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HomeMy WebLinkAbout1900DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36.09 -1 -23 BOX 17 01900 S• r WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEALTH 3/71 Division of Environmental Health Services COUNTY OFFICE BUILDING - CARMEL, NEW YORK This report is.to,be completed by.- well. driller a.nd submitted to County.Hea,th_Qgpartme together with laboratory.report..of _ _...... -- I nt _ `ajnalysls oi'vuatet-sample indicating water Is of'satisfactory Liactenal quality before certificate of construction compliance is issued. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION - a I I T If yield was tested of different FEET 300 350 390 -ins drilling, list below GALLONS PER MINUTE 1 1-14 5 DATE OF REPORT I WELL DRILLER (Signature) % l/ 14W, MILL DRILLING, INC. NAME ADDRESS OWNER Robenat Contractors, Inc. c/o E. Rader, 11 Overlook.-PTO-2 Lk. Vw. Mnr. LOCATION OF WELL (No. & Street) East Branch Road (Town) Patterson (Lot Number rew.StE PROPOSED ❑ DOMESTIC INESS El EST B ISHMENT ❑FARM ❑TEST WELL USE OF WELL ❑ SUPPLY El INDUSTRIAL ❑ AIR CONDITIONING ❑ OTHER (Specify) DRILLING EQUIPMENT ❑ ROTARY COMPRESSED AIR PERCUSSION CABLE ❑ PERCUSSION ❑ (SppeHE Y) CASING DETAILS LENGTH (feet) 6 DIAMETER (inches) 6 717 HT PER FOOT ® THREADED ❑ WELDED x O YES ❑ NO .x I YES " NO YIELD TEST ❑ BAILED X HOURS 1:1 PUMPED COMPRESSED AIR G.P.M. YIELD (G.P.M.) WATER MEASURE FROM LAND SURFACE —STATIC (SpecUy feet) DURING YIELD TEST [feet) Depth of Completed Well LEVEL 20 400 in feet below land surface: 00 MAKE LENGTH OPEN TO AQUIFER (feet) 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 FEET to FEET FORMATION DESCRIPTION . Sketch exact location of well with distances, to at least two permanent landmarks. 0 10 Silt and boulders. 60 Broken & soft ledge. 10 60 INCA .400 Hard granite. \ `.D I I T If yield was tested of different FEET 300 350 390 -ins drilling, list below GALLONS PER MINUTE 1 1-14 5 DATE OF REPORT I WELL DRILLER (Signature) % l/ 14W, MILL DRILLING, INC. BREWSTER LABORATORIES BRMSTER'- W.:.Y: ._ _ __. e- ._:......_._ __�.�..> ..�� ._..�.......__........ . WATER ANALYSIS REPORT SAMPLE NO. 3423 SOURCE: Robendt Contractors, Inc. - new well East Branch Road Patterson,, N.Y. COLLECTED: May 24,# 1975 BY: Kill Drilling, 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 collecttd. Play 31: 1975 'Rdy Bickwit P. E. Director � CA- _7 77' obenat Contractors Inc. µ_ _Patterson Owner or Purchaser of Building Municipality Owner Building Constructed by East Branch Road Location - Street Modular Building Type Filed Map #1428 Section Block _6 Lot GUARANTY CF 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- vic'es of- the° Putnam County D`ePiartm�ent °of' ` Health as to "' the r` or` riot " °th -e failure of the system to operate was caused by the w' llfiAl or negl' en act of the occupant of the building utilizing the sy to Dated this 10th day of July 19751 Signature L Title 1I' co p 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 i t ( ; �L ,- PUTNAM COUNTY DEPARTMENT - OF HEALTH Division 'of Environmental Health Service's, Carmel N Y 10512 CONSTRUCTION PERMIT OR SEWAGE,DISPOSAL SYSTEM : Patterson; Town or, illage: East Brach o d Ail Locat-at arc F 1 ed IIgtk ed i fc 11 Est; tes 6 Job, S01,584 Subdivision Lof Rob`en`at Contractors Inc E Rade wner ' e Address A r.,Oscawana'. Lake _Road !4' _ Building Type Modu1 aTr Lot Area 1.448 R. 4 Putnam ba11 er, NY 10579 4 = Number?:of Bedrooms 0 three' Total Habitable Space ' 2' z- = 24� t ' p Square Feet Separate Sewerage System to cons;st of y- 100.0 ";! Gal Septic Tarik 23Q lineal feet 1X 36 1,nCtl width',arench ; To be constructed by ? Atldress r Water-SuPPIy Public Supply "from _. X rPrivate', Supply .to be drildi by L_ Address Other , Requirements None F x 1_represent that.l :am wholly and completely r sponsible•for the design and location -,of the proposed "system(s).; `3) .that the'separate'sewage, disposal system ? above tlescribecl will be constructed as'hownon the appr d amendment there to and in acco(dance'with the - standards, rules an regu a• ions o e :Putnam ' County- Department of :' Health, and that on completion thereof'd "Certificate of Construction Compliance" • satisfactory tp, the Commissioner of Healttiwill j b'e submitted• to'• the Department, and a ,wnt6nm guarantee will be` furnished the owner his successors heirs or assigns by the builder, that said builder :will. place in good :operat!ng.,condition any. part of •aid sewage disposal system durnpg the pei+od of,two (2y:years immediately following the.da4e,ofthe ls;u -• ance'of the approval of: the Certificate of Construction.Conipliance. of; 4he original systertl or any.•repairs °theretop2) that the drilled well'd_eseribed above , will be, located as shown on the`approJed',plan and that said well will be installed m accordance_ with. -the standards, rules andegula i�f'ons of the :Putnam' County Department of,'.Flealth :Date X75 tr-1' Apr1�1 1 0 , • Sign 1L41 A0 Address . A ' ,. 6 O 3 L' icense No. 29206 ;APPROVED FO,R CONSTRUCTION This approval expires one r fro he date =s d unless construction --.o f the builtling has bean untlertaken and is.. revoW6le for ,ceu or may be amended .or modrfied when cons retl essary by a om' 9� Ith LHny change -or alteration of construction" requires` a new ermit pproved for disposat of do" san y sewage d/ � to ater F iii only Date e BY ` + Title N a PUTNAM COUNTY_ DEPARTMENT - --GY - HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA DISPOSAL SYSTEM FILE NO. Owne �:-* a X'°" "�� n ', dress AW.Clg 000,09 _ _ � f � � c / � ` ��' l' meta i"� % !�&9 ac.� Located i ✓i ° S.l "ir- t t� i'!,5 ;,.ti 4/ fib— — : • •yn, SOIL PERCOLATION DATA • BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION No. Elapse Time Start -Stop Min. Depth to Water From Ground Surface Start Stop Inches Inches Water Level in Inches Soil Rate Drop in Min. /in drop Inches ® 1 w 3 5-_ 1 3® 0 4 2 5 Notes: 1) TeAts 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. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTTON -OF SOIL- �NG�aUED IN TEST``HOi1ES ' _..,_.... DEPTH HOLE NO. G. L. 1 756-ri Cri 6f1 L ® ®ri,lA. 121t `o i 18ir 2411 Lae �,AY�9 411w 30 11 3611 42►r 4811 5411 6011 661f ,s'® 7211 °�1n e< 7811 8411 ♦e w ICAT -LEVEL AT_.WHICH...GROUND INDICATE LEVEL TO WHICH WATE� LE !PESTS MADE BY Amin. 1M. /. T° ¢� AFTER BEING ENCOUNTERED Date L.LII✓ 1 V 1V Soil Rate Used /® rvl "Drop: S.,D. Usable Area Provided T No. of Bedrooms K Septic Tank Capacity Q e Gals. Type Absorption Area Provided By L O L.F.x2411 width trench. _ Other Moor_ A _ ivame John H. Prentiss, P.E. bi.gn7n r. Address R.D. 6, Box 353 PRF,k Carmel. New York 10512 THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Cal. Che -pE �F NE STl�t�j �° Date R),te : /7j 11 '.' T'CU' 1_C)} 1 y yes _ __ }pro,, C Coll mc�ntS__ Propor. ty a_i.nes or corners found r Ca.n 'estimat ; }souse location . R),te : /7j 11 '.' T'CU' 1_C)} 1 y yes _ __ }pro,, C Coll mc�ntS__ Propor. ty a_i.nes or corners found Ca.n 'estimat ; }souse location . . . . . . . Slope of tile line and' trenc. ce to 1 Room allowed for expansion trenches . . . Over 50 ft. from suamv, i'ratercourse . . _ Natural soil not stripped or SDS area �: ,nec'essarlly-gra -ded 10 Ft. maintained from prop. line and 20 ft. from house . . . . e • . , _ . Separation of trench from house, well etc. follows plan Nwiiber of. bedrooms checks Stcnes, brush, stumps, rubble, etc. greater than 15 ft. . from nearest trench , V 15 FL- of peripheral soil horizontal t -fir from / trench . . . . . . . . . . . . . . . t/ Junction boxes properly set Could surface run off from driveway, roads, . ground surface, etc. channel near SDS, , area. . . .... . . . G . Does 16t cTra.inar-A nnrPnr n.T'_ -in arPSa nt' RnR FIFA, GRADING OF_ SI`rE ACCEPTABLE ® V ! I I FIFA, GRADING OF_ SI`rE ACCEPTABLE ® V ! I I i AS BULL "T° DATA. L --LL > _ ._ _ 3Ki'' °d, structure located from survey by surveyor notedvbelo%�_ �, n well °located by Su rye. yors survey.- + Q weli drillers report-- _tt�• 11_ Engineers Tank, Doxes, pits, galleries d latera s or.nteo rr t nn +rz;r� b91 neer: 1 H'eOlthdept: I 'Field inspection by: Health dept❑ daha• �.:��a �o Eng.lneer Jo datfa )7 4 NOTES::. V,` {,',= r.,'`r_ 'ri } 1 _ v r. DfMENSIONS i T - - - - - A D' 8' - A F F- -- - - 4 h A,. r r H' ?_ _ 4 1 . K A iK ` -- --B a S N! A �Y -' �F SYSTEM D_ EStGIV �UIL OWNER. _ _ - - -- OCA101 Stl T eet' „\( x �, — c — aT,own�raercti_s�a rCOUnty:S�ur�>wt Stole kk`Totz k�- r SUBDIVISION . `l!! G. 'Mop", I'4 is t. P?�F'ROYEC? ' F �- vy�opeSSlUn�/ !8rocfc •� �y ' , _ , I:.OT N= jjzL Y mid.H rRty �cyy 8;ulider2gr, ��� —G° �, rn.� v 1� ` :u , �' p /��P• fts "TV r ;, & urveyor E. r.�js.i!T_ — —� i— ,� a• - aw Dare:. ' AUG,, d -1�7 7 $cole�L JObsN0::1SC� F +s y LFftN e ° h JOMN H`P13FNTISS PE a Dwg:' " s• lDwDA!/F,.' �.. 2oFrN'Eo4`._3 F. GONS.UtTIN -G 'EtVGfMEER n k x t r I .,.a J. t r.. 1 t F' •�t i l i:6