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01474
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me- Fbk:ttWAi3E-'biSPOSAL'.'L,'-'SYgTEM y,
Owner Loi-
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1,000 Widt,h,
j one
Water Sup p! y:
Sr
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ress
uildf type
Has Erbsiont6ntrol Been -Com
-1 976
Date
''AdUress 2.
afm
Date _-r itip
McGlasson Builders. Inc. Patterson
Owner or Purchaser of Building Municipality
Owner Tammary Acres Subd.
Building Constructed by Section
Holmes Road
Location - Street Block
Frame 2
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 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 suc'n.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.. -o _ the.,. Putnam:_C.o -unty _ 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 28th day of April 1976 Signat
Title
lr 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
G`
L. 1. F. E.
LIMNOLOGY INFORMATION AND FRESHWATER ECOLOGY INC.
PONDEROSA ROAD CARMEL, 'NEW YORK
914 - 225-4070
ANALYTICAL
LABORATORY DATE 4-26-76
am OR PLANT ATTENTION COPY to
McGlasson Buildees
Wm=k%t1&sjammary Holmes Rd Patterson vial T #
COLLECTION TIHE(S) SAMPLE # if any
comcVMdyGlasson T% Me n'T n k Grab XX start
Campos to finish
LABORA Y ACCESSION# DATE COLLECTED DATE RECEIVED /TIME A= ANALYZED/TINE
7K ne
6 0 164 4-23-76 4-23-76/130o 4-23-76/1330
ALL ANALYTICAL noMMUREs comm To FEDERAL GOVERNMENT STANDARDS An An PERFORMED ACCORDING TO CRITERIA ESTABLISHED
BY STANDARD METHODS, 13th ED., 1971, AND E.P.A. METHOD-EPA-670/4-74-009 OR MORE RECENT. THE FOLLOWING RESULTS ARE
EIPRESSED IN mg/L UNLESS OT&VISE DESIGNATED.
coli 0/100ml MF
This water is potable and acceptable for drinking.
THIS IS TO CERTIFY THAT THIS REPORT IS CORRECT AND COMPLETE TO TEE BEST OF MY KNOWLEDGE
WELL COMPLETION REPORT
3/71
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services
COUNTY OFFICE BUILDING - CARMEL, NEW YORK
_ This- Keport-s #o- be.�ompleed,by.wela; drillez:and_sabmtectto Ci3chty- l#eeltl��DepaFiinerit togethef °witfi-Caboiato "ry °report off'
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
MaGlIasson Builders
ADDRESS
Mai -n St. Carmel, NY
LOCATION
OF WELL
(No. & Street) (Town) (Lot Number)
Old Bullet Hole Rd. Patterson,
PROPOSED
USE OF
WELL
BUSINESS
V DOMESTIC ❑ E TAB ISHMENT ❑ FARM ❑ TEST WELL
❑
SUPPLY ❑ INDUSTRIAL ❑ AIR OTHER
❑ CONDITIONING (Specify)
DRILLING EQUIPMENT
❑ ROTARY a A R PERCUSSION ❑ PERCUSSION ❑ (Specify)
CASING
DETAILS
LENGTH fleaf)
2.1.
DIAMETER (inches)
6
WEiciMT PER FOOT
9
THREADED ❑ WELDED
E SHOE
YES ❑ NO
I .
"'_ YES LJ NO
TEST
❑BAILED D PUMPED COMPRESSED AIR HORS G.P.M. 6
YIEL6(t3.P.M.j
WATER
LEVEL
MEASURE FROM LAND SURFA STATIC(Specify feet)
t
4UR?IG YIEjD TEST (feet)
total ara6Y.dOPrri
Depth of Completed Well 200
in feet below land surface:
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
200
ledge
Artesian Well Co.,.W-
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE WELL COMPLETED
2/12/76
DATE OF REPORT
2/14/76
W ILLER (Signatur
R. D. 5 Route 52 It a Ida a
/fc( / /r( -- �/ /
YSI EM
'
oF
amar
ldress
93 I-en
Totil`Ha6'It6bleSp4ce eat
Number. of rooms-
'-sewerage, Sy 1c,
0 by
sw
hn
pp y
Ass
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 M42711C- /dssail
Located at- ( Street sA O�M�bMr�&a ��—��� Lot Z
n ica e nearest cross streefl
Municipality P�/'ph Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME PERCOLATION. PERCOLATION
apse Depth to Water water nveT
No. Time From Ground Surface in Inches Soil Rate
Start -Stop 'Min. Start Stop Drop in Min. /in .drop
Inches- Inches Inches
1 1114 *1
5
•a
Notes: 1) Te'gts- to` be �r'epeat0d 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
DEa 'rnT'TP1TT nM O^TTCT TTrfN^TTTTMr..1TITT\ TTY mnclm TWNTTlf/
D8PTH HOLE NO.
0
Soil-.-Rate Used Min/1 "Drop- S.D. Usable Area Provided
0
No. of Bedrooms Septic'Tarik CapacityGals Type
Absorption Area Provided By_L.F.x2�+" __width trenc
Other
ivame .Join H, Prenti s §, P. E. 6ignatur '
Address-
Cannel - Npw ynrk 1 O 9
vk, PRf N
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved Sq. Ft /Gal. Chec b ;4
Fss�ry' No. 292, - -9-
�
OF THE Sf;
Date
•
j e°'
Y
•
3
n �
A
•
0
Soil-.-Rate Used Min/1 "Drop- S.D. Usable Area Provided
0
No. of Bedrooms Septic'Tarik CapacityGals Type
Absorption Area Provided By_L.F.x2�+" __width trenc
Other
ivame .Join H, Prenti s §, P. E. 6ignatur '
Address-
Cannel - Npw ynrk 1 O 9
vk, PRf N
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved Sq. Ft /Gal. Chec b ;4
Fss�ry' No. 292, - -9-
�
OF THE Sf;
Date