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HomeMy WebLinkAbout0695DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23.12 -1 -5 BOX 8 00695 me j,'rW ,�. ., . .. ,. ` '_ ETM . , 00695 r WELL COWiPLETION R PORT PUTNIANI COUNTY DERARTr:iCfJT U( HF /,LlIS 71 Division of Untitonnh,,ptal tdctrlilt Scrvicos COUPJTY 0FFICL'c DUILUING •.CAFI.AEL, IJE0 YORK This report is to be completed by well driller and Submitted to County 1•16idth Departmi:nt tc°jether \•vith laboratory report of analysis of water sample inclicating vrater is of satisfactory bacterial clua!it.y before certificate of construction colTlpliance is issued. REPORT MUST BE SULIMITTED WITHIN', 30 DAYS OF WELL CO ^5?LE:TIUN i (Drilling in.,overburden-,' 1 0' 30 el and boulders Hit solid rook at 30 ft. 30 40 Drilling in rock - setting casing.- grouted 40' 160 Drilling in rock - If yield was tested of different depths during drilling, list below FEET GALLONS PER MINUTE . bAIE WLII COMPlE1CD VJ[l.L l7r;ILLCfI (Siyntlura) • C. 6/13/74 ' � NAME, GRESS OWNER F1k1j1z=TA3X- EDWARD PESCATORE . VIEW ROAD* TOWNS 1p NEW YOB, _ (No. 6 Street) (Town) (Lot Number) LOCATION Or WELL v T0W1WS *' 1gEW YORK CAIN VIEW 80 .PROPOSED (� E usIN r� � D WEIL -° DOMESTIC t —I ESTABLEISSS IIMENT -FARM U,TEST USE OF • WELL j1 PUBLIC ❑ El AIR ❑ G OTHER CONDIT ION IN OTHER u SUPPLY INDUSTRIAL DRILLING COMPRESSED CABLE OTHER 0,5PEF.CUSSION 'EQUIPMENT RO'(dtRY AIR-PEPCUSSION •(Specify) CASING DETAILS LENGIH (tool) DIAMETER(inches)IV _ 40 six /EIGHT PER FOOT DRIVE SHOE 19 I ® THREADED D WELDED ® YES a NO �i —VI—AS CASING GrWtj_ fL•D? . - [2 YES 0 NO YIELD r� HOURS G.P.M. YIELD (G.P.M.) TEST LJ BAILED El PUMPED ® COMPRESSED AIR five 836 GR WATER IAEASURE FROM LAND SURFACE— STATIC(Specily loot) _ DURING YIELD TEST fleet) Depth of Co:nplcted Well LEVEL Overflowing GG in feet below Land svrface: ZW ^^ ~ft• MAKE' LENGTH OPEN 10 AQUIFER (tool) SCREEN DETAILS SLOT SIZE DIAIAETER (inches) IF GRAVELq iomeler of well including. GRAVEL SIZE (lnche.$) FROM (loot) TO (toot) PACKED: rave l pock (inches): I I rt DEPTH FROM LAND SUFFAff .® FORhtATION•DESCRIPTION Sketch exact location of well with distances, to at loest two permanent landmarks. FEET to FEET i (Drilling in.,overburden-,' 1 0' 30 el and boulders Hit solid rook at 30 ft. 30 40 Drilling in rock - setting casing.- grouted 40' 160 Drilling in rock - If yield was tested of different depths during drilling, list below FEET GALLONS PER MINUTE . bAIE WLII COMPlE1CD VJ[l.L l7r;ILLCfI (Siyntlura) • C. 6/13/74 ' � Owner or Purchaser of building Building Constructed by Municipality 1 . A i a J .....�o a�,J? �Lnf' • .i EGa.J �a Ate T ` ... . Location —Street Block Building Type 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 successors, 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 occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination., of the Director of the Division of Environmental Health Services of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the- willful or- negligent act of the occupant of the building. utilizing the system. �J Dated this o day of Jll ,j 19 Signature _ Titleidn -�F_(� . (if corporation, 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 REQUIRE TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services,, Putnam County Department of Health FIELD C:f1_-HCK LIST 1)3;te : Insp.by: INITIAL, SITE II'1SPECTION Yes No Comments Property lines or corners found ..... ._ _ Can estimate house location . . .. . . . . . Will driveway need cut . . . . . . . . . . . . Must trees be removed -note these. . . . . . . . Is deep hole representative of entire SDS area Additional deep holes needed. Sufficient SDS area available considering _. driveway cut,house location,separation . distances, etc. DEEP HOLE DATA Depth: Water elevation: Rock elevation: i?2 f Soils description: Date: FINAL SITE - INSPECTION Ins p. by: House located where shown on approved plan � SDS located where approved . _ d =_3 Slops of rile line and trench acceptable Room allowed for expansion trenches ` ' Over 50 ft. from swamp; watercourse.' _ Natural soil not stripped or SDS -:area unnecessarily graded . . . . . . . ' .... 10 Ft. maintained from prop.line and.. 20 ft. from house . . . . . . . _ Separation of trench from house, well etc. follows plan . . . . . . . . Number of bedrooms checks Stones, brush, stumps, rubble, etc. greater than 15 ft. from nearest trench . . . . .. . 15 Ft. of peripheral soil horizontally from trench . . Junction boxes properly set Could surface run off from driveway, roads., ground surface, etc. channel near SDS . . . . area .. . Does lot drainage appear O.K. in area 9f -SDS FI AT, rRAT1 OF SITE. GGE -gTA LE • - I COUNTY OF WESTCHESTER DEPARTMENT OF LABORATORIES AND RESEARCH BACTERIAL EXAMINATION OF TREATED WATERS LabAo. Bottle No. e Date Coll' d / Date Recd Coll'd 'by A ency C611'd for 'Coll'd from;' Naive r`. • Address _ � (St.,' Rd.) (City, Town, Vil oge) : I,Z�i" Code} (County) identr"ficatioii- of Source+ Sampling Point ,. Yes CI No Supply Chlorinated when: sampled Free Comb.: pH ': EtULTS OF EXAMINATION OF WATER Standard" Plate Count per.Iril Membrane Method ;At35'C- 24,hrs. Total Coliform /I00 ml Coliform group MPN /100 ml These results indicate sample was .of satisfactory sanitary quality when the sample was collected Henry Siegel, M.D.; Director • h mg`s � '�`" t \ .r. Y r 4 a .t+ �.} w yr� v K''r"ar ._ , , '', .,; a� Js .. d ry t t �` �F•� #i S�'Rt x'• Sa't'�.a • :a is M. Y rr t•'r" 5 �' i t^ f t.n ) y � $ f a 4.S i +u} }l7 J 4 1 +. i tt * t. 1 , Jr1.•: 4i "3 � ..S 2 3 a,' <. +�.; � � � 6a �q.'Q'"�•!j d w e . • a.:� � y-r"V rh .n, t Aj, colp �� (� �_�.r.. -- t '•i7 ,� �; Thy 'aa /y;: ,11A��*"�Pllf�'tsr.'31b.�L�itUi JAU y., a t ,,,• - t - 14` }IRONM[MAl HFA T jj - � /"y'+; f ;;� O�•.. � +�.a �' �'J4,+,P'rti�. ��� � `fit � .r Ftf { B �� t� +•` +.aY 'i S�f H Hi .�i�P ice. F F4": x�• Y�:I��pcS l+"�'�Y t`�i V✓ t 1 dt y µ �,1; �.1 V� . " 3 ,77 'i S�f H Hi .�i�P ice. F F4": x�• Y�:I��pcS l+"�'�Y t`�i �r t t . " 3 ,77 ro Ns � t1 a i r f }fit. CM /! � Z4 4o w'• /r'".45� a r #.t �!, Qd$ • l•r ' " /!,�&',5�� /.�`�p�r1�,f'�;j�5� -%J) ,, .i... :l Cy%t1�7� tz � i t n, x � t ^ j. s � ,• or.3 l�,°�n �k gsrs�s.��. .. ' � �• t F k. t ,rS 1. I as. lyp,'4 77 C i` � i o air •�j�%75 ... Si ' e ���v ,�_�r�ra *�c'" .yri 1t1 r.n��' . .. ,fit"/ �A�i �'' L`�:� �' �• L k4 d go PUTNAM COUNTY DEPARTMENT OF HEALTH-. DIVISION OF ENVIRONMENTAL HEALTH SERVICES .COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM FILE NO. Owner ;Fpw �� T 6S CAMC, 2f- Addr'1, ss 1196, TA-,q_ [`A' e I A Located at (Street Mdlnate oua)T- , �0 s: Block � ' Lot �w nearessccrToss s r Municipality e�ay ®� �Q7 {i.5o0 Watershed �sT jZANc W (�Ro �� Rj v el ,• SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK'TIME PERCOLATION PERCOLATION No. Start -Stop Elapse Time Min. Depth-- o a From Ground Start Inches er Surface Stop Inches a er ve in Inches Drop in Inches Soil Rate ' Min. /in drop P� l �o•�� 0�:�7 3 4 Z 2 Z I 18 14"•,x, , 3 11 Al )V-11 Z 13 'b , 174-, 2 4m 3 llst9' 11:44 Z� f74• 2'la S�� 4 - 2 Notes: 1) Te'�t6 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. PUTNAM COUNTY DEPARTMENT OF HEALTH- DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM -- FILE NO. Owner T ES c Attu 2f_ Address a 1 Located at (Street) cud a _Block Lot �r n ica e nearest cross s r _ Municipalit aTMA'soj Watershed f-A 63o'1'DrJ RiVelL. SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK'TIME PERCOLATION PERCOLATION No. Start -Stop Elapse Time Min. Depth to Water Water From Ground Surface Start Stop Inches Inches I ve in Inches Drop in Inches Soil Rate Min. /in drop P/ 1 W-41 11.11 3 � g 2 1j:13 11 :414 'Z 2 I8 4. 3 J-1 4 W-11 Z 4 171 2 I► - 0-1, 11 =- 1 . j I74 3 11 44 a- S-d 1 5 Notes: 1) Tuts to be repeated at same rates are obtained at each percolation for review. 2) Depth measurements to be made depth until approximately' equal soil test hole. All data to be submitted from top of hole. DEPTH G.L. 6" 12" 18" 24" 30 36" 42" 48" 541,1 60" 66 72." ' " TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST'.'HOLES .HOLE NO. �[ HOLE NO. (21- HOLE N0. . Tr�pSo1L. _ `�h•�lso1L- r '�'P.Sor c_ A l i . g 78 84 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH W TER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Date y- Soil Rate Used ��' MiiVl "Drop: S. D. Usable Area Provided No. 'of Bedrooms 3 Septic Tank C 9>A Gals.' Type ' ewr 611r.- Absorption Area Prov ded By 017 L r width trenc . �� �,�� �4 Other STANLEY I � A 4� �o . 1) �; Address auftwai x m_ Y. 105011 ;,,1 ',f ►' '''' EfCL .. . THIS SPACE FOR USE • BY HEALTH DEPART Soil Rate Approved Sq. Ft /Cal. Checked by -X4 Date ;sRc ¢d.,.�;"`+��� L'T�"'�t'' j12^cpY,i.XGS( a7� 'f✓'t.°,'p""' +C S+.y,,Tt*r' .3 ©C va '�"- �3':m.;: t"�g -SN:Gn � .�, ti •., - G£N�4AL NOT &5 .c• .,: y.:1 wi�r .. i ✓ 5.., .. n. All regdiiements' and constEu? J details .shall meiG t r6gure of ttm Division of Environoert& `rzi `+ i = $ 9enitation Dept SCf HAalth' (f, i Ldp k! Gounty ;of Y�e3triam # 2 House sewer sh4l -], 4" ;cast ' set oh -a grade of .L' %4 in'6h -per ria;tery ght and' root proof �� ,y. -�- t 3, Drovide 4" approved on-M4 a ,;pi pp, . or:;,,equq..,.to junction tioxes slopes 'as reauire4 to meet 'fief`. !_, conditions 4 Absorption. fields° shall i:con's jdi`nt or perforated :bitumiitans imp ®grated fiber pi spa �xy,M r r? o- laid on. a grade of 1 /lbv ppr°fd wpshedrgsave� or crushed stgne•. :€miforu size. '(QA'+' to 23,/2. ").'�T '` •• r stzall be laid In 13!' of stare s ' nits invert shall be •6" Prom the u bottom of the''tr �nch : Cove ov y/ z r,r ' gravel shall be e,mini gm to :I max mum. The'.mUm COVeTT sha e >` Geed wt� ever • po ssi ble ;: § �b;e 3bx W r a ti. and of the langth shown oa "the" - ,r ;, �K , ` For'-detair's of septic tan'd;r, *r r r } distribution�bcx and'; junction b kti':.,' -�, ?ky. r .+'� 1' •.."r _ _ _ j 'see COl]Zlt}tj $t'andflrd5: - • - rt 9o�c�at:�p.� T�c� �� 7 All•. trees in field area.and _pJ n, 1 ©' thereof shall ber�rero Heavy 1'pads aff field area: ...9 Leader and footing drains mu dischge serer from- ,septic'fie3 lfl AFter...eompletion =o f s?,ptia`; r „ 7, system, top dress field area• vi topsoil and seed ,until a gcjc Ada-- _Y {stand of grass is'egparent,:* �. 11, Well ldj4M,rater endly-sif 0 `�t�R "Fo.uS� �:�• be submittefl'to:Health nep:t ;,:Ce CerGi.f4cate of •.Constructi+n• r Compliance id'11 be•issued...i. • n f r,Y, __X {, S E P 1' 31972 {,"rt >r '3,rQ, kt.�Y+i.S tf.! _...— a(a F - _ -c; EUT�iA► EP Of, y Y ( $StrA �'{' µ �, �f r t• E,// Y �. -0a;'t ' -0IFiCIOR' DIE4k, l . r •;i -ay"" :1:c v 4hC „�i -'k.' n 1j"�} RONMENTAI'HAtTH.S1 c1t °r�%ZW4. igr{ OF L`R�Czr4 TloF1 ,( Si c V Ou ��': 1 I . 7 S• ti . i 4 t �dl�:�: 4. -7. u?,! it y F d i k/ dl T _ t 'f ��IS L�l".1.5 ✓��P �/�?.El,ChiQS� 'Y°_ l yn 4 � �rY�� ar } � * ' � '.yr5a.�•- � � ���`h0..9 ?... r,ry a. a f f t r .� .`rY^.`�'^ � '�..i � L.LA'?R+x•r',,�s'' ✓epic! 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