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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.19 -2 -24 BOX 29 i. Ir y ohm I L. ' r 03758 a- _ _ - .... .. .. - -... -•. -. _ - __ .. �R1 L t L ce �_ T 1l!- b Cam-- -- � • - - L/ -- - LocG V ion Szrez v B1 o �. Lo -= _ -- 10c� Of Ir _ - �J J_ .,_ �-� _ - r - -. -- � =_. _- _ - ---� - - - -� - �- •-_�- -�_._: ter= �_ '._� _� -_.- - - C_ V _ -- VP�'IlL DRILLER' S . LOG AND REPORT Well• at County of Name of Place City, Village,or Town Owner _ : ep�,t�'�of- well' 'Diame;ter field, (o Was well disinfected? - 1 gpme ype or no Amt. of casing above gr. ound_/ &Below ground 11 Well seal in. ft. packer, cement grout Draw a well.diagram in the spape provided below and show the depth of jcasing, the well seal, kind and thickness of formations penetrated;.wate.r bearin formations, diameter of drill holes with dotted lines and casings) with solid lines. WELL DIAGRAM _ FORMATIONS. PENETRATED RED . J ARKS Di ete in.: Depth --T, —thickness and Type of well j in ft.' if eater bearing method _. vie 1 'dynamited? 2 yn _ �ifas . . •.._ v> - 25 .. PUMPING TESTS_........._ �. .. Details- _ #1 ;#2 #3 ` 'D Static water __ -I- ! level, in ft. I 1 below rade I .-T Pumping rate . in g.p n. ` 75 Pumping level inj� ft._ be10 a grade Duration of ..... . 100 =��,J� test, `in hrs. - - 17ATER AT -END .0F " TEST ...., . ...� . ear... 'Cl Caoudy Tur id i 150 Recommended.•depth of pump in dell, feet below grade I ^�LLLS IN SAND & GRAVEL: 200 Sand. Eff. size. mm Unif. Coef.•.... a.4 t��� ��'-'i���wVJ „ ' Length of screen ft. i F J Diam. of screen in. { _ t. ! X50....... Type of screen I Screen openings x i :.. _......: COMlylE NT$ : f f• Dra' * a sketch of the property on the back of this sheE,t Drilling started' "; - Completed locating the well and,sEVage dis osal•. systems. P Y � ��[�iell Driller gnature, .wc a.• , .._ _ WELL.hOCATION SKETCH Drag a sketch showing outline of property): general slope..of ground, location.of °structures', roads, ditches, watercourses, wooded areas, swamps, ponds, rock outcrops, sewers,.septic tanks, leaching systems for sewage, test holes wells and springs.. Give directions and distance to nearest communityo coal Consider space between lines equal to 25, 50 or 100 feet. Make top of page North and draww.sketch accordingly, In. r 1} Form L-$--Ba 7-70 w OOQNTY OF WROTCHESTEH' . DEPARTMENT OF LABORATORIES, AND RESEARCH VWMwns, New York MW it RESULTS OF EXAMINATION OF WATER Wi1a... 3II 1s Laboratory number .......................................... Collected by ........ ........... ............................... ................................................ :1 `# x,.,10-72 oopy Date: Collected Z.,? 72 Received _,. ........ :................... .... Reported ........... ... Valley {T) Putnam...... ' Place .................. .Putnam . ... ..................... ......... Counr� .. 1 ` (city, vittage. K let.F ti `.. Street: _ ood House 2 Kit. laa. Sampling point Valerio Builders..lnc* Box Valley Owner ..17b..Jefferson Tenant ........................... ............................... BACTERIAL EXAMINATION Chlorides ............................ p.pAL :a z bacteria per ml., agar, 24 lus.:at 3 5c C- ............ 3 .................. t Nitrates ................. .......... P.P.M. Test for oliform ( Residual Chlorine: M.P.N.* per 100 ml ................................................. .... ............. >L Comb. v pH Value YAmbrane per 100 ml. ..........Fecal per 100 ml. .......... These results indicate the of the sample of a satisfactory bacterial quality for the indicated r .source was .x use when the sample was collected. . Henry Sie8d, M. 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PUTNAM `COUNTY DEPARTMENT OF HEALTH Div ision of _Enwronmental,:YHealth Services, Car me/ N ' Y 10512 CON$TRLCTION PERMIT -FOR SENVAGE DISPOSAL,SYSTEM k -z �w(.)✓ci> ��-e� s • ' ' Town or .Village i F - Locatetl at -, . ' _`^ � t ;� LI k� Subdivision Lot Job �Y xQC�- �. LIb S Owner. \l A ... : -, Address MI-T"µ' Builtl,n9 TYPe Q� S Lot Area r j e } Kr AV Number of Bedrooms = Total' Habitable 5paceM1 Square Feet Separate Sewerage5ystem to consist of I Zy0 Gal Septic Tank Imneaf feet X; C �� width trench'• To be constructed`by `iO m Water Supply Public Supply. Frbm Private S;q Pp to:rbe�drilledSby - E . ,. ., Address-, r r Others Re4u�rements �N 1 represent that I am wholly, and completefy'responsible for the design 5nd IocaUon of `the proposed �ystem(s) '1) that separate,. sewage disposal, system:. above.d scribed will be constructed as shown �n the aporovetl'am'O'Aci 6e i there to and in accordance w tl ,the standards' eules an )regu a ions o e u nam County '.Department of Health, •an`d tFiat on completion thereof a Cert,ficate of Constructiorn Compliance tat isfictoryto ttie Commissioner of''Health,will . _, be' ubmittetl to' •the Department and.:a wrmtten guarantee: will be furnmshed the -owner his�su`ccessors hemrs or assigns by the, builder, that said builder will -e ,,;place in, good operating' conddmon' any •part of said sewage dmsposaFr system: duririgt.the per_ioil of two,(2) years ,mmediately following -the date -'of the issu- `ante of the ;approval of the Certmf sate of ,Construction ;Compliance of- the originalssystem or any:repairs- thereto; 2)'fhat the `drilled well:desciibed above ' will be located as'showh on.fhe Approve pan and that; said well will be'lnstalled in accordance with the ;standards rules and regula i� ons;' of ;the Putnarrm• r County Department of Health.s 4 w C Date - Signed Address License No. APPROVED FOR-,CONST:RUCTIONh This approval expires one year from the date issued unless construction ,of the bu,�id�ng has'been undertaken and is revocable for .cause or.:may be amended or rriodi fied. when considerednecessary by the 'Commissioner of Health;, ;.Any - change -or• alteration of,- construction requires - permit Approved for disposal of domestic mtarJr sewage a , d./or 'r ate ater supply only T�tl Y VALERIO BUILDERS, INC. Box 176 ® - w t �eY #ersoii �l a11ey; Y�ew�..York � `10.53.5. a... Tel. 245 -3128 PUTNAM COUINTY DEPARTMENT OF HEALTH Division of Environmental Sanitation County Office Building Carmel, New York Gentlemen: Date April 21, 1971 Rea Property of Valerio Builders, Inc. Located at E/S Wood Street Putnam Valley (T) Tax Map #062 Block 04 Lot 10 This letter is to authorize Howard A. Kelly a duly licensed.,professional engineer to apply for a Construction Permit for a Separate sewerage system and private water supply ;,to serve the above -noted property in accordance with the standards, rules, or regulations as promulgated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of .Article 145 or 147, Education Law, the Public Heal#?i :Law, -hd,. the. Putnam County Sanity *r_ Countersigned: �'ki 4 (Address) C� " (telephone) Very truly yours, R�. eal); ?. m c � m 3 z VALERIO, Presid Builders, Inc. OF FUTNAN Li Li- rJT•J\ J=1'__ ..�..u- � �)Lrl .._. -.. -� .._._r r�:�_`. J_�_ _�.z.:�L Sivl_. ,' r . T.J Ci : \0 QS; -ei V 0. (.Lrt CO. V►Lh.r*tJ Add-- — Sec C�(�z —. �;1.oc', 0�_ Lo t l° ici�ali� �i ntAwi U (ki� ;i2-�rS °c!� J QI!�1 PL ?C C", TT^:' T `^ j� «1,}'T�= n C 1� V VVIJ :=` l.'�r 1✓ Li- �l_��._.J li Hole CiJLr,, PrI:�C� .:o. �'ir,: c Fro- 'Cro!r:' _._ _��_, _... Ir.c'-.e; S ?_._� . SIC= Z: t � _... S l a .. ^ J �0. J {fail.. D--03 � c3 i 1 - - -- 2 • 3 1, II1C T� _ I -C• - =S _s_ 2� ✓� 3 a to be r °_ c `S�� (?o:J- S? ao "j n� =e 1 _ ems_ -r TEST PIT DATA PE 0 U T R�-: LD S'�.; D', I T T E D :''_T D r 1,TCATIO"' LE DESCDTPTION 07 SOILS '- C'N T E R E D ?'• --T HO -0. DEPTH HOLE N., 0 HOT,-:' NO HOLE N G.L. 6tr 12" 18 T- 2 W! 30`1 36`• 42 54` 66" 2 liNDIC21TE LFVE�, AT Mir 11 C G R\. O'u-'N D �,T T7 IS V OL'\. rt Jam, '11C. 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