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01/02/ "994 18:54 914 - 734 -7320 ` ALL PRO ROOTER
PAGE 02
93- 9I�
°$ NAME G 1 t `i E_
SITE IMTION SAME
MRrL = ADDRESS
D t & (Resat onshp `t ' i. e, cw , — t,etc. )
TYPE F=Lny
sED rte» PLL ^�.�...�enk'4 2 ?9s"
(include sketch locating all adjacent tells).-
HM: Repair must be in same location and of same type as original sewage disposal. system.
Different location may require submittal of proposal froom licensed professi =l eaginer or
Voposal approved proposal Disapproved
Tnspor's Signature & Title Date
jeegsal approved with the follvwi0 conditions:
1. Procurement of any Tmm permit, , ifaWiaable.
2. Submission of as built repair sketch in duplicate showing:
a. Owner's name.
b. Site Street Name, 'down and Tax Map ruanber.
c. Imtion of installed couponents tied to two fixed points (®.g.,ham corners).
d. System description (e.g., 1250 gal. concrete septic tank, three precut 6' diam. x 6' Beep
dxywells surrowxled by one foot + gravel).
e. installer's name and number.
3. System repair to be performed in accordance with the above proposal and conditions.
as owner, or agen f cwneir agree to the above oanditions.
iGNA7M TMs= row �,, �/ _ nm 6/9
IS.- Wife l; YeUw 030 ffi); Ph* ( iamit)
01/02/1994 18:54 914-734 -7320 ALL PRO ROOTER PAGE 03
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A�OWA&E TfsjxsAL-
t PUTNAM COUNTY DEPARTMENT OF HEALTH
P4L \K b
Cannel, N ` Y f0512
- Division of =Enwronmenta/ Health Serviosa, Perk'"
- CERTIFICATE rOF 'CONSTRUCTION: COMP.,LIANCE .FOR SEWAGE DISPOSAL -SYSTEM i 4
m
Town;al. Village:.
y�am
•Tex- Map•.Lot'N. -'�'
k'. S
10 : of ietlrooms Date hermit 1 }wed
constructed essentially as ,shown oh the plans of `the 'complet��lWgq�j?J, copies
d regulations in adcordance with the filed °plan, and 'the , i gf%,�the
ake such aetbn ai may. be neeeayry to secure ih e4i lore ;of an i.uh nita►y
stemsfuill,beeonie•nUll and voldtas soon a a`pub'pe� kirl aw r beeom"
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WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH
3171 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
analysis of. uvater sample indicating water isrof,gal isfactory bacterial quality before.certi.lime,;ot construction compliance is issuedo
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION
OWNER
NAME
Paul Guidotti
ADDRESS
East Branch Road, Patterson
LOCATION
OF WELL
(No. 8 Street) (Town) (Lot Number)
East. Branch Road Patterson 23 & 24
PROPOSED
USE OF
WELL
BUSINESS
® DOMESTIC ❑ ESTABLISHMENT El FARM ❑ TEST WELL
❑ SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ OTHER
)
DRILLING
EQUIPMENT
COMPRESSED CABLE
❑ ROTARY 14�U AIR PERCUSSION ❑ PERCUSSION ❑ Ope E y)
CASING
DETAILS
LENGTH (feet)
82
DIAMETER (inches)
6
WEIGHT PER FOOT
19 RR THREADED El WELDED
VE SHOE
YES []NO
W
MYES
CASING
NO
YIELD
TEST
HOURS G.P.M.
❑ BAILED ❑ PUMPED ® COMPRESSED AIR
YIELD (G.P.M.)
�•',_2-2
WATER
LEVEL
MEASURE FROM LAND SURFACE —STATIC (Specify feet)
DURING YIELD TEST (feet)
Total Drawdown
Depth of Completed Well
in feet below Land surface: 455_
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
65
Clay overburden
65
455
granite
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE WELL COMPLETED
10 -17 -83
DATE OF REPORT
1 -27 -84
WELL DRILLER (Signature)
'
E.: PAIZc ZL
1.105. Z3 = 2
2•41ZZ.q6, CLMPUTEp
yZ3•o5 l.tigP
L =84.le's "CpPAPUTED
84.17y hAAP
a
WCD
LL oN
J
Q�
d
7 FiEtoS e 60' ¢nau
74 ro z4rpiAL5
0• II - °28 -310
EAST 6Q.ANC H ZOAD
( C.OUAJTY HIGHWAY M965)
SUPIVE•Y OP' PROPEZTY
PPEPAP -Eli F02-
PAUL E L1NDA A -JQ GU IDOTTI
51TUATF— IN
TotcJIV
(:)F7 PA 7EQ -60Q PUTWAM• Co., Q.Y.
SCALE 1 "C30 AUGUST 10, 1983
AL)ciusT Zs, Q s63
`�-� 1 `2• , 1983
WC-.W F�"` ,, 4
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,us sve.1E / V. i PCEPAZED IU AC-- 0ZPAIJCE k1fM -m-U4, MAP 10? A IJIU -,Cn W CC SEGllO1J4
L1E E1U ST1l Ks G4p1= ot` PeACr1Cf-- R. 0- LAJJD tLAn 1EYli ?"109 Cr TIE 1..IE U '40V-V- ° MM- EDUGCr1OL
.DbPTE2> LIE-kJ Y !V- --r$TL AAp4p-C1A'f IG" c P L Akd. U1.1Ce.2r-ML61n --qELjc1Zz&- tC A4j
e Eh0? XAL IJ1JJD 'SUe1JE C i. 640 CE=PKAT -Ct J? Llc r 544Dtc 11..1. ALL czR:nar -Am . wEPEfX.
WALT. ¢L:4 .1 OQL,I -7D'iUE PEZ501J FL's 1i1110A 7}{E &ex-- vALtD Foe MAV? AAAJ- Al-(r-> CORES
UeNiel QS PMPAMD A. 1 OU W 5 BE4dLF •RO -%F- 'tiIEEBOC GI_IL`1 lG' /jdt0 MAP cR-- COPIE.47
rnJE CC4APAQ%4 A JI> LE1 MLI(m %WINM Tlo1J 057LM�, eEAP- 7US UAPZEAPA' D 6EAL CC74E
E.OECQ.1. CX-- CZAnQU -1 AEE LO- -TZ44SCZ- eAeL.E 'p �u2�tE`fc(Z �1F�o�.E SlC,1.L�lUtZ� APPEAk- i
DC>mo*-lAL l0,E5rriLma*lb OP- S1B5EMLEWr au►.1EP5 1JEQE�iJ
F51 E. MA.1Ll 'sf1Z.EFS•
L.tG 1.10 VOy
Owner or urc aser of Building
section
ding_,Construc,ted. bY =w.a ._ y. _._. �. Block_,_..._,
X51' F.z.4/L'e'0 2�
Location - Street
T7FC?��
Municipality
Lot
Subdivision Name.
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 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 success-
ors:, 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 determin-
ation of the Director of the Division of Environmental Health Services
oI-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 SU. 19 0:3 Signature
Z
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 TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
Division of Environmental Health Services, Putnam County Department of Health
eocatea at
Subdivision
Owner /Address ,1
t
l
Build+hg Type
7
Number ofBec
Separate Sewer
To be constrw
Wat er. Su
M1 pp1Y
r
Other Requ�rei
h;
(;represent =that
above tlesccibe,
County.,-,De"par,1
be submitted -;1
place �n ' good,
anceof- ahe.a[
will be located;
County Depart,
Dale
AP.PRO' ED F(
,revocable: for u
regwres a "rtew
� Date �_
+ Rev 9 81
`TTTaT p p�� ATV! p 1 ^� pLfap•�t� -i
n r cS �1J d 1� �•91VY edl 8 H ®�' �t'9H�T1�YY" 1V ®� HH1L't'A'L�Il ,ti Permit q r O
Orvrsion of, Environmental Health Services, Carme/ N Y t (0512 3
;fifl1T FOR SEWAGE DISPOSAL SYSTERA r2 .;
own r i lage
•.,, � ^ -/ Lip � � k .rn tsr w. - •,�"' ti ...+. .� i._:.
Tax Me, P el`ock Lot x �-
-', ,Subd. Lot` R �7 L _ Renewal 'Revision', '1
rsri`1 f k r '
p �/{�/ r "Date Of�: Previous Approval {�
�y1
LOt Arae Fill Section Only ❑
P C H �.D Notificataon Re aired'
7 Y Q
Desagn Flow G /P /D a
n `to consist of al pt� Tank a }tl + +
�'Li' f t �f s r • dress'
Public SuPPIy From �` ' , �' a:.
Private Supply tobe dnlletl by i
(LL i25..�� +�-d
7.
!v
ti
r :..
:= Tr } N
7
s , a
ly antl Para te „sewage.�tlispOSal
nstructetl as shown,on the approved amendment there w les an zregu a �ons;o e u nam `
Health and that on completwn thereof a, Constiuction,COmpliance satisfactory,•to the Commissioner of Healthwill''
iartment and a wrtien gudrantee�wilhDe furnished the owner his wccessors, leirso`i assigns by!4he4builder thatsaid builder will'; i
condd�on' any part`of'said.sewaga disposaF systerri. during the period of two(2) yea►s;immediafely following the date ot'the issu it
the Certificate of Construction Compliance `of theoriginalsystem or any repairs thereto -2) that the "drilled welladescribed above '
n the approved plan and that said well will be Installed':in
or ance�_w_ it h th standards, r es.and regu a,�ons 'of the Putnam:
ealth
q a �
r ,+,..- s ,� r •'" S 19ned ,,Vt ap,. -y x .\ �. t P E x �R A .T e Ci �'T3
Address f 4 w� License fdo ti 1
RUCTION; This approvalje Aires one y frornthe� date issued unless construction of.the building has "Been undertaken and is.- S
be amended oFmodified when considered necessary °'by the :Comm sione t Health AnySchange or,aiteratbn" of construction
Approved for disD9sal�of domestic _ y iA and /orwate w pply only.r •. ,, 'f
Y,g
z
'rte::....- .._�_._.� -. ..�_._��_:.... ._�.......__,_ ✓__�.1.._.� ..__�..... r -. _ _. _ _ .......L _. ....._
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
~COUNTY`-OFFICE BUILDING, CARMEL,N. Y. 10512 �u
DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.
Owner VL (,"TUIDDTT► Address—APT. 107�Fir - -_t�> CDU2T.Ftsi- ��i�c_,IV.4'. l2SL¢
Located at (Street RAST BWc14 2D. Sec. (, Block / Lot
�Indicate nearest--Eross s reet
Municipality f V4-rrr =25ox) Watershed N I Y. e.
!/
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
1 2'05- z :18 13 37 ! 3
3 2:57)- 3;d5- 15 3 36 l 1ST
17
5
�7
2 2:30 2:4& Ito 37 3 l !S^
3 3. to - -3 7Z6 Ito 3(g 37
- '+ 3`. eta 3 a j 33 3 % 39 Z 76 Y
5
Notes: 1) Tests to be repeated at same depth until approximately equal soil
rates are obtained at each percolation test hole. A11 data to be submitted
for review.
2) Depth measurements to be made from top of hole.
mole
Number CLOCK
TIME
PERCOLATION
PERCOLATION
Run
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 too - 2,,(4-
2 2:J�- 2,7,q
15'
3&
37
/ is
3 2:45 -- 3;01
3s'
l !�
4 31,bi - 3• �5
34.
35r
37
1 2'05- z :18 13 37 ! 3
3 2:57)- 3;d5- 15 3 36 l 1ST
17
5
�7
2 2:30 2:4& Ito 37 3 l !S^
3 3. to - -3 7Z6 Ito 3(g 37
- '+ 3`. eta 3 a j 33 3 % 39 Z 76 Y
5
Notes: 1) Tests to be repeated at same depth until approximately equal soil
rates are obtained at each percolation test hole. A11 data to be submitted
for review.
2) Depth measurements to be made from top of hole.
TEST PIT DATA REQUIRED TO BE SUBM,11ITTED I,fITH APPLICATION
DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES
D�'PTH~ :...HOLE . NO. TFOLE NO: IB�. ....:..- - a HOLE NO..:.._
G.L. TOP ! CQLL _ 7-0P Sot L_ 'ToP S011-
6"
12" SILT' IL M M
18" $ M Cora
2411
70
361
42"
48"
5411
60"
66"
72"
78��
61c-r /LOAM
SDwt. � l: D Gr
84" W
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED - nJo Af PAar�NT" arZ0V .1j>wd -rr,-2
INDICATE LEVEL--TO WHICH WATER LEVEL RISES AFTER BEING.ENCOUNTERED
-
.TESTS_ MADE BY _ -... , ._.... -..... �_,.. - �._ ...,.. _ Date Zi.. Z .., . __..... _ .....
DESIGN �.
Soil Rate Used__0 'Min/1 "Drop: S.D. Usable Area Provided 840 C
No. of Bedrooms .3 Septic Tank Capacity (000 'Gals. Type FQr= LAST l,wtar=TV=-
Absorption Area Provided By L ZO L.F. x24" width trench.
Other
Name _72ni4o J. Oo vc-2 J-12, igna ure
Address .� 25 ! -/C--rzr racer_ COVIZT" SEAL
THIS
SPACE FOR USE
BY HEALTH DEPARTMENT
ONLY:
Soil
Rate Approved
Sq. k /Cal.
Checked by Date
ili_Y DVNEILewJ(a-
_ON AP 5l6
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Nr.Y.
Rfopo.5E.D SITE GAMILY DW�tttnfr
2A- 'EavisEc, MAP
T-C, o/ij PATTE
P 601EA-
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