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01528
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ENGINEER �UT4AM`CC UNTY- DEPARTMENT OF HEALTH .
'TROVIDE'.
z. Poston otl,�w T m
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OSA
TRUCTION.-coMOUANdt f_60,rstft ---,DISP 'LSYSTEM,
CERTIN
.0VIDOW �E
--Map
Loiated at -Tait
�Subd.v Block
/C' wt #
Formerly Tax Map Lot #
}separate 5i4varage,9 y stern by
_
L E. - Addresf
pon
'itti-og of Septic Tank and,' 434Z
Other -requirements Z 2,
Water Supply: Public Supply From
Private I
u.pp y D rilled By
Address
u 0. of Bedrooms Date Permit , IssueO .
!.H 'Completed? Has garbage grinder been installed? /VO
as �Eroslon �Cdnfroi dean
C '4sted . deFry ng' the were constructed essentially as shown',on the pla . na Of the .6ompleted, work 60pi6s
that the sksjteiu(6) ap-
and a , !6dokrdanda.�with the B; :nalei3 and regi4ations, in accordance, Piled '�by the
6f which�aie`attacoe4), in
}Putnam County e �of: Health l
A
:
Date
Certifled,b4 P F
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nise N
;09,
Addr
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r, Any person occupying pr tern(s all pro take, such y be: niecissley to saicure thia,cqr!ectl6n of an unsanitary.
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OT s)
su and void -fro . m piior�a I" of "A he' `separate tc shall become null as a public wnitary,�j4Wir%p6ic6mG4,,
I - , I 's"OT. '' -_ - I s.,Lgppn I , .
- . 6 t 11 Water supply. beco4nin j4iilli6lei Such.app
liavallable'ishel Ihe�,'aRprP0v t a u �44�i a _kII _iqva s,-.a e ,
a',
ti
iui)ject,.to, rii6dijl on.or cha jry th' -itid of ii� sinner Heal c revocaflon, odifl, Ion or change necessary..
(S Title
gtWerit i Co Cd,
Gate
By—
L
. PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Owner or Purchaser of Building
d
im
Builid' g- Constructed by
/, Z / le,
Location - Street
- zakle
Municipality
Building.Type
Section Block Lot
Tax Map Number
1&,ea;��e
Subdivision Name
l0
Subdivision Lot.#
GUARAN-rEE OF SUBSURFACE SEWAGE DISPOSAL 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 guarantee 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 approval of the
"Certificate of Construction Compliance" for 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 system.
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.
Dated this day of 19
General Contractor (Owner) - Signature
Corporation Name (if Corp.)
Address
rev. 9/85
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Signature
Title
Corporation Name (if Corp.)
Address
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Putnam County-DePaltment of Ilealtb
I Health services
as oted for conformance with
es and Regul '
I Lt
Date
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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 completed by well driller and submitted to County Health Department together with laboratory report of
r��a
z alysis:of_yater sample;indicating:WateF t3 9fr.Eatifactpr zatctertal: cdalIrty e4?re: certificate; of _construction.complian s1 = s5�lect; ti
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION
OWNER
NAME
John & Patricia Ullrich
ADDRESS
Yorktown Rd.,Lake.Carmel.,NY 10512
LOCATION
OF WELL
(No. A Street) (Town) (Lot Number)
Bullet Hole Rd., Patterson, NY
PROPOSED
USE OF
WELL
jj BUSINESS
Lam} DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL
El SUPP Y F] INDUSTRIAL ❑ CONDITIONING El (s(specify) ER
DRILLING
EQUIPMENT
COMPRESSED CABLE
U ROTARY KJ A R PERCUSSION E] P PERCUSSION ❑ ER
CASING
DETAILS
LENGTH (feet)
0 t
DIAMETER (inches)
6 n
WEIGHT PER FOOT
19 lbs .
a THREADED ❑ WELDED
S O
X TES ❑ NO
�j
YES LJ NO
YIELD
TEST
HOURS G.P.M.
❑ BAILED 'J PUMPED ❑ COMPRESSED AIR ( 15
YIELD (G.P.M.)
15
WATER
LEVEL
MEASURE FROM LAND SURFACE —STATIC (Specify feet)
50-6o,
DURING YIELD TEST (feet)
Depth of Completed Well
in feet below land surface: 2851
SCREEN
DETAILS
MAKE
LENGTH OPEN TO AQUIFER (feet)
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 toast
two permanent landmarks.
FEET to FEET
0
4
1-ay and boulders
-
Hit rock at 4 feet
4
30
Drilling in rock,set
30
285
Driliing in rock granite.
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE WELL COMPLETED
12/19/85
DA" F P RT
3 / %l
WELL DRILLER (Signature)
- 2L, zfz�' r/
,_ .._ .. „ ..>___. ......._._..... _ - - - BREWSTER=•`L ABORATOREET -� -
Box 224 - BREWSTER, N.Y.
(914) 225 -2072
- WATER ANALYSIS REPORT -
SAMPLE NO. 6107
SOURCE: John Uhrich, Lot 10
Bullet Hole Rd.
Patterson, NY
COLLECTED: March 27, 1986
BY: P. F. Beal & Sons, Inc.
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method 0 per 100 ml.
This result indicates the source of the sample was
of satisfactory sanitary quality when the sample was collected.
March 31, 1986
�— 4- s� -r— —— - -�- r - �- x- -- ---- -- — ■
4 +� _
riALTH ENGINEER TO ,PROVIDE PERMIT if'-
dal PUTN AM COUNTY DEPARTMENT OF ~HE
�r ON CERTFICAT OF COMPLIANCE,
1 Division of.: Environmental .Heal[h: Services Carmel N. ,Y 10512 PERMIT ,
CONSTRUCTION PERMIT FOR SWAGE DISPOSAL SYSTEM Patters an.__
•- _ Town or village
V Located at B :U 1- e t 'H 01 e 'R 0 a d Tax�Map 73 6iook _ 6 Lot 1 `�
Burdick ` W'o o d s S D Su,�d.t N Renewal Revision
10 0
subdivision
Owner /Address-
John & '. P a t r T C16 ' U'1 1 r 1 C h..- ' Date',Of Previous Approval
House 961 A
'Building Type Lot Area: Pill •section only ❑
•1 ,. ;
Number of Bedrooms 3 Design Flow G /P /D �+ �0 P C. 'H. D 'Notification 'Required
",Separate sewerageIsystem�'to consist of 0_00 Gal. Septic Tank' and �19 FtELDS
To be constructed by
Address
1
Water supply Public :SuPPIy From.
Private SuPPIy to be drilled by,
Adddress
,Other 'Requirements -� /3_1�1�• r �� `f✓� �� .
.iI represent that l am wholly' and completely responsible for the design and location of the proposed. system(s).; the .separate, sewage disposal system,
above described will be constructed as shown on ,,the-approved amendment thereto and in accordance With standarCS,'iuled : an regu a ions o e' u nam
County 'Department of _Health, `and that on corimpldtion,thereof a' "Certificate -` of- Construction Compliance satisfactory to the'Commissioner : of:Healthwill
be; submitted •to the Department--and a' written guarantee will be, furnished the owner, his successors, hevs.oipssigns by the. builder, that said builder will
Wets in. good. operating con d_tion. any, part of..said, sewage disposal, syti' during the period of two (2) years immediately follovring the date of.tha issu-
ante of 'the' approval of the'Certif.icate of :Construction 'Compliance, of the, nal_ system o► any repairs thereto 2)'tliat.the drilled well described above
will b'e located asshown on the approved plan antl that said woll will beanstall m ccordsnce ;with <t e,,stan rds ►ules,'and ;regu a ions of tde 'Putnam. I County Department of Health
P E
Date signed
i
License TNOU ✓LL-
Address ,e�lr M.
FCPPROV.ED FOR:CONSTRUCTION T his 'approval'_expnes: one year from the.,tlate issued unless construction. of the Du�ldmg has been undertaken and is
eyoeable for cause.or maybe amended or modified',whene sidered net _ss_r .,:by :the Com ioI Iof' Health. Any change ation of. construct ion
requires a. new. per APP ►oyod. for ;disposal of dourest mtar = sewage, nd /or rive wa
Oate
R. Tit
.: le
UPI KQC*
E jJ1,M1*TTED WITH APPLICATION
TEST PIT DATA REQUIRED TO B. ST 1,
DESCRIPTT Oil OF SOILS T,,"C0TJJ',!TEaRED Ili TEST HOLE-3
DEPTH HOLE- NO.-. HOLE NO. S. HOLE NO.
(;_T._
611, 77S.
12•
1811 JA*PV CdAID
2411
-7.011
3611
4211
4811
L4 04M
5411
6011 SAND
66
7211 ROCK
7811 14,
8411
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL TO -WHICH WATER-LEVEL RISES AFTER BEING ENCOUNTERED
TESTS Date
DESIGN
Soil Rate Used Min/1"Drop: S.D. Usable Area Provided 50oo 5.9
No. of Bedrooms Septic Tank Capacity 4000 Gals. Type *459wie-Y
4
Absorption Area Provided By xc)_..L-F.x24" to width trench.
Address
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
ure
Z:
sm:� .,
=Qn.
� 7,
L
T_13,0
Soil Rate Approved Sq. Ft/Gal. Checked by
At rl�%
RECE.IVEv-
SEP 3 0 1985
PUTNAM coUNTY
J)EPT. OF HEALTH
h4l
LZ
10 1
PUINAM COU1V!'Y DEPAIiIMCNl OF 1iCAL111
DIVISION Or ENVIRONMENTAL 11tALT1I SERVICES
COUNTY OFFICE BUILDING, CAIiMEL;..N. Y. 10512
DESIGN DATA S11W1!- 8EPA11ATE SEWAGE DISPOSAL SYSTEM FILE N0.
Owner ToNN s PAMem w1rich Address rBUUFT ljotr RA.
Located at (Street 0 «4 PEA.
oLE Sec. 73 Block (o Lot indicate nearest cross sEreaq
MWACIpality. Mfl-eAsa"- Watershed
SOIL PEHOOLAT'ION TEST DATA REQUIRED T'0 BE SUBMITTED WITH APPLICATIUHS
7101e
Number 10 CLOCK TIME PERCOLATION PERCOLATION
Hun 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
158 -88
30
min
28
32.50
4.50
6.66
228 -60
32
min
28
33.75
3.75
8.50
302 -34
32
min
28
32.00
4.00
8.00
435 -65
30
min
28
31.50
3.50
8.57
1
5
156 -87
31
min
27
28.75
1.75
18.00
227 -61
34
min
27
29.00
2.00
17.00
302 -36 34,min 273 29.00 2.00 17.00
1
r
It S E P 3 0 1985
5 PUTNAM COUNTY
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.