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WELL COMPLETION kEPORT PUTNAM COUNTY DEPARTMENT OF HEALTH
4
3/71 Division of Environmental Health Services
COUNTY OFFICE BUILDING - CARMEL, NEW YORK
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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)
Dover Lane Patterson 1
PROPOSED
USE OF
WELL
BUSINESS
D DOMESTIC r] ESTABLISHMENT ❑ FARM ❑ TEST WELL
❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING E] ((Specify)
DRILLING
EQUIPMENT
COMPRESSED CABLE
� ROTARY DAR PERCUSSION ❑ PERCUSSION ❑ ((Specify)
CASING
DETAILS
LENGTH (feet)
301
DIAMETER(Inches)
611
WEIGHT PER FOOT
19 lbs .
R1 THREADED El WELDED
YES NO
YES
NO
YIELD
TEST
❑ ❑ HOURS G.P.IiA.
BAILED X PUMPED ❑ COMPRESSED AIR ( t
YIELD (G.P.M.)
f
WATER
LEVEL
MEASURE FROM LAND SURFACE —STATIC (Specify feet)
'301
DURING YIELD TEST (feet)
Depth of Completed Well
in feet below Land surface: 1501
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 (feet)
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION
Sketch exact location of well with distances, to at least
two permanent landmarks.
FEET to FEET
0
Drilling in overburden
clay and boulders
Hit rock at 5 feet
-
Drilling in rock,set
cas-ing, grouted.
0
Drilling in rock granite.
.150
If yield was tested of different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE
0
Di OF4t PORT
tj 5
WELL DRILLER (Signature)
L�L �%i
:'_7
BREWSTER LAB0RArT-0R1ESr!:---
Box 224 - BREWSTER, N.Y.
(914) 225-2072
— WATER ANALYSIS REPORT —
SAMPLE NO. 5655
SOURCE: Tavino Builders, Inc.
Dover Lane
Patterson, NY
COLLECTED: January 2, 1985
BY: P. F. Beal & Sons, Inc.
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method
Hose Bibb - Well
Map - 76-1496
Lot 1
This result indicates the source of the sample was
of satisfactory sanitary quality when the sample was collected.
January 7, 1985
0 per 100 ml.
Thoinap Courtien Patterson, New York
w�
Owner or Purchaser of Building Municipality.
Tavino Builders, ._..hnc. ..._ _ 76 _ (Map . #1456)
Building Constructed by Section
Dover-Lane
Location - Street
1 family dwelling
Building Type
1
Block
#13
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 utili -zing the sys em.
8 January ..... 85 „-
Dated this day of 19 Signature vr2G0'
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
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PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET- SEPARATE SEWAGE.DISPOSAL SYSTEM FILE NO.
Owner )!�kAj IderS. Address -Dea Ns Go,rynet's jSre�5+ec- N
q00-ver Lesn�
Located at ( Street Lj!) S+ a- I�Tecra« Sec. ) 4 S . 6 Block Lot / 3
�indlcECte nearest cross street)
Municipality P a-�'��
s v v.
Watershed
C c o t u v,,
SOIL PERCOLATION'TEST DATA
REQUIRED TO BE SUBMITTED WITH APPLICATIONS
2
Hole
G-57-
16
210
Z7���
1 3�y
5 ,71
Number CLOCK
TIME
PERCOLATION
PERCOLATION
Elapse
Depth Eo a er
Water 1Fv e
No.
Time
From Ground Surface in Inches Soil Rate
Start-'Stop
Min.
tart Stop
rop in Min. in drop
/in
5
-7 :o4
Inches Inches
Inches
1
&35
Z
2
�:y2„ -
G-57-
16
210
Z7���
1 3�y
5 ,71
3
6*-!Sl - (o `5/1
Z
277/b
4
5
7•oy
°,
Z 33"
Z 5
3%Y
5
-7 :o4
- 7•i0
!o
z 5%Z
Z (0 38
'7/�
1
7 ' to
- 7•'l!
3/
2
7'12
-7:17
7- 3 3iy
Z 5
' ;�y
y•oo
3---7.17
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25
2.5 31
31y
�00
(0: 14 1 .
-41
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2d 319
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5
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(10
20 /y
9.00'
�- Saowrea.
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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.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION,.�:.
DESCRIPTION OF SOTLOO ENCOUNTERED IN TEST HOLES
-bhP-T*H- HOLE ._ NO 1P..- HOLE - NO 2 -- - ----- - HOLE NO.
G.L.
611
oesol
1211
ONLY:
0,_x
2411
W
3011
by --Date
3611
4211
u
r 1.0 Zym
yn a
C JD
o
4811
5411
60".
6611
o.
7211
7811
8411
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED beyond ��
INDICATE LEVEL TO WHICH WATER LEVEL -RISES -AFTER BEING ENCOUNTERED pof
m&ffs, MI WE �.BY, ?T -Tio--�,o - Se ? c- 13 , S e A I -
U.9 �q SS -P-.r PC- Eateac_-t-12,128-At ACELI�19-73
DESIGN
SF ,ef �eA
Soil Rate Used /0 Min/l"Drop: S.D. Usable Area Provided V
No. of Bedrooms 43 Septic Tank Capacity /VOO Gals. Type Corarae
Absorption Area Provided By 4
j"!RLL. F. x24,, 5b width trench
33 3 Other ova
gnature
Address SA -sr- SEAL
AZ /,040/9
THIS
SPACE FOR USE
BY HEALTH DEPARTIENT
ONLY:
Soil
Rate Approved
Sq. Ft/Cal.
Checked
by --Date
S -P
/ 1984
C
DEPT.
OF