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HomeMy WebLinkAbout1881DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36.05 -1 -7 BOX 17 4 vq - .� J .�T, L 1 . � --~ Date 26 Certified by License No - Address conditions resulting from such'usage.­'.,�A0prov6[ of the I ra 'Wb- e item .pc9me. ny rid sobwas a �public,:sanitirjj.-seWer becomes subje�f� to modification 'or change :W�:e­ d tp it IV& the ;SEWAGE �QISObSA ST. Located. at Lot Separate Sewerage System bujlt:, b9 Address Consisting 'of G. all sep ti . c Tank lineal Fe t width trench 0 1669 Other requin t ur, al nr rain -861 x .,6z �Me'i -Depth Water Supply: Public Supply Fr6m Private Supply Drilled By ss Has Erosion Contro Ir Been, Completed? _L. attached), and in accoidance-with the. staridards, rules and r6jidlatio-r�'s,j I- i -filed, and the ­eimlt 'I sued !the Putnarn County t t.of Health. :sued 'the FU m WELL COMPLETION,,-, REPORT PUTNANtI'COUNfY DEPARTMENT OF HEALTH 3)71 Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK _...... .This, report. is :to be completed,4 y. vyell ,driller and submitted" to Cou ity_Health Department .together with Jaboratory .report of 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 MILL DRILLING, INC. Y NAME ADDRESS OWNER Robenat Contractors, Inc. Southeast Office Park, Rt.22, Brewster, N LOCATION (No. & Street) (Town) (Lot Number) OF WELL East Branch Road Patterson BUSINESS © E] ❑ ❑ PROPOSED DOMESTIC ESTABLISHMENT FARM TEST WELL USE OF WELL ( SUPPLY ❑ INDUSTRIAL ❑ ❑ CONDITIONING (Specify) DRILLING ❑ ROTARY �A R PERCUSSION ❑ PERCUSSION ❑ EQUIPMENT ((Specify) CASING LENGTH (teat) DIAMETER (inches) WEtuHT PER FOOT © ❑ SHOE X ❑ W CASING ? � DETAILS 21 5 19 THREADED WELDED YES NO L�J YES NO YIELD HOURS G.P.M. ❑ BAILED ❑ PUMPED © YIELD (G.P.M.) TEST COMPRESSED AIR 4 20 20 WATER MEASURE FROM LAND SURFACE —STATIC (Spec /fy feet) DURING YIELD TEST [feet) Depth of Completed Well LEVEL 30 380 in feet below Land surface: 380 MAKE LENGTH OPEN TO AQUIFER (lest) SCREEN DETAILS ,. SLOT SIZE DIAMETER (Inches) IF GRAVEL Diameter of well including GRAVEL SIZE (Inches) FROM (feet) TO (feet) PACKED: gravel pack (Inches): DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to at least two permanent landmarks. FEET to FEET 0 15 Clay and boulders. S' e 15 380 Hard granite. lr• o� If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE ®tl DATE WELL COMPLETED DATE OF REPORT WELL DRILLER (Signature) 01 a 9 -19 -77 10 -4 -77 MILL DRILLING, INC. Y r . i I T C ....P. -r� ... ......_. ... ...�- ...c_. --. -rte ._,. . �.. :. - ..,��.�... _.. . �... ..�.,. _ .�.. -- ._ .... ........ , -.. .....� - � ... -. _ .. _ .. .. .-.. BREWSTER LABORATORIES Box 124 - BREWSTER, N. Y. � WATER ANALYSIS REPORT SAMPLE NO. 3945 SOURCE: Eugene Radar - new well East Branch Road Patterson, New York COLLECTED: Sept. 19, 1977 BY: Mill Drilling, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method 0 per 100 ml. i This result ixdicates the source of the sample was of satisfactory saxitary quality whex the sample was collected. Sept. 24, 1977 c Roy Bickwit P. E. Dlrecror 0 i Mr. & Mrs. Edward McGlone Patterson Owner or PurcFiaser oT Building Municipality Robenat'Contractors, Inca Brook Hollow Estates Subd. Building Constructed by S`ectlon East Branch Road Location - Street Block Frame 3 (Part Plan) Building Type Lot GUARANTY OF SEPARATE SEWAGE- SYSTEM represent that We afC 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 �6'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 fA65 to such s�rstem,. 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 Ernvironmental Health Se- vices of the Putnam County Department of Health as to whether on not toe failure of the system to operate was caused by the t ' t`. act of the occupant of the building utilizing e v L Dated this 1 day o 19n') Signat Title torpor ion, give name a address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMP�jETION 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 4 I ..Mr..... &: _Mrs... Edward _ McGlone - .Patterson Owner or urc aser or Building Municipality Robenat Contractors, Inc. Building Constructed by East Branch Road Location - Street. Frame Building Type Brook Hollow Estates Subd. Section Block 3 (Part Plan) 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 o.f the - system - -to . operate was caused by the willful or negligent act of the occupant of the building utilizing the syst 6. 1 Dated this 26th day of October 19 77 Signature .1 '� Z� Title Robenat Contractors, Inc. If corporation, give name and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMP.TTETION 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 4i ite�Supply'.to.lb eAr Address d o ~' !CceAs" he bus will- er ii t Ll*cense No.- Date T'I J PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING. CARMEL, N. Y. 10512 �r 2- DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO.' Owner AfgLld4► Daly soLAddress Located at (Street 6dicate /ty'Vj�G►n� /Ail$ Lot. nearest cross, s ree . Municipality Watershed �-o'®1�6y., SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS o e Number CLOCK TIME PERCOLATION PERCOLATION Run No. Start -Stop. Elapse Time Min. Depth to Water From Ground Surface Start Stop Inches Inches Water Level in Inches Drop in Inches Soil Rate Min. /in drop 2 26 / 5 O z 1/011h iw 3 - 2 kf / 3 /33 ) '1154y '+ /3¢/ /3¢rr >f ?� 1 2 - 3 n ... .v'Y�R Ir •.Y Notes: 1) Te'�ts to be repeated at same rates are obtained at each percolation for review. 2) Depth measurements to be made depth until approximatelyy equal soil test hole. All data to be submitted from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO.- HOLE NO. HOLE G.L. 611. 12" 18" 24" 30�� y .� 42" 48" 54" 66" 7211 - 781 84 11 . INDICATE LEVEL AT WHICH GROUND WATER IS ENCO TERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Date DESIGN Soil Rate Used Db n/l "Drop: S.D. Usable Area Provided 00 No. of Bedrooms 212C Septic Tank Capacity Gals. Type Absorption Area Provided By L. F. x24" width trenc Other ® "k de ° 'r I® B ame John H Prentiss P E igigature a . Address C. D. 6, Box 353 NA k- PRF.yp�sc,�� THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Chec e y >° Date M A,' FAI �-14 if, 73,03 4`4 T;m".A K APPROVED C 71 791 M T I -tff DIRE SION. MF.ttTAI HFALM I A. Structure incoled trom survey by surveyor rnte I belowg Wall lic(ittj uy*. Suive):lr, survey._ wc-,,, -diio,rs report E r ., i n e P r s m, e s u I e m c n f s .0 713r. k rCA 6 p t 0 119 r 18 -3 Ek 10 11! r 0 1 S I C a I e a ey:GonrracAnI Eng ne!f: flt 31rh dGtpt: L7 Floia inspection by: Health dept El d li I fa Eng I nedf late. NOTES: A, Q I. M.E N SION .5 A 'A C A D 0 a E A F F A J: j A .9 :2 T SANITARY M Q I Q A 3U! LT" • jA OZN'Zh`:^ LOCATION Street: e7A5 To w nj TT%Wx - _jqh,z_ _County,':'-wn4T- S tate PRE4, 10 if Mop "61 ocF �L OT Ns _-3 4K Surveyor. _&, - A, Dr tw Date I `7 , J QH N H,. P .R ' N, T. T'I S S P.E . C 0 N s u.L-T-'l NG E•,NGINEER.' �RD 6., Pnx 5, CARMF.L .14Y '1-.7