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01666
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CITY, VILLAGE; "TOWN' & /OR`N.AME OF SUPPLY DATE'REPORTED
SAMP.L, ING..POINT:
lUTi!W:
It i.Qm -,:oat
BACTERLA_PER ,ML (Agar plate; count at-35 C):
COLIFORM GROUP ,(Most probable No. /I Oml._)
HARDINESS, TOTAL ` ppm
:DETERGENTS -
NITRATES (qs'N) mg j, .:
IRON, TOTAL IpCJ. j,
W
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WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH
3/71 Division of Environmental Health Services
COUNTY OFFICE BUILDING - CARMEL, NEW YORK
Th[s._reoQ[l is to.be completed by- well_ driller: and - submittecj��o eCv rft _He,�Ith. �.r gn ti?g [ t2ithulahoratory .ce�ori;af:
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
Dominic Cotroneo
ADDRESS
Carmel, r)Y
LOCATION
OF WELL
(No. 6 Street) (Town) (Lot Number)
Corner Bullet Hole Rd, & Fair St, Patterson
PROPOSED
USE OF
WELL
BUSINESS
DOMESTIC ❑ ESTABLISHMENT ❑ ❑ TEST WELL
FARM
11 SUPPLY El INDUSTRIAL ❑ CONDITIONING ❑ ((Specify)
DRILLING
EQUIPMENT
COMPRESSED CABLE
11 ROTARY AIR PERCUSSION ❑ PERCUSSION ❑ O� ER )
CASING
DETAILS
LENGTH (feet)
44
DIAMETER (inches) WEiuHT
6
PER FOOT
1.9
THREADED El WELDED
O
'X YES. . ONO
' X
CASING
YES
CnU
ED?
NO
YIELD]
TEST
❑ BAILED ❑ PUMPED
HOURS G.P.M.
L_ 1 COMPRESSED AIR 2 110
YIELD (G.P.M.)
10
WATER
LEVEL
MEASURE FROM LAND SURFACE — STATIC (Specify feet)
351
DURING YIELD TEST [feet)
j
total drawdown
Depth of Completed Well
in feet below Land surface: 200
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 least
two permanent landmarks.
FEET to FEET
0
8
bank run
,_... .,._.._.......:..�_...... .. _.., _.� .. ..... __ .. a . ...._....
Boyd Arteslan Well Co., 1i
R. R 5 -Route 52
Carmel, N.Y. 10512
8
24
clay
24
34
sandstone
34
200,
ledge
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE WELL COMPLETED
9/10/76
I'DAT F g PORT
1 S 11./ 16
WELL DRILLER �(5ignature) .
Hol
Phyllis & Dominic - Cotroneo Patterson
Owner or Purchaser of Building Municipality
McGlasson Builders
Building Constructed by
Fair St. & Bullet Hole Road
Location - Street
Sunny- Acres SUM..-
Section
Filed.Map #828 -
Rock
Frame 32
Building Type Lot
GUARANTY OF SEPARATE SEWAGE SYSTEM.
I represent that I am wholly and completely responsible for the
location, workmanship, material, construction and drair_age 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 :Wade 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 -
_tri!.eg. of the FUr�.�P. ua''21t- ��partT"�er�t of �iealth as `tG wlletiier' or° ilCit file
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 22nd day of December 19 76 Signature_
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
f
,� ....�.._ _. n►� r.,�°�� &...uor�lnrc Cct;r�ii�eor,...�.,,.,,�.�..� ,.... -. _....v,�:.._,...�_- �atcef�dn _- ._._,___... . _. .....�:- A,.,�a__,....,L.�,.._q �....�
weer or Purchaser o : Bui d n g Municipal
palit
y
McGlasson Builders' Sunny Acres Subd.
Buildihg.Cdnstructe,d by SOction
Fair St..& Bullet Hole Road
Location Street
Frame
Building Type
Filed Map #828
Block
32
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-
vicas _of the Putnam
y failu County Department_ of. Health.. as_ _t.o- whe.trer'-..or..no.t- -thy-
r opy erate
was caused by the willful or negli�ent
act of the occupant of the building utilizing the systepK —)
Dated this 22nd day of December 1976 Signature.,
Title
If con ration.,_' 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
Y�
Siructure located. trom surv@q by surVeygr-, noteQ{-beior;Q-`1
W ®il 14cated a'y:' Sunmynrs surve,y -_
WellArlilecs•re,p7o7t._
:•
Engineers •n.e,surements.D 1_
To ft K, . boxes, pits, gollenes 8i to to rat s:ln.ca ted oy't;ontractor_: - `•• -, .1
• Ong veer: • -' •
z ,. w`eaitnaapi:
FI@Ia ips itct.lo'n by: 1164lrn d@pi•Q•` dott@'
5 Ehg'vn@ -@ f AD dot,
rl .
NOTES
VLt
s ! ,
1 E` N. i.^ O�V S r•
A
Y-
s
A
A z H B H + �:
A
A K Q K Fa
SAM SYSi M UE�L BlUI�"
OWNER. 17�r� T'R
OCATION Streot a ��
U DIVISION: }�
IIoGk`_ LOT••Pds ji7-_
tulidp :r
sursSey'or ..vit _ a
raver Date X130/„ i t $.GaleL� o::L6 2.
0V J;O;H N
7. H P R
CONSULTING-
P.-
3
f
t
Siructure located. trom surv@q by surVeygr-, noteQ{-beior;Q-`1
W ®il 14cated a'y:' Sunmynrs surve,y -_
WellArlilecs•re,p7o7t._
:•
Engineers •n.e,surements.D 1_
To ft K, . boxes, pits, gollenes 8i to to rat s:ln.ca ted oy't;ontractor_: - `•• -, .1
• Ong veer: • -' •
z ,. w`eaitnaapi:
FI@Ia ips itct.lo'n by: 1164lrn d@pi•Q•` dott@'
5 Ehg'vn@ -@ f AD dot,
rl .
NOTES
VLt
s ! ,
1 E` N. i.^ O�V S r•
A
Y-
s
A
A z H B H + �:
A
A K Q K Fa
SAM SYSi M UE�L BlUI�"
OWNER. 17�r� T'R
OCATION Streot a ��
U DIVISION: }�
IIoGk`_ LOT••Pds ji7-_
tulidp :r
sursSey'or ..vit _ a
raver Date X130/„ i t $.GaleL� o::L6 2.
0V J;O;H N
7. H P R
CONSULTING-
P.-
DESIGN DATA SHEET - SEPARATE
SEWAGE DISPOSAL SYSTEM FILE NO..-
0wner��� ®v..,i.,.'�
Located at ( Street
' Indicate
Address e� o
Z .'f' ock Loth
rfearast cross s -re � �
Municipality / A GC: so
r, Watershed Cam' n�
SOIL. PERCOLATION TEST
DATA REQUIRED PTO BE SUBMITTED WITH APPLICATIONS
Hold
Number. CLOCK TII';E
PERCOLATION PERCOLATION.:
}dun E apse
No'. Time
Start =Stop Min.
Depth. Lo a er a er . ve
From Ground Surface in Inches Soil Rate
Start Stop Drop in n - /in drop
Inches Inches Inches
10! /,
2,0 7 W 0
4, ofic
5_
3 0 4 /®
'
Notes:. 1). Tests to be repeated at 8Ame depth until apppproximately equal soil
rates are obtained at each, ^er : :olat:on test hole. All data to e submitted
for review.
2) Depth measurements to be made from top of hole.
2.
Notes:. 1). Tests to be repeated at 8Ame depth until apppproximately equal soil
rates are obtained at each, ^er : :olat:on test hole. All data to e submitted
for review.
2) Depth measurements to be made from top of hole.
`PEST PIT MMA I'M C?UIRLD Mn nV - SU13P�I.T`1'1 n l.IJTFT APPLICATION
DESCPfYTIO1`.1 Or'. 0OIL:�..I J' GUTdi' ►;TIED ,err ''i'EST HODS
_Frml' IIOT,F' .,�r1.O. -.: - =. _T'?T T�' . *drJ�a - jF'r T'.•.:`� \ ...... _ .:......
r.
G.L.. Te se)
6 ". Or q�lics
1211
30"
48"
it S-
4.
60"
66" .�
8411
l7\'DICAT LEVEL AT WI°IICH
GROUND WATLe IS ENCOUNTERED
'f1MT(<A.7_F 1,17. TG;I. TO:..WF1T: ^.L:
in1.A 1.', rt TIE VET.. R.1.SFS .h` t 'FR FAT ?T14T(; FT COTINTERFT�
TESTS' 4ADE BY �P.Y . � F
.T 7 /i;/�t .. Deeo '�✓. �KP f r.
to it -
Provided '�� ' f Am, /g4le
DESIGN
Soil Rate Used 810 Min/l "Drop: S.D. Usable Area
No. of Bedrooms 7X/ee -
Septic Tank Capacity -. 000 Gals.
Type &drso e
Absorption Area Provided _ By 33LL. F. x24" ,/ . S
vidth trenc .
Other e., e
"`
dame John-H. PrentJ ss,
P E, i na izre
Address R.D. 6; Box-353
Carmel.. NY I05I2