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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
This report is to be.completed by Well driller and submitted to County Health Department: together with laboratory report of
analysisof-.watar sa- m..pleindicating :water- .is..o €s ,satisfartory baitierial.,quality before g cificate..of caonstruction.comoliance is Issued -
REPORT MUST BE SUBMITTED WITHIN' 30 DAYS OF WELL COMPLETION.
_z
NAME
ADDRESS
OWNER
James Carlucci.
16 Veterans Road, Patterson., NY
LOCATION
2 (No.. & Street) (Town) (Lot Number)
OF WELL
Mallne Drive, Brewster, NY
PROPOSED
BUSINESS
a DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST.. WELL
USE OF
WELL
11 SUPP Y ❑ INDUSTRIAL ❑ CONDITIONING ❑ (speEfy)
DRILLIN EQUIPMENT
COMPRESSED R PERCUSSION ❑ CABLE ❑ .OPH Efy)
❑X ROTARY A PERCUSSION
CA SING
DETAILS
LENGTH (lest)
3O t
DIAMETER(lnchos)
6 n
IWEIGHT PER FOOT
19.
® THREADED ❑ WELDED
.•.
YES NO
WA; CASING TJUTED?
YE5
NO
ELD.. �...___ ._ ...
TEST
_._.. ,:_.:_....� .. -.... _..._ ._.,. ____' _... ��:_: �._ .. _.... -, _- �..- .= :��HOURS'""-,�'.'G.P.M.
❑.BAILED L PUMPED ❑ COMPRESSED AIR
-�` -- -•-
6 71
YtEID "(Q.P:IN:J -" .�- . __.. -
71
WATER
LEVEL
MEASURE FROM LAND SURFACE — STATIC (Specify feet)
201
DURING YIELD TEST l lget)
2201
Depth of Completed Well
in feet below Land surface: 2401
MAKE
LENGTH OPEN TO AQUIFER (feet)
SCREEN
DETAILS.
SLOT SIZE
DIAMETER (lnchea)
IF GRAVEL-
Diameter of well including
GRAVEL SIZE (Inches)
FROM (lest)
TO (feet)
t.
PACKED:
gravel pack (lncheal:
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION
Sketch exact location of well with dlatencea; to at least
two permanent IanQmarks.
FEET to FEET
Drilling in overburden
0
.10
dirt, cla. and boulders
Hit bedrock 1
10
30
Drilling in bedrock
casing set and --routed
_�,3.
rock-granite..
//:r1
!,iAy 1 1986
D pT 4M cOVNT Y
, OF Hl��LT�
Af
If yield was tested at different depths-during drilling, list below
FEET
GALLONS ' PER MINUTE
DATE WELL COMPLETED
DATE OF REPORT
WELL DRILLER (Signature)
l
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. - ..4�
ELLIS A. TARLTON LABO:RAT1ORY
DIVISION OF ELLIS A. TARLTON, ENGINEERS, INC.
CHEMICAL' 34 PLEASANT STREET D ' NBURY, CONN. 06813 -2328 WATER - WASTEWATER
PHYSICAL METHODOLOGY
BIOLOGICAL P.O. BOX 2328 iO3-748-7903 APH�C EPA - ASTM
__�.r.- <,....� _...- .a�EPCiI�T�OF`B�►C'T€i iOLOG(C�L "hND °C IE Ii ►L E AMINA%ION OF WATER
NAME AND
ADDRESS OF
PERSON TO
RECEIVE
REPORT
I Mr. James Carlucci
16 Veterans Road
I Patterson, N.Y. 12563
tDATA
SOURCE OF SAMPLE
Water Supply, 12 Malone Drive
Patterson, ,N.Y.
DATE OF COLLECTION March 26, 19 8 6
COLLECTED BY J. Carlucci
Hydrogen Ion
COLOR
TURBIDITY
ODOR
CORROSION INDEX
DISSOLVED SOLIDS
Concentration
LANGELIER
(PH)
6.3
3
.70 NTU
none
RYZNAR
2.80.0
. M04.
Alkalinity as CaCO3
Fluoride IF)
Nitrite
.010
Mg /L
Bicarbonate
34.0
Mg /L
.60
Mg/
NITROGEN
Alkalinity as C00O3
Chlorine Residual
CONSTITUENTS
Nitrate
5.60
Mg /L
Carbonate
0 •
Mg /L
.00
MO/
AS
NITROGEN (N)
Total Hardness
as caCO3
174.0
Conductivity
522.0
onia
.000
Mg /L
Mp /L
Micromohos/cr
Albuminoid
--
Mg /L
Iron as Fe
• OO
Mg /L
Sodium
4 8.. O
Mg/
Chlorides as CL
109.0
Mg /L
Manganese as Mn
• 00
Mg /L
Mg/
Detergent as MBAS
0 •
Mg /L
Sulfate ae 604
.2 4 . 8
Mg /L
Mg/
The arithmetic mean of all standard samples examined per month using the membrane filter (echnique shall not exceed
one colony per 100mt. Coliform colonies-• per standard sample shall _not - exceed 3/50m1, 4 /100m1. 7/200m1, or 13/500ml
in: la) Two consecutive aamplee;- (.).-More then one etin0ard sa'm'ple wAen' less than 76— 'ire' exitninet per °montA; —oi (c)
More than five per cent of the samples when 20 or more are examined per month.
MEMBRANE FILTER TEST
Collform Colonies /1100MI.
E
AT THE TIME THE SAMPLE WAS SUBMITTED:
,. Tl:: rr..,Al[ c` the anWy::is o! !ilis iample were satisfactory and met requirements for a potable water.
® 2. The results of the analysis of this sample were satisfactory for a potable water but certain of the chemical or physical constituents were high. These 9gas follows:
pH below 6.4
El3. This sample was not satisfactory since.itdid not meet the bacterial requirements for potable water. The presence of organisms of the Coliform group in a as I pf�t�lble water Is
undereireble and, while not necessarily. Indicating the presence of any diseiwproducing organisms, does indicate that such contamination migIOurvive to tht�me extent. The
presence of organisme.of the Coliform group.may also indicate.that thedreatment-was not adequate at the-time the sample was collect* r
4. This sample was unsatisfactory as a potable water because certain chemical or physical constituents were above acceptable limits.1 ese g Tel to
V r
O
COMMENTS y�•q ���}
Hard water, with above average mineralization and acid reaction.
Physical,:appearance is good. No iron or manganese are present to cause brown
metallic staining. Sanitary chemical history is good, showing no organic
contamination by disposal system leachate. Chlorides are above the area
isoahlor of 8.0 mg /1 and may be due to road salt or softener backwash.
Sodium in excess of 20. mg /l is above the limit At which people on low salt
diets should be warned.
The rate of corrosion towards iron and copper is above average due to the
chloride content.
Certified .��� •,�
A -1
Owner or Purchaser or Building MUMIcipality
Building Cbns.tructE y Section :
Malone,'Road 4.
Location Street Bloc. :
One Family Residence 3
Bui i.ng Typ e_ 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 succ.es-
sors, heirs or assigns, to place- in..good operating condition any`part.of
Aid 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 o.f the Director -of:the Division. of Environmental Health Ser
vic.as of:. -_ the"_ Pu .tnara..,.County- :D.epartrrient •of` Health. as 'to. whether
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 �O day of 19 Sgnature
Title
I corporation, glve.name
and address)
- - - - - - - - - - - - - -,; - - - - - - - - - - - - - - - - - - -
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS :BEFORE
CERTIFICATE OF COMPISETION WILL BE ISSUED.
GUARANTOR IS REQUIRED TO FILE NOTICE.OF TE OF FIRST USE OF SYSTEM.
Division of Environmental Health Servic� !I��utna my Department of Health
D pr�11,4 v,
19(96
�r�
.,...,. ,.,. -.» .,. ;� ;,:,�•� �.^,n.� ++mow - ?g,,.',..^+,� «�r:r -•�aa a •c,. ¢ >., ...� �.,..mc.: s .,u n.r.� fi w , ;rn: w '.'�.. .r-,r r^^� ,..s:.,,'.k:^t s "r i ^..� ,.- '�SisTecr
PUTNAM COUNTY .DEPARTMENT OF HEALTH Permit • '
I bivision of :Environmental Health, Services, Carmel,' -.N. Y. 1601
CONSTRUCTION ...PERMIT FOR SEWAGE DISPOSAL SYSTEM' Patterson
Town or Village '
Ma'lone:. ^7
-� ._, „I_ocatad..at -= . _.Road: _ _ _ -- •Taz= .w,a� -.: � �• x>jlock � •a , �.bt� ,��.:,� - ....�.�..
Subdivision Map C, Put. LA-6 Subd. iota C Renewal p Revision
i
Owner /AddressJ.-Carlucci, 16 :Veteran RD .Patterson NY Date Of Previous Approval,•
Building Type (1) F'am. R6s Lot Area l6, 000SF Fill Section only
Number of Bedrooms 3 Design Flow G /P /D 600 P.C. H. D. Notification. Required
1000 420LF of 21 wide Leaching renche,
Separate Sewerage System to consist of Gal. Septic Tank and g
To be constructed by Bertrum Address Patterson, NY 12563
Water Supply: Public Supply From
X_ Private Supply to be drilled by P.F. Beal
Address Brews ter , agy
Other Requirements 3ft. o.f . Bank Run Gravel Fill
I represent that 1 am wholly and completely. responsible foi 'the design and location. of the proposed system(s). 1), that the separate sewage disposal system
above described wiff lit constructed as shown on the approved amendment' there to and in accordance with the standards, rules and regulations o e u nam
County Department of Health, and that on compietionthereof a' <'? Certificate of Construction Compliance" satisfactory to the. Commissloner.of Healthwill
be submitted to the Department, and a written
guarantee will be furnished the ,owner, his successors, heirs or assigns,by the builder, that said builder will
place in good operating condition any part of said sewage 'disposal system during the period of two (2) years immedi ate ly.following the date of the Issu-
ance of the approval of the Certificate of Construction Compliance of the original system "construction theret 2).thit the drilled well described above .
will be located as shown on the approved plan and that said well will be Install accordance ards, ules and. regulations of the, Putnam
County Department of Health.
Date 12/3/84 Signed._ P.E. R.A. XX
;x ...
Address MuS'cOOt North `RFD X 48 NY 5LAc�nse No. 1105E
APPROVED FOR CONSTRUCTION. This ipproval'ezpires one year from date is d 'Issloner nn of th building has been undertaken and Is
revocable for cause or may be amended.o►;modified when eM.' necessary. by the C lth. An change or alteration of construction
requires a new "-""°��
permit. Approv for disposal ^of dourest Sawa d /or p water supply only.
Date ` BY Title
Rev. 9 -S .
�x :�i.::''_JO =tom ,_.- - - -a+ - - �:..•,r.L iG+:tti5r� .. _ -.. x
x... _�ar^� - -�7 ..
" pUi'14AM COUNTY DEPARTMENT. OF. HEALTH.- DIVISION .0F'ENvmon4mTALEEAWH.SERVICES
INDIVIDUAL WATER SUPPLY /SUBSURFACE SERE DISPOSAL . SYSTEMS
FIQ�
......._._. .- INSPDGTh1
_ __.
D.H. 1 Lot
Depth to G.W.
Depth to rock
Soil Description
0 ``ft.
3 ft.
6 ft.
9 ft.
D.H. 2. Lot
Depth to G.W.
Depth to rock
0 ft.
3 ft.
6 ft.
9 ft.
5011 Descr
r
D.H..- Deep Hole
G.W.- Groundwater
D.H. 3 Lot.
Depth to G.W.
Depth to rock
Soil Description
0 ft.
3 ft.
6 ft.
9 ft.
.12�..ft
DATE:
FINAL SITE INSPECTION INSP.BY: V, Y YES NO COATI'S
House SSDS located per approved plan .............
Length of trench measured;
Width.of trench average
Slope of the line and trench acceptable.........
Roam allowed for expansion trenches ............. DD 17iwA
Over 100 ft. from watercourse., ..................
Natural soil not stripped or SDS area
unnecessarly graded ............................
10 ft. maintained from property line and
20 ft. from house.* ..... I ......
Distance well to SSDS (ft.).
Number of bedrocros checks.......... ..............
Stones, brush, stumps, rubble, etc., greater ei�fl�D
/
than 15 ft. from nearest trench...............: 8 /.,Quo CEO
15 ft. of peripheral soil horizontally
from trench ..... ...............................
Braes properly set ...........:...................
Could surface runoff from driveway,.roads,
ground surface, etc., channel near SDS area....
Does lot drainage appear OK in area of SDS.......
FINAL GRADING OF SITE ACCEPTABLE ..................
r
r
Plumber
CLOCK ,TIME
..5
PERCOLATION
PERCOLATION
No.
Start Stop
apse
Time
.-.Mina
Depth to - Water
From - Ground
Start
.- Inches.
Surface
Stop
Inches
Water ve
in Inches
Drop in
Inches
oil Rate
Min. /in drop
PTH #1 .... l...g
2__10:.19.
:,45 ... , .
. _ :.
I0 :15
10:49 ..
30
. 30
:15
.15 . -.
17. 75.
17.75 .
2.75.
2. 15
30/2. 75_11
30%2.75 =11
-.3
10.. :.53 _.
11 :23
30
-.15
17 75...
2 75.
30/2:`75 =11
..l
_9 s'50._ ... -_ _ 1*,0 ,.:.20., -
30
16 : -- ._:_.lg:..
3 .
..30/3 -10
2
10 : 21 _
to -5i
3n
iF.
ig..
3 -
3ni�_i�.
3
i n :• rl,)
11:22
30
1
'7 C� .
�n '7q_i i
Notes: 1) Tdsts to be repeated at same
raes are obtained at each percolation
for review.
°2) Depth measurements to be made
depth until ao roximately equal soil
test hole. All data to be submitted
from top of` hole.
..5
Notes: 1) Tdsts to be repeated at same
raes are obtained at each percolation
for review.
°2) Depth measurements to be made
depth until ao roximately equal soil
test hole. All data to be submitted
from top of` hole.
i
/
Mahoipac,NY 10541-
Iv
T
THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: U y�F of �VN 0 "0
Soil Rate Approved-, Sq. Ft /Cal. - Checked by te.
.. ... _; ... ; •►•tip j�� ..
U zrzm -G.=" W' 41 ISTS '-� ~w. to
c -l1L+ c -Sltt c•31iD c- 31G•(t 31SY c•�1G-1
''s154 c -S1S�
e: s1s5 ftP•MNCMIAfceA . tr�sr .. STOP. sTQni
' jI •w� 104 Til11K PQ' - Pa"
- .. ..
.... j _ n64P!LS �`, 50 1: •�• /st T�'� GO "�
1101 .. - _.........
SG .6S '
/76 H = N o. ao� E• . ..-•`- ... -zoo �.. '
' MC.!_.or•�E pL�.G (PAPER 00A0)
SSDS
SCALE. 17_40'.
t..
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S or•.1•• Tslw sopy"4f�6NLT' '.':C"' • )° - . ':..:': _ , ' J•d ■ + .JOEL LAWRENCE GREENBERG ° "•' 4 -za-ee
ARCHITECT - TOWN . PLANNER ■itli1i••+
'n•u.1+.9! ooc o.•.. •n 9//9/86
• `MR:.JAME5 CgQLUCGI'- 1 ruleooT NOIITN Ni0 •!, !o! 4:8. �dr•A0a60
_'MALONE.'P(AGG 1 e.•st•. t+ rAMOfAC NEW YORK 10f1
• -ro rLAt• ... ,+V�1J.. -.� _ NIA f!f f•t!
3
- -.
DESIGN CRITERIA • . , "--^-- °___�._ �.^,_-- ... —.. _�_; - - - _
d 1.
3 BEDROOM HOUSE, 1000GALLON PRE- CAST*CONCRETE SEPTIC TANK REQUIRED.
1000GALLON PRE -CAST CONCRETE SEPTIC TANK PROVIDED.
...... 9
dG
'4?
b 2.
SOIL 11 -15' MIN. f IN.'. = 0.8
µ
DAILY FLOW 200 GALLON PER BEDROOM: -200 .X 3 =, 600 GPD•
.Z......'
600'GALS; +- 0-.8'= '750SQ:'FT: ' +-2. °.-'375'LF :`R'EQUIR'ED.- ,.__7........ -, -- .... ..
7
di.
5"
. •375 LF. PROVIDED
-'8 -- _.'101...
101;
1
THIS IS TO CERTIFY THAT THE SEWAGE DISPOSAL
SYSTEM WAS CONSTRUCTED AS INDICATED ON THIS
PLALN.AND THAT THE SYSTEM WAS INSPECTED•BY-ME _
BEFORE IT WAS CQVERED OVER. THE SYSTEM WAS
CONSTRUCTED IN ACCORDANCE WITH ALL STANDARD
RULES AND REGULATIONS, OF THE PUTNAM COUNTY
0
DEPARTMENT OF HEALTH AND THE NEW YORK STATE
-.78
'.
DEPARTMENT OF HEALTH.
=74
.63
•
- .....15 _4...-28..
251e
SMTUNIC
r,.Mt 'Op loalth
'II
Pam CoffitY "Ith Ses°Saee
Divieio
ad �
_
�rcaa09
Ia tl,,,, Of the
-WELL
28
35
g
avD 2, - ?E& ;•
y
Z
No GAP- 'SACAE
ce(NDme-
S
'- Dat
g�Nataee 3C � 4�FiED .4
.5 .aPENCE .:
t..
• V
S or•.1•• Tslw sopy"4f�6NLT' '.':C"' • )° - . ':..:': _ , ' J•d ■ + .JOEL LAWRENCE GREENBERG ° "•' 4 -za-ee
ARCHITECT - TOWN . PLANNER ■itli1i••+
'n•u.1+.9! ooc o.•.. •n 9//9/86
• `MR:.JAME5 CgQLUCGI'- 1 ruleooT NOIITN Ni0 •!, !o! 4:8. �dr•A0a60
_'MALONE.'P(AGG 1 e.•st•. t+ rAMOfAC NEW YORK 10f1
• -ro rLAt• ... ,+V�1J.. -.� _ NIA f!f f•t!