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Home My WebLink About1489DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -3 -30 BOX 14 N�lml IN 1111 NN .I 1 in T - 411 '. ' , -fA 'g f r - ' IN . -. 3 PUTNAM COUNTY 'DEPARTMENT OF HEALTH \' Rev:'. Division of Environmental Health Services, Carmel, N.Y. 10512 Engineer Must!] vide P.C.H.I). Permit q=- -a - --- CERT[FICA CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Patterson Town.oi "V e . Located at BU 11 e t Hole Road `~ - Taz Map 7 3 Block " ` Iqt . 7.1 Carl & Loretta LAC AN rdick Glen Owner /applicant Name Formerly Burdick Subdivision'P'ame Sabdv: Lot q 3 Melling Addresa 67 Carpenter Road zip .10549 Date Permit Issued" ' Mount Kisco, NY ';Separate SewerageSystembuiltby Patrick - .Tyndall Address_ IVy Hill Rd, Brewster, NY. Consistlagof 1,000 GauonSepdcTabkand 400 Linear Feet of Absorption _Trench. ;Water Supply: Public Supply From Address or � X "Private.Supply Drilled by Address Building Type— - Residence Has Erosion Control Been Completed? � of at time Of 1'n SpeCtlOn a :imp- cif i n.n - i on Number.of Bedrooms 3 Has Garbage Grinder Been Installed? -.not Other.RequirementsFi l 1. rAa7 li rP n Gi X11 flan Yl�t. yet Placed _ S. I certify that the system(s) as listed serving the aboye premises "`Mere constructed essentially as shown on the lans._f the completed- work:,( copies. of which are attached), and in..accordance with the standards rules and .regulations, in accordance with the f d plan, and the permit issued by the Putnam County' Department Of Health. As Not As Built Date -? Certifled,bY; P.E X . • AOQ►ess. . Bo 3 =;4 t 0• _ 0 i lcenss nio. 0.5:1011 Any person occupying. premises, served by,the above system(s), shall promptly take suco'action as may be necessary to secure the correction o1, 'any unonitary" " oh ions resulting from such usage. Approval of the 'separate sewerage system shell become null and void-&$ soon as a pub.'_ sanitary sewer becomes sab s -and the approval of the, private water supply shall be "come null end void when a public water "supply becomes available. Such app gvals are subject 'to Aodifiration or change vvhheen, in" the Judgment of the "Commissions& of Health,.such revocation, modification or change Is necessary.: Date •►J �! H f / � g TitleJ_L C -BREWSTER LABOTIATORIES Box 224 - BREWSTER, N.Y. (914) 225 -2072 SAMPLE NO. 6429 SOURCE: Carl Lachman hose bibb - well Bullet Hole Rd. Patterson, NY COLLECTED: December 17, 1986 .BY: P.F.Beal & Sons, Inc. BACTERIOLOGICAL EXAMINATION Coliform Count, MF Method 0 per 100 ml. Hardness 2 gpg Iron 0.08 mg /l pH 6.4 This result indicates the source of the sample was of satisfactory sanitary quality when the sample was collected. December 19, 1986 Roy Bickwit P.E. Director CA-1-0- . ` 4y _ WELL LOCATION WLLL LUrirLr.iiU" rtr.ruAl Office Use Only DEPARTMENT OF HEALTH Div_ ision .Of . Environmental Health.. Service :s PUTNAM COUNTY DEPARTMENT OF HEALTH STREET ADDRESS: TOWNIVICUICLIC111 'TAX GRID NUMBER: Bullet Hole Rd. Patterson Lot #3 WELL OWNER NAME. ADDRESS: Carl Lachman,67 Carpenter Ave.,Mt.Kisco,NY 105 9 0PBBLICE USE OF WELL 1 - primary 2 - secondary 19 RESIDENTIAL O PUBLIC SUPPLY. ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED __/ EST. OF DAILY USAGE gal. REASON FOR DRILLING ® NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST / OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA, ' WELL DEPTH 120 ft. I STATIC WATER LEVEL 30 ft. I DATE MEASURED 10/17/86 DRILLING EQUIPMENT ® ROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION„ ❑ OTHER (specify): ' WELL TYPE ❑ SCREENED ❑ OPEN END CASING. 4N OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH 21 ft. MATERIALS: [XSTEEL ❑ PLASTIC ❑ OTHER LENGTH.BELOW GRADE 20 ft. JOINTS: 0 WELDED 0THREADED ❑ OTHER. DIAMETER 6 in. SEAL. M CEMENT GROUT ❑ BENTONITE ❑ OTHER WEIGHT PER FOOT 19. 1b./ft. DRIVE SHOE: OYES O NO UNER: 0 YES IND SCREEN DIAMETER (in) SL07 SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? DETAILS - - - FIRST _ .. _ - - - OYES ONO - - -- - HOURS' SECOND - _.. _ . - . a.._. _ - - -- - - - .... GRAVEL PACK O YES O NO GRAVEL SIZE DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH It. WELL YIELD TEST pumping t If detailed METHOD: 19 PUMPED I tests were done is in- O COMPRESSED AIR r formation attached? O BAILED ❑OTHER ; ❑YES ❑ NO It more detailed formation descriptions'or sieve analyses 1PIELL LOG are available, please attach. DEPTH FROM SURFACE water Bear- ing Well Die- (meter FORMATION DESCRIPTION cone, ft. ft. WELL DEPTH It. DURATION hr. min. ORAWOOWN ft. YIELD gpm. Surface 1 Dr-11ing in overburden clay & bldrs Hi rack at 1 foot 120 6 100 5 1 21 )ri.lir.g in rock,set casing., grouted. 2 rock granite. WATER ❑ CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? -O YES ONO STORAGE TANK: TYPEbLf,1 1 Xtrol 203 CAPACITY 32 'GAL. 9.9 PUMP IHFORMATION TYPE submersible CAPACITY . 7 MAKER Gould DEPTH 1001 MODEL 7EH03412 VOLTAGE2HPl , WELL DRILLER NAME p . F .Beal & Sons , Inc . DATE 12 6 ADDRESS PO Box B SIGNXTU Brewster,NY 10509 i A PUTNAM COUNTY DEPARTMEW OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Owner or Purchaser of Building . Building Constructed by Location - Street Municipality k <! �? S � ��< Building Type i3 3 -1 7(i Section Block Lot (� u,0LC3 G� � Subdivision Name Subdivision Lot # GUARAIgrEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM pa"v_I' a ll�jkl I represent that I am ( 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 guarantee 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 approval of the _. "Certificate of Construction Compliance" for the sewage disposal system, or any ` 'repairs made`- by`n+p_-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. l�wJ`�i' hof6e re�oohs��e Ara%d4-*,`a�e r1`J/eH�cL�iJ� %4k+,ys� fi t, or %hcon-vevlleKee or po /�K�`�o�/ ih a eveyf-,0 e�ir. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environinental 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. --, /-"?- Dated this 6e day of 19_E2 Signature Title General Contractor (Owner) Signature Corporation Name (if Corp.) Address rev. 9/85 mk V / / � G 7 � - �-- C�6 ration 'f Corp.) Address �jPUTNAM COUNTY DEPARTMENT OF HEALTH mit Per,« J!.< Division of Environmental Health Services; Carmel, JV Y 1dff0 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM.A Town or. village. ,•.....:..2 _ _ _ ,».,.,,..._ �^a Block.. - 3. LOt..� Z Located .at C3i:l 1�'Y "t'1f71� 1�. - -" ax •Map _ .. ` - 3_ �l SUDdiVisiOn� Subd. Lot N Renewal, Revision El owner /Address - � �J �•' ` ` L11 I-i AJ A 1n,'n t Ft. �l 49Daie of Previous Approval - Building Type oS iT�>~ 1�(G1= Lot Area 43 469 _5Q • Pill sr_ctio'n only ❑ Number of Bedrooms Design Flow G /P1 /D P.C. H. D. Notification Required Separate Sewerage .System to consist of j e�ae� -' Gal. Septic Tank And _� �� /• �E/t/C 71_1 0/ 147;(4--L% To be constructed by h i ✓ IZM 1 t-A Address Water Supply: Public Supply From ' Private .SuDPIy to be drilled by" - Z Address AR >,• j /,.•.. � , �='- I L t.o , Other Requirements ' O -b tern 1 represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the .separate aew6ga disposal above described will be constructed as shown on the a proved. amendment there to iiWin accordance with the standards, rules an regulations o e ,rt nam D h Will County Department of. Mealth,' and that on completion thereof a 'certificate; of Construction Compliance" satisfactory to the Commissioner Of Hd be submitted to. the Department,_ and a ;written °guarantee' will be' furnished the owner, his, successors, heirs or assigns by.the.6wlder .,that said' a will r place in good operating. condition any part of, ,said sewage- disD.osal system during' the period of two.(2) years tmme-diately following thedate' he iszu ante of the approval of the.Ceitificate of Construction, Compliance of..the oiiginal'system-or any repairs thereto;'2j that- the`drilied well de t 1. d.atiove will be located as shown,on the approved plan and that said'wetl wilt be installed in accordance with the standards, rules and regu a ons of Pu nam County Department of Health. " i Date MA�t -{ i3. I985CG� SKJned < P.E�i R. a. z 150 Address � � ` �- Liconse No � rdertaken. and is APPROVED FOR CONSTRUCTION This approval expires on year om the a e ouedunless . nstruction of the building has bef of.construetion revocable !or use o may be amended or moCified when eonsi er d ecessary on of Health. Any change or altC requires a ne per t.' Approved for ,disposal o! domestic n a' sewage, t supply 'Only. Date BY - Title7 Rev. 9 -81 I al PUTNAM COUN'T'Y DEPAR'IMUU OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES ,• - - FIELD INSPECTION REPORT (Name of Owner) (Street Location) INITIAL SITE INSPECTION YES NO Wetlands on/or proximate to property .............. Property lines or corners found ................ Can estimate house location ....................... Willdriveway need cut ............................ Must trees be removed - note these ................ Deep holes representative of entire SDS area...... Additional deep holes needed..... .... .... Sufficient SDS area available considering driveway cut, house location, separation distances,etc... Adjacent wells /septics ............................ Access to uronosed well location for drilling..... D.H. 1 Lot Depth to G.W. Depth to rock Soil Descri tion 0 ft. 3 ft. 6 ft. 9 ft. D.H. 2 Lot — Depth to G.W. _ Depth to rock — Soil Descri 0 ft. 3 ft. 6 ft. 9 ft. _..._ J 12 ft. DATE: INSP. BY: D.H. - Deep Hole - G.W.- Groundwater D.H. 3 Lot Depth to G.W. Depth to rock 0 ft. 3 ft. 6 ft. 9 fta 12 ft. Soil Description J� DATE: 10 - , I YM I NO I Mt=S FINAL SITE INSPECTION INSP.BY: House SSDS located per approved plan ............. Length, of trench measured ,3 Width of trench average C'2 Slope of tile line and trench acceptable......... Roan allowed for expansion trenches .............. Over 100 ft. fran watercourse .................... Natural soil not stripped or SDS area unnecessarly graded........... ... .... 10 ft. maintained fran property line and 20 ft. frcm house Distance well to SSDS (ft.) .......��'.. Number of bedrooms checks ................ 4) ......... Stones, brush, stumps, rubble, etc., greater than 15 ft. fran nearest trench... .............. 15 ft. of peripheral soil horizontally fran trench ..... ............................... Boxes properly set........ ......... .... >..... Could surface runoff fran driveway, roads, ground surface, etc., channel near SDS area.... Does lot drainage appear OK in area of SDS....... FINAL GRADNG OF SITE ACCEPTABLE.. PtTTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS r. r :... (Name of Owner) REVIEW SHEET - CONSTRUCTION PERMIT VJ DATE �' - BY: (Street Location) DOCUMENTS Permit Application Corporate Resolution Plans - Three sets Engineers Authorization Design Data Sheet (DDS) Deep Hole Eog Consistent Perc Results (3) 30" Perc Hole Other House Plans -- Two sets If PWS - Letter Variance Request REQUIRED DETAILS ON PLANS Sewage System Plan Sewage System Hydraulic Profile - Gravity Flow Fill Profile & Dimensions - Volume D or J Box;Trench /Gallery; Pump pit details Septic Tank - Size, Detail Well Detail, Service Line if over Construction Notes Design Data Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing /Gutter Curtain Drains Perc & Deep Holes Located Representative of Sewage & Expansion Area Expansion Area;shown;gravity flow,suff. size If Pumped Pit ..& D- Box Shown & - Detailed Wells & SSDS's w /in 200 ft. of Property Located Property Metes & Bounds House Setback: Necessary (Tight lot) House Sewer 1 /4 " /ft. 4 "0; Type pipe No Bends; Max. Bends 450 w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 10' to P.L., Driveway, Large Trees 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains- Curtain,Storm,Leader,Footing 25' to Catch Basin 10' to Water Line (pits -201) Septic Tanks 10' from Foundation 50' to Well 15' Well to PL GENERAL Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS Plans & Permit Same .'...From : Ground Surface in Inches. • Soil Rate Start Stop Drop i Min -An, drop T�_,_... T. ,.,..... :TnnhAq . . �. r�t ;•5fi� � 74 .:J;. -�''� SST P.IR',J�Tl� REQU�ZFtEU y DESORPTION OF °' -SC D�PZ'$ NO• �� . j (n .,'ay;r�eAr��:�1- shut }uk, ��w�t�.5► 3n 42n,. it i r �li�:.�.i�;��ili �r; �ti f' 4�.. t;a:" '�i:1y� �.�:,!:M. �..:�' 1•'..'. � .: .,�:.•�i .' r 1 t: is I +� uk1 l�ji ..... ,. .i .... i � �r��... � "�.�.s pia,. •.x�..:.ii��wn•f•r.iP('D/1T.TNT HOLE N0.. �_:2 '� �..,._� -_ -• - HOLE NO:._. —�� . a.aW +w; +•:•; ' , — I� jj1� L'i►� H L' "1'rn rw �a..a 114D+ �ICITA -- Usable Area Provided 006. . WiTY —Gals ur EAL B} 5flAhTlAbltEPTG1't¢6iti$:; of Health lth Servioe anoe with R T, TO—T, 7 9 -.-- - - one of the nt. S PT ; c s.YS.T M DES ? U " K L L Q R 7't A L-AG N MALI BLLETvi4i.F VOA A1iESt1N, N - IU .4 Boy. T •r,wrC+ ScA, A 5 _� ,r �:� sc�out� oetiats�a G to opa;m 5 ;A�H:i B} 5flAhTlAbltEPTG1't¢6iti$:; of Health lth Servioe anoe with R T, TO—T, 7 9 -.-- - - one of the nt. S PT ; c s.YS.T M DES ? U " K L L Q R 7't A L-AG N MALI BLLETvi4i.F VOA A1iESt1N, N - IU .4 Boy. T •r,wrC+ ScA, A 5 _� sCKM tiF: vise pie �3u�N„< SCAQ C— m r 6. wrt-L 1,o