HomeMy WebLinkAbout0277DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
13. -1 -8
BOX 4
memo
I
■ 1 , . 1
r 4 �' "� ikf
I e'� ire
rA r. ,
111:.
pz �. .� 1✓ '3 Ste'"„". CF." h .✓7"v.%r, 4�*i ,�4�...f Z.. �rJ .� {'1� jr' '
u r1"i�.�k„w yy ��-,� � -, ;; Z"., � �"y i YG� � �� x .,rNT �\ S y � °f",..�tcti'• h r 'ei'°r"j ti t,1�..' �C pr �i' O ✓ h 4 1r ''.. 1'
i r .✓ S r �� v '4 s t 1 'a, r
PUTNi4MrCOUNTY :DEPARTMENTlOF,HEa►Ljy , > N 007410 �r
h!t i rwo COUNTY CENTER > NE-' CA 58641 f� ✓'P' ! ` . _ at lj ^�\ �Cyi �R ��rfi� rJ
� .',r a4`;�r< K t a �.'� �` �-r CARMEL, N,^EW YORK 10512 %"` t, �• -�� r�i err ,..fs \tiD_'dtef'"�.� ;.J >_�,..�'�1:9 �vtl�,'\�.'� ,
:fr,�� v�'a. �h °S"''t"wr'.I+.,�4ti�'':rff•'h,� d `,,a:,f i?,� rr ,"� r ti r'i i�',.4..fi i ��a rF i4" Ivtt 7'>�.k
: '� ✓^°`�i\ f:���x..'zaS ;Y`c+'.,.,• y'` - '�l �" ..L ..� Z'" � .r „".ark x: ��r � r ""`s..,LL l"irr �,,. ���C�. �u'`�v 'ir�l.;fr ' P. �, r'i"`
K
:_j-t 4 1�..,. ,y�- ?,u�t j3 ,�, � ...xj' E r f" Z '�L ijf«-�dj -"��..✓ 1..tJ �, -'�'�. rr�'S'a+.lf ,,ti
� i'+" \a h'� f C` q1 .f 1 t ,�. ... sr :� l t ✓ t ✓� � : rta:S \> > a \'`'r ti� - .� -h i s'`y -`S`' w�1�"lt fir v t, t , j>-cti~ '" i
f �`¢' tai �.. r r � t'• i 1" j - 't f •'ter •a .•.' x��.r�r; `� .a.\ij` si �y� ;.y i` Lv�'. p� � .fC +� �"
The Sum of ref t , x r DFol.l..,a�'rsr S 7r „�
'� ��. f "aS..7 '� - 2�^.',•j.., r - ..`'`i.,.l,� ism✓ i\ r a.,. ..r...- t✓ �"f ✓`1 � '\
'a� may. ,(''?. !.r ,y `�a �.3 -!/” .t, �l'r '` ''�,at l/ \ 1 � ✓ �sc:,.E r j`�'� 1..�. 4,��r a2 ✓r, 4.. rr.
i d FQr � t'iir•t ray: 1/ fr rr r� Y ti l I'fs t\., ,,� ^r*r,� 1 *" c r t'i- Z'.ri'�l '"\� T
14�r' '� r '3" s ��"`r.�'�'� �,r� r;�\ � .�'� L r `�' ✓.���r"� �� �4 i1��"` � �. j: � *+r �'-� `'t� .", \�''1i'"'`� i ��',��•1�%7'
�> -
` =ti\ ^` ✓ f
I �•,rs �,; v�1 rs .. /�`-< y ,+' r 'c' � rM. �/'y' � y '.� f,.`r p � � �"°.�'r. \ & Ll.. r ''.�:i
v
' �k� t � ,t= i .. �CheCk��r �ti •.IY�O K ""�\ J^ i. ,.. -1 rr � .�� �� r�R,` .Z vT,... - f ....r^ .r • �,r . t-^ � ..l`>•..
..r. � F.'1.. r.`:''i r':.la X 'Z ✓:-mac ,.- : \ -. ?. .wit s.
. @v ww.vwwwvv.w.rvwwwuuw wwww w.w:w w.e wrr. -. ay. vw tiw.u.uw w. +av ...ve awvvcu- ..ww.- v.u.,..0 ..cuv:
WELL COMPLETION REPORT
X3/41
PUTNAM COUNTY DEPARTMENT OF HEALTH
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 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
OWNER
NAME
MICHAEL O'KEEFE
ADDRESS
26 NEWPORT ROAD, PATTERSON
LOCATION
OF WELL
(No. a Street) (Town) (Lot Number)
CUSHMAN ROAD PATTERSON
PROPOSED
USE OF
WELL
ESS
DOMESTIC ❑ ESTABI SHMENT ❑ FARM ❑TEST WELL
❑ UPP Y ❑ INDUSTRIAL ❑ CONDITIONING El (Specify)
)
DRILLING
EQUIPMENT
COMPRESSED
❑ ROTARY AIR PERCUSSION ❑ P RBCUSSION ❑ OTPHER ecify)
CASINO
DETAILS
LENGTH (reel)
75
DIAMETER(Inches)
6
WEICWT PEPER POT —
19 a THREADED ❑ WELDED
X
YES NO
s a3Tit
X YES
NO
YIELD
TEST
HOURS G.P.M.
El BAILED ❑ PUMPED 5a COMPRESSED AIR 1
YIELD (O.P.M.).
5
WATER
LEVEL
MEASURE FROM LAND SURFACE —STATIC (Specify reef)
overflow- 2 gpm
DURING YIELD TEST (fool)
Total Drawdown
Depth of Completed Well
In feet below Land surfaces 575
SCREEN
DETAILS
MAKE
IENOTH OPEN TO AQUIFER (feet)
SLOT IZ
DIAMETER (Inches)
IF GRAVEL
PACKED:
Diameter of well including
gravel pack (inches):
GRAVEL SIZE (Inches) OM feet TO (lest)
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION
Sketch exact location of well with dlsfences, to at least
two permanent landmarks.
FEET to FEET
0
15
sandy bankrun
5
40
clay
60
till
F;n
575
mica shist, limestone
If yield was tested of different depths during drilling, list below
FEET
GALLONS PER MINUTE
DATE WELL COMPLETED
5 -29 -84
DATE OF REPORT
8 -29 -84
WELL DRILLER (Signature) 7
Al A "e,
��f v 7
v
BREWSTER LABORATORIES
Box 224 - BREWSTER, N.Y.
(914) 225 -2072
- WATER ANALYSIS REPORT -
SAMPLE NO. 5636
SOURCE: Mike Okeefe Faucet - Well
Cashman Rd.
Patterson, NY
COLLECTED: December. 5, 1984 -
BY: Joe -L Plumbing & Heating
BACTERIOLOGICAL EXAMINATION
Coliform Count, MF Method
0
0 per 100 ml.
This result indicates the source of the sample was
of satisfactory sanitary quality when the sample was collected.
December 10, 1984
/l 'f
r
PJTNAM COUNTY ;DEPARTMENT OF HEALTH '
-. Division Of Environmental .:!4ealth :Serl!ices ,Carmel N Y 10512 /
CONSTRUCTION. PERM.`IT FOR SEWAGE DISPOSAL SYSTEM i4jw
!; Town or Village e
Locatetl . at
Tax Map
Subdivision
�i Lot obct<
Owner � ' r LQ�'i.✓➢�..Sff Address
Building Type =Lot Area ♦ Q�i
GG
Number of Bedrooms Design Flow Total Habitable Space -� Square Feet
. /"'y
Separate ..Sewerage System to consist ofe�L �! ' Gal Septic ank and
To be constructed by _ �- V Address
water Supply Pu Inc Supply From
Private Supply to. be.. drilled . evs
..Address ' . [
OF
Other r- Requirements : -
;r
6 represent that I am wholly and completely responsible for, the design and locat' —6f the ji 5- d 6 51em(s); 1) that the separ5te sewage-, isposal. system.
above. described will be constructed as shown on the approved amendment ther tip apd,,tn- Accordgsic itch the standards, r61es en regula ions o the a nam
County Department of Health, and that on completion thereof a "Certifica ''.of..G�ehstftct16A Con* ianc satisfactory`to the Commissioner of Healttiwill
be � submitted to the 'Department,, and a written' guarantee will be- furnis d t prAier his3Suc'c .s - i; ::he s or..assigns by .the builder chat said builder will
place in good operating condition, any part of said sewage`disposal-syst cp c}iringiiti @`pertod.of'itwc�Q) ears immediately- followingahedate =ofthe issu-
ance of'.the -approval of ,the Certificate of Construction ,Compliance 'of he iginalFsystem or dny. re�y�r,-� vs hereto; 2)that.jhe'drilled'well described above
will be. located as shown on the approved plan and that said wel(will be insta ed ^i accdRonl he `Stan ards, rules and regulate ons' , of the 'Putnam
County Department of Health G t
Date = b� / ' L p�
�-- ,Signed P. E. R:A
Address ` L se No
APPROVED FOR CONSTRUCTION: " This•approva4 expires one year -from the' date d urij onstruction ,of the building has been undertaken and is
revocable for cause or.may be amended or inodifted when �sid retlfiecessary 6y: Commissioner of Health. Any change or.alt_eration of.coristruction
requires a new jermit Appro ed for disposal of dome i sa itary w e, -and r ater supply -only.
Date _ BY Title
1
-s
DEPTH
G.L.
6
1211
24"
30"
C, 'M j 1"PET W.11"IT A 11P.L1 CATI ON
TEST JD'M1 J),V111"i
CY6.11 10 01-L'". IN HOLlis
110L-L" 1\10. HOLE 1' .0 1101E NO.
V,
36"
Q,mal-li &- AJ
42"
48
Ala- WIL-Cw
54
I
6011
6 6 itr
7211
7811
84't 't
11\TDICATE
LEVEL AT I,= CH GROUED WAT._'L_!_'1R IS ENCOTUTIM.P.R.7"D
INDICATE LEVEL TO WMCH WATER LEVEL RISES AFTER F-E-ING
TESTS MADE BY .-Date.
E11COUNTEREP o,
Soil Rate
DESIGN
Used min/1 S.D.
Area Provided
No. of Bedroois
11 1- Septic Tank Capacity 6C)
Gals. __T
-y-p-q
Absorption- Area Provided I3y__4i4dL.V-x24"
tl4k( qn(jll.
NameRZ-A/
770-XIII-91AII, Sig
Address
r
S r14 L
Jf
THIS SPACE FOR USE BY Tj_Z11;VJf DE�RIIMYJME,_[�IT ONLY.
8oil Rate Approved -Sq. 1,t/Gal. Checked by,
4
Date
Illip-Ok.) zl IIIAWFA F
8-29 -84
17 1,V WA-,-ey 71,-4r R-4-5- -A-r,-4A-,-4 /A-
,,Vlrll 7iYE EA'IT71AIC- rMX- of Z,4&,o SU PS ADOPTED a y mr
MOW Xae-t S'7;4r-4- avc 1AIC
'ClzEA M4R AIR. /9/6
A-11-Elo CIV/-Y 7, /989
Re-7d;e A7.
g--,4cZW • h'eAl YORX- e28 eA-VXOk1,4Y 49205
m' ..
b �
4fElL (l
4 '.. 72,
L \
u
2 7*,(- -n uK
65' a� �.F.
'I` Putnam County, Depastmeg ,Ittb D$ervicae --
7t?1
\ \\ Division o� r•rvi =o� a =t'- 5; 93'
3
��EgEU ARCH _
APP'L