ..DESCRIPT- ION: OF rSOILS..IJCOIJI�1�i'F�PED IN•;TEST= :HOLES i ,, D ;PITH HOLt N0: HOIE NO HOLE- NO ,. .: �, -_ 1. _ -, ;, % . +; 11 G,- . ( b l► - 12" r x _ ;; f 18 "` h c 2 11 -IL , f...- 7 . • 1. Y -1 30 - - . f - - ,. x 611 t' _ :3 , r I .11 ' - i �" - 11 k {y{ 1. 1 8 Sr4N0't C>fl�( i ,� �`1 60„ -! 11 6b "° . ,_ n - -- - 1 .. . , i 7211 _ , 3 Y 1 q i - ,. , 7/� / /J //�J./1 V b 41 W, I ... I1�TDICATE L' 'VEL AT .:�w" CH GROUND WATER IS ENC OUNTERED 111 o A �' , 11 In m- C1ATE" LE 1 b- ATER LE'�TEL _= RISE"5` EPR R��rG.. ENCOUNTEREL �/ o. /U�; ;,WHICH . . •AiP 'PESTS P�ADE BY -F /r � � 3L 73 � ,4-a, ` � , ..T /!. F�//7/73 y�1o�E: Dcte: ^ .. ., - I d _ k = s -s , .. ,,i_ DESIGN ; 11 ' ,Soil Rate Use'dMn/1 "Drop S D 'UsaUle Area Provided 11 - , :. : :;: 4.1 - ,- «.: ,_.. , r .. r, `` No of Bedrooms 1. Septic Tank Capacity /o?p (j' Gels �\�i�" "' , /�/, Absorption Area Pr "ovided Bye& F. x24" '— � �E �;ench I. _, �� KiHU t+�� P F� ...Y., F f ,?'y , ,� 9G �G�., b - .. :i i .. Q .-� 1Vame: lgna ure:. _ _ t -- s 1 W, s .` Addr s s Ov�'�F�i.� E' lid SEF�L �' 11 { -e ©f : a , { O �y�r -pe 0.0 �� 1`1 I C/3�2i�lE+L �V Y �--- �. %, �FE�ST9�P .. \ ,\ 1. x- •THIS SPACE FOR USE, , BY -.HEALTH DEPARTr2ENT ONLY I I ' �, ';x5611 Rai. Approved Sq F't /Cal < Chckedr by Date - . Y- „�- - - . ,. l W n s '!a's ,�' x fi -1 do ti�`T, a ..a �" "'.S -s Au ��...�.., yc ' .a. o .� _ r a �,�e �-- } `•.,�"" g .. -. - w., \i -: '. - i Y .11 f �.. 1 .,. r , - y - _ ' 1 .. ..... _ _ .. . .. _ . . \ \\ ,' e `•. .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 NAME ADDRESS OWNER Peter Wagner 2;71 Prilip Avenue, '�.ronx, IN.Y. 10464, LOCATION (No. 8 Street) (Town) (Cot Number) OF WELL BataVia, Drive, Putnam Lake, Patterson, P ,ire SCREEN DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: DEPTH FROM LAND SURFACE FORMATION DESCRIPTION FEET to FEET 0 10 Hard Docked clay 10 320 Hard. P-ray Zranite. Diameter of well including gravel pack (Inches): Sketch exact location of well with distances, to at least two permanent landmarks. Se '� '0 W.'7 k� ", W 7 a If yield was tested at different depths during drilling, list below e FEET GALLONS PER MINUTE 200 2 _. �} 2,50 4 % 310 7 RA DATE WELL COMPLETE57 DATE OF REPORT WELL DRILLER (Signature) 1/3/?4 1 /lq /`7u -// ,President VJTLL D.RTL!,VTG , INIC ❑ BUSINESS ❑ ❑ PROPOSED DOMESTIC ESTABLISHMENT FARM TEST WELL USE OF WELL ❑ ❑ ❑ CONDITIONING ❑ OPNER) SUPP Y INDUSTRIAL DRILLING ❑ ❑ COMPRESSED ❑ CABLE ❑ EQUIPMENT ROTARY AIR PERCUSSION PERCUSSION if ) (specify) CASINO LENGTH (feet) DIAMETER (inches) WEIGHT PER FOOT ❑ ❑ ° O ❑ NO DETAILS 21, 6 17 THREADED WELDED YES NO YES HOURS G.P.M. YIELD (G.P.M.) YIELD ❑ ❑ t ❑ TEST BAILED PUMPED COMPRESSED AIR 4 7 7 WATER MEASURE FROM LAND SURFACE— STATIC(Speci7y feet) DURING YIELD TEST [feet) Depth of Completed Well LEVEL 0 320 in feet below Land surface: 320 MAKE ILENGTH OPEN TO AQUIFER (fee() SCREEN DETAILS SLOT SIZE DIAMETER (Inches) IF GRAVEL PACKED: DEPTH FROM LAND SURFACE FORMATION DESCRIPTION FEET to FEET 0 10 Hard Docked clay 10 320 Hard. P-ray Zranite. Diameter of well including gravel pack (Inches): Sketch exact location of well with distances, to at least two permanent landmarks. Se '� '0 W.'7 k� ", W 7 a If yield was tested at different depths during drilling, list below e FEET GALLONS PER MINUTE 200 2 _. �} 2,50 4 % 310 7 RA DATE WELL COMPLETE57 DATE OF REPORT WELL DRILLER (Signature) 1/3/?4 1 /lq /`7u -// ,President VJTLL D.RTL!,VTG , INIC Q s` y BREWSTER LABORATORIES Box 224 - BREWSTER, N. Y.­ WATER . ANALYSIS i'; SAMPLE NO. 3 7 SOURCE: Pe t e Gagner - n e vj we Z Z Batavia Drive Putnam Lake, Ar. Y. COLLECTED: ,Tana 4, 1974 By: giZZ Drilling, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. Jan. 5, 1974 Q Per 100 ml. oy Bickwit P. E. Dlrator 4� 104 Q- Li /* too o C-) tv I/ Af i--.:.,E V 4 C-, /?,4A/,t AVAI l-1Z -5.1-'Ii Ph, P A /ZE A 7C? AV6, Veel"7-v 67" 3' ;6-0 '1-05 IIIFEEOE0- 7 (M P4 KV10(15 ID/R?' 1`14Z 7— 54-' IAl 07W/-,e OF N. S% Fl: