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01428
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Joseph & Delores ,Elnt,,,
Owner or urc aser o "Bii wing
76,, Map #1456
Section
Tavino.. Builders, Inc. -1 �.
Building Constructed .by Block
#12
Westgate Terrace
Location - Street Lot
Patterson C1ara.Pfeiffer
Municipality Subdivision Name
4 bedroom dwelling #12
Building Type Subdv. Lot #
GUARANTEE 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-.a bove 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, an. d hereby guarantee to the owner, his. success-
ors;, heirs or assigns, to place.in good.operating condition any pat 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 determin-
ation _of_ the _Director-_-of -the Division- of Environmental Health Ser-v•ces - - -
of the Putnam County Department of Health as to whether or not the fail-
ure 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 19 Signatur/ZZ
Title
Corporation Name (if corp.)
Address
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMPLETION WILL BE ISSUED.
GUARANTOR IS REQUIRED T.0 FILE NOTICE.OF DATE OF FIRST USE OF SYSTEM.
Division of Environmental Health Services, Putnam County Department of Health
DISTANCES
REFER ro row OF PArr_-,vsoN TAX MAP % 7 c _5 sw, ' 1 . 3-c= L
NO. 76 —23.12
Pin -D=137,5 5-D� 113
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REFER M F11 ZO MAP NO 1456 A- E= MY 3-E= 119,5 PU 7i-P a r,) 0 U n fy
SS
Gr 154' -(5-G= /32
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A- H= 126'
c r., 7e- r/ 3L
YL
131 -M= /32'
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A. -T= 137 B -t,) -- /37'
/4 -3' 13-0= IL11
H= 410 f) L 45'
401
sty. 3. TAV, 0,
1/.0 40' FN 1. A
45'
46 j,
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County Department'pf HealtU
Ivision of Envirormental Health Services
1ppkoved as noted for conformabos with
d Regulatifts of the
j AnXb County H It
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BREWSTER LABORATORIES
Box 214 - BREWSTER, N. Y.
WATER ANALYSIS REPORT
SAMPLE NO. 5529
SOURCE: Joseph Elm Lot 12
Westgate Terrace Faucet - Well
Patterson, NY
COLLECTED: September 4, 1984
BY: P. F. Beal & Sons, Inc.
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method
0 per 100 ml.
This result
ixdicattr the
rourct of
the sample was
of satujactory raxitary
quality whrx
the sample
was collected.
September 5, 1984
Bickwit P. E.
Director
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 comgle,#ed by well driUer and submitted tq..County_ Health,pegartment tc Vthea.;withJJaboratory 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
Tavino Builders Inc.
ADDRESS
Deans.Corners .Brewster NY
LOCATION
OF WELL
(No. 6 Street) (Town) (Lot Number)
Fair St. Carmel NY 12
PROPOSED
USE OF
WELL
BUSINESS
® DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
❑ SUPPLY ❑ INDUSTRIAL ❑ AIR OTHER
CONDITIONING (Specify)
❑
DRILLING
EQUIPMENT
COMPRESSED CABLE
® ROTARY AIR PERCUSSION ❑ PERCUSSION ❑ ((specify)
CASING
DETAILS
LENGTH (feet)
3o t
DIAMETER (inches)
6 tt
WEIGHT PER FOOT
19 lbs .
THREADED ❑WELDED
O
YES ❑ NO
�j 7
2 YES LJ NO
YIELD
TEST
❑ ® PUMPED El COMPRESS ED AIR HOURS G.P.M. 0+
BAILED 3
YIELD (t3.
300+ +
WATER
LEVEL
MEASURE FROM LAND SURFACE—STATIC (Specify feet)
30
DURING YIELD TEST (feet)
Depth of Completed Well
in feet below land surface: 160 t
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 (test) TO (feet)
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION
Sketch exact location of well with distances, to at least
two permanent landmarks.
FEET to FEET
0
5
ra_ 3_ng in overburden
clay and boulders
Hit rock at 5 feet
0
Drilling in rock, set
30
160
Drilling in rock
granite.----
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE WELL COMPLETED
6/E 84
DATE OF REPORT
7
WELL DRILLER natur
1
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
= °-COUNTY OFFK BUILDING, "CARMEL, N. �Y. 10512 - - - - - -
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner am ; Vic . &•14QCS I"Address t)��n� CefY1'S re.�s'ttr
Located at ( Street uJCSt �,t4 T..rrTSec . I�1SC Block Lot 1 'Z•
(7n 'ica nearest cross street)
Municipality RL+t4i4'S *r Watershed CC Q +o r,
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME PERCOLATION PERCOLATION
Elapse 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�ioc+�
I
2 3� SS
3 :S7
Z
ly 'A.
1 5
�I4 31y
2,61
3 XrZ
3'39
Z
►S ��q
Z 3
3
Z.33
14.iv t�:t3 /3 ZI Zy3�y 3.5'9
So..kk 3 '2: Sb 4: ao
MAY 2 5 1984
Notes: 1) Tests to be repeatedPW")W until approximatelyy equal soil
rates are obtained at each per All data to be submitted
for review. ALTH
2) Depth measurements to be made from top of hole.
5
y :06
4:13 7
Zo /,q
Z 3
3
Z.33
1
q :14 ...
4:19 14
Z I
217y
Z
2
y48: --
y.t1 3
t 3
2y
I
3.aa
3
4: z1
A* Z3 L
z Q &
z'1
L
14.00
MAY 2 5 1984
Notes: 1) Tests to be repeatedPW")W until approximatelyy equal soil
rates are obtained at each per All data to be submitted
for review. ALTH
2) Depth measurements to be made from top of hole.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF-SOILS ENCOUNTERED IN TEST HOLES
DEPTH HOLE N0. Y~ HOLE N0. HOLE NO,.
G.L.
6. 706 if sat
I
I
12"
i
18" • ;i
2411
301
3611
42"
48"
54
60"
66 "� t ►�
72" a a .S
i
78" -
8411
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED Opt 4RV%C *%* tfC-J
INDICATE LEVEL TO WHICH WATER J.ZTEL RISES -AFTER BEING ENCOUNTERED,
TESTS MADE 'BY � ' 1 V eis6a ^ew wole by &Ness Date %set
L1JAJ1 Vl\
Soil Rate Used Min/1 11Drop: S.D. Usable Area Provided
No. of Bedrooms Septic Tank Capacity /GV® Gals. Type
Absorption Area Provided By L. F. x2�+" ,®'— width trenc , o
Other el l 3
ivame 1 4,j ey.o Ir :r-w— signature
Address 9'� l+s� 5 SEAL
THIS SPACE FOR USE BY HEALTH DEPARTMT ONLY:.
Soil Rate Approved Sq..Ft /Cal. Checked by
Date
I