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Home My WebLink About1523DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -4 -19 BOX 14 01523 I . IL ..4 I '�T LL 'M V 11 I I . 01523 91 WELL COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF HEAL Division of Environmental Health Servicm COUNTY OFFICE BUILDING - CARMEL NEW YO Wl report is to be compel t—e Ty well— drillerr and submitted to County Health Department together with laboratory report of _ :analysis cf �l ter ;sample,i 4icatir�gmaater is of.saitisfectory bacterial quality before certificate of construction compliance is issued. REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION OWNER NAME Key Realty ADDRESS R. D. 6 Bullet Hole Rd. Carmel, N.y. LOCATION OF WELL (No. 6 Street) (Town) (Lot Number) Bullet Hole Road Patterson, N.Y. 15 PROPOSED USE OF WELL BUSINESS ® DOMESTIC ❑ ESTABLISHMENT ❑ FARM ❑ TEST WELL ❑ PUBLIC SUPPLY ❑ INDUSTRIAL ❑ AIR ❑ (Spec CONDITIONING (Specify) EQUIPMENT ROTARY D ❑ OTHER AR PERCUSSION PERCUSSION ) CASING DETAILS LENGTH (feet) 2 3 DIAMETER (Inches) 6 WEIGHT PER FOOT 19 ® THREADED ❑ WELDED YES NO X Y!S TIU.T. YIELD TEST HOURS O.P . ❑ BAILED ❑ PUMPED � COMPRESSED AIR 6 YIELD (G.P.Af.) 51,2 WATER LEVEL MEASURE FROM LAND SURFACE— STATIC(Specltyfset) 381 DURINO YIELD TEST fleet) 4051 Depth of Completed Well In feet below Land surfaces 40 5 SCREEN DETAILS MAKE LENGTH OPEN.TO AQUIFER (1e. IILOT SIZE DIAMETER (Inc es ) IF GRAVEL PACKEDr Diameter Dlomsr of well Including prowl pack (Inches). SIZE (Inches) FROM feet TO (Net) DEPTH FROM LAND SURFACE FORMATION DESCRIPTION Sketch exact location of well with distances, to of least utwo permanent landmarks. FEET to FEET 0 12 Overburden Boyd Artesian Well Co., Inc. 12 405.' Gneiss &"Q uaf tz If yield was tested at different depths during drilling, list below FEET GALLONS PER MINUTE DATE WELL COMPLETED 3- 24- 86 =�,Z!05F PORT 6 WELL DRILLER (Signature) Rt� Carnre1, ly/Y. 10512 Yorktown "Medical Laboratory, Inc. LAB t 3o6- 626 321 Kear Street --------- - - - - -- Yorktown Heights, N. Y. 10598 Collection station Used: (914) 245 -3203 . Carmel Peekskill _ Mt. Kisco New City_ .° Director: A16rrt N:: PadovanJ M: T: (ASCPJ :" r- �- Date Taken: L�� ✓QQ�Q �C Date Received: / — ,(, ok ,,; ,J Date Reported l� !C-(ij Collected By: Referred By: L J Sample Source: p LABORATORY REPORT ON BACTERIOLOGICAL QUALITY OF WATER GENERAL BACTERIA Standard Plate Count per 100 ml _ (Agar plate @ 35 °C) MEMBRANE FILTRATION TECHNIQUE (MFT) Total Coliform per 100 ml Fecal Coliform per 100 ml Fecal Streptococcus per 100 ml MOST PROBABLE NUMBER TECHNIQUE (MPN Total Coliform: MPN Index Der. 100 ml Fecal Coliform: MPN Index per 100 ml OTHER ANALYSES THESE RESULTS INDICATE THAT THE WATER SAMPLE (WAS (WAS NOT) (NOT APPLICABLE) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO THE NEW YORK STATE DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. C y An 7" Albert H. Padovani, M.T. (ASCP), Director LEGEND RDS = Recommend Disinfect - ing Water Source < = less than TNTC = Too Numerous Too Count Key Realty Corporation Owner or Purchaser of Building TM 73 Section D owners 6 ' �$uilding �Constr`iicted byr.._._.. _.._ .. . -. .• - - Block - - , -... ,..- _.,,.. -M. .... F.. -__ ...�......:_. _ .:. - - -• - -. Bullet Hole Road Location - Street T. Patterson Municipality Modular Building Type 1.15 Lot Burdick Woods Subdivision Name 15 Subdv. Lot # GUARANTEE 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 guarantee to the owner, his success- ors, 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 occu- pant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determin- ation-of- -the Director-of-the Division of Environmental. Health Services, of the Putnam County Department of Health as to whether or not the fail- ure of the system to operate was caused by the willful o igent act of the occupant of the building utilizing the syste f% a 4 � Dated this 16th day of April 19 86 Signatu e Title President Key Realty Corporation Corporation Name if core. 93 Gleneida Avenue, Carmel, NY Address THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPLETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health 2�oP��Zh�.�P:s Mat�r�iaL �~ 1'o1AL LB�r (j� 444' / u I /ZL�P ^9~ k or` a 2 -� 20,x• � b 29 -a 1,01-F I TO P`' 111. 1j _ 4 e�ov�► i �4 QvJG LLf tJl9 / Patna® Co tY Department of Health Divisi it tai Health Servioes _ appro/�lp `has noted for aonformanoe With 4111 *able .ales and Regulations of the / Put C ty Department. 7'-e� 818uatare Ti Date Structure located from sury &y, by surveyor nottnnea L• (iiowo_— Nell located by,.' Surveyor- survey._. weirdrilivrs Iepoii Engineers mu;uie men Is.0_ Tor. k,.Doxt5, piis,goilenes fs IoferaIs incatcd 4f,Cnniroctor: +� tn��aeer: ri�githdq.pt: �i Field Inspection by: Health dept K d i o: *�� j�pril i �1f Engineer' 0 tote ' h! NOTES: " Toi'Ai, G,� a� 2.of�• Ica• 4 i DIMENSIO_N.5 u A - B =_4.Q =�0. A D _ O/I B D I D %1 –Ou n, SANITARY SYSTEM DESIGN 4� ,OCATION Street: own'. f'Arfi_F-hpN. County:,f%1TJe.t -1 Stote. ur3DlyIslo V. P�Jgt��c14 WcacoO�� B ock •, ip L OT N e 3wlaer:.Kv.`� iurveyor: D WAt.G LI 1� �-,� • d' _ _ Town' aA Date- 16 r ��C`(Scale:I11 =5lJ� k� :Jab N D �_. JOHN H, PR 6NTISS i'E. _.I CONSULTING ENGINEP:R RD `), F.ti::.... is, GAftiiv!EL N I ^ril ?. -(9i4: E3713- -5lt0. f i •.i +f ii E; �l i�. A _ F : :1075/ —g - F F r - SANITARY SYSTEM DESIGN 4� ,OCATION Street: own'. f'Arfi_F-hpN. County:,f%1TJe.t -1 Stote. ur3DlyIslo V. P�Jgt��c14 WcacoO�� B ock •, ip L OT N e 3wlaer:.Kv.`� iurveyor: D WAt.G LI 1� �-,� • d' _ _ Town' aA Date- 16 r ��C`(Scale:I11 =5lJ� k� :Jab N D �_. JOHN H, PR 6NTISS i'E. _.I CONSULTING ENGINEP:R RD `), F.ti::.... is, GAftiiv!EL N I ^ril ?. -(9i4: E3713- -5lt0. f i •.i +f ii E; �l i�. J. NEER -0 PROVIDE PERMIT # PUTNAM COUNTY DEPARTMENT .OF HEALTH' ENGI T b ON CER FICAT F: OMPLI CE. l Division of Environmental Health Services, Carrhel, N.,: Y. 10512 PERMIT SQk CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM'. T. Rafters 1- To.. or 'Village Bullet -. Hole Road :.. Tax :Map 93 Block Looatetl °ai subdivision Burdick Woods subd. lot n 15 Renewal _p Revision 2300 .owner /AddressKey Realty Corp., RD 6- Bullet Hole RD., Varmelagybf.MWN Approval _ Building Type COloni al Modular Lot Area O 9 _ 341 grrpq Fill Section only 0 Number of Bedrooms 4 Design Flow G /P /D 800 P. C. H. D. Notification Required fires Separate Sewerage System to consist of 1250 Gal. Septic Tank and 444 ft.- x 24" wide laterals To be constructed by OWner Address AbQVP .Water Supply: Public Supply From x Private Supply to be drilled by Boyd Artesian Wells, Inc. Address Rte. 52 , .Lake Carmel, NY 10512 Other Requirements R -0 -B Fill Section: 30 " deep x 5610 sq. ft = 470f cu. yds. I. represent that I am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate sewage .disposal system above described will be constructed as-shown on the approved amendment thereto and in accordance with the standards, rules an regulations o e Putnam County Department of Health, an on completion thefeof a " Certificafe of Construction Compliance" satisfactory to the Commissioner 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 immediately following thedate of. the issu- 6nce of the approval of the Certificate .of Construction - Compliance of the original system or any repairs thereto; 2) that the drilled well described above will tie located°as shown on the approved plan and tliat:said well wili be installed in :accordance with the standards, rules and regu aeons of the Putnam County Department of Health. e Date November -17, 1985 Signed P.E._ X R.A. Address Pair S e NY 10512 License No. 29206 APPROVED FOR CONSTRUCTION: This approval expires .one year from the data issued u construction of the building has been undertaken and is revocable foi cause or may be amended of modified wti, idered necessary - by. the Co missio er of Health. Any change or alteration of construction requires a new permit. Approved for isposahot do stie sa r swage," ntl /or pr ate w er supply only. Date BY Title Rev. 6/85 PLTrNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS FIELD INSPECTIOV REPORT -DATE:.: - INSP. BY: (Name of Owner) (Street Location) INITIAL SITE INSPECTION YES NO COMMENTS 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 ...... ......... ... ...... D. H. 1 Lot Depth to G. W. Depth to rock Soil De 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. D. H. 2 Lot Depth to G. W. Depth to rock Soil Descri tia 0 ft. 3 ft. 6 ft. 9 ft. 12 ft. li.n. - lieep nu.ie 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: LI & -so - FINAL SITE INSPECTION INSP.BY: M YES NO COMMENTS House SSDS located per approved plan.........'... Length of trench measured Width of trench average Z Slope of tile line and trench acceptable......... / Room allowed for expansion trenches .............. 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.. ... ..... Distance well to SSDS (ft.) .............. 1- (2C2I...... Number of bedrooms checks ........................ Stones, brush, stumps, rubble, etc., greater than 15 ft. fron nearest trench.. ............ 15 ft. of peripheral soil horizontally from trench ..... ............................... Boxes 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 GRADNG OF SITE ACCEPTABLE .. ... .. 1 • • • •• r Ts v i 3757, olm-M.Arg •+�. DESIGN DATA,.;SHEUfi SUBSUFACE_SEWAGE DISPOSA.L_.SYSTEM..._= - owner e e e Address K l el �a %e Located at ( Street) N( Z: Sec.T#45 Block Lot (indicate nearest cross street) B04ickGv1604 S «6d �,Lef (fir Municipality P4 e_r$* an Watershed Cam' ti SOIL PERCOLATION TEST DATA RDQU= TO BE,- SUBMITM WITH APPLICATIONS Date of Pre- Soaking (I Date of Percolation Test HOLE NtNEM CLOCK TIME P RCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level No. Time Ground Surface In Inches Soil Rate Start-Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 1 1410 (44f PEL 1-7 3 2 3 1433 (+fI ' 4 14f7 IN z7 3 9 -to ;04 ¢ 9 _ 24 )17 - 2 104 1.41 rz t O i 3 t4 -9-(` f4f"3 �z-+� lq' L? 3 L —� 5 1 lam: 1. 2. xev. 9/85 D6r i . Qr HEAL Ft Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to•be submittbd for review. Depth measurements to be made fran top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUN'T'ERED IN TEST HOLES DEPTH., jiC)LE iiOI,E ENO _ G.L. e, D O woes _ 2' 3' Logm 4' 5' _�6v�erirtG 6' 7' 8' - 9' 10' 11' 12' 13' 14' - - INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED .. Novi DEEP HOLE OBSERVATIONS MADE BY: DATE: I1 6 DESIGN Soil Rate Used 8 °00 Min /l Drop: S.D. Usable Area Provided 00 ` No. of Bedroans - Fo mr Septic Tank Capacity 8 _ gals. Type Absorption Area Provided By L.F. x,2.4'° width trench Other 12-o -6 4-7 (60--6 . Sc SIONI Vo "u- ( d.-Te, Y .(. .,) P Name JOHN N. PRENTISS, P.E. Address R09 FAIR ST-914-878-6170 ': GAKMEL, NEW PORK 10512 2 .• �� N0'...29206 THIS SPACE FOR USE BY HEALTH DEPARTMENT 0 Soil Rate ApprovErd "' sgaft /gala Checked by Date L removable cover -7 inlet i;1101 berar 12 W-ors wtar lateral 1.9 � vftrwu�) to %bsorpvion tronch clay 9190. or 04uly• Both boxes) ECTl0`N--?-.�-1k--- OIN0 of box must be 10 "Ol and firmly supported to b0I01I frost 11no. Footing to extend to 36 rJO10W ground level, 2)W(3torproafed moo or C,,=Crot(,- construction 07 9 IC 3 from so tank to box and betwoon all bozos 41�78%ftfajffoftno ipilepure equal distribution may bo requirod. LoT /4 t ti '41 -pk5lzll, V"rL IJ LZ A Jut 6 /51- -6,\' - f 1'e' Z' e-A-4- I'( 6'-rc! J� 4j C-,X rA I� lb t 1 --rzec—a V41-TH-1d' of e- it to I o� 10 clay a q. all fill to bo +�/ i� ROB gravel ZCT10N.-E-QB I M SCHEDULE Tank inside length. Tank inside wrath Liquid Is vis J_ parity- Fiaid Width_ (it e-rElls L on h a a .b g 0 x1 0 S.- - �dp F Fi ll . I — 410 , Got .7 Gal/Sqf _.Sq Ft F 5. Jong The current A)"Ch th;S J;1- with in all - acprovatl/perrf I a ti !4ater b, .11f a rrivl- cordance Village/C" dri I) es,0 !-qu4iod 1: cati•oll is i. instti loci. MV o 01 Imit of groi Yet id pipes i 7 d , n g paper to p so" ilding paper 6 top soil Iplic tank to next rode L —F , - box 12'deep ep 37 3/4 stone or 0 gravel LOW graded ad . d .0 raded -_j 4"0 forated a et one CURTAIN T CAL CURTAIN DRAIN L removable cover -7 inlet i;1101 berar 12 W-ors wtar lateral 1.9 � vftrwu�) to %bsorpvion tronch clay 9190. or 04uly• Both boxes) ECTl0`N--?-.�-1k--- OIN0 of box must be 10 "Ol and firmly supported to b0I01I frost 11no. Footing to extend to 36 rJO10W ground level, 2)W(3torproafed moo or C,,=Crot(,- construction 07 9 IC 3 from so tank to box and betwoon all bozos 41�78%ftfajffoftno ipilepure equal distribution may bo requirod. LoT /4 t ti '41 -pk5lzll, V"rL IJ LZ A Jut 6 /51- -6,\' - f 1'e' Z' e-A-4- I'( 6'-rc! J� 4j C-,X rA I� lb t 1 --rzec—a V41-TH-1d' of e- it to I o� 10 clay a q. all fill to bo +�/ i� ROB gravel ZCT10N.-E-QB I M SCHEDULE Tank inside length. Tank inside wrath Liquid Is vis J_ parity- Fiaid Width_ (it e-rElls L on h a a .b g 0 x1 0 S.- - �dp F Fi ll . I — 410 , Got .7 Gal/Sqf _.Sq Ft F 5. Jong The current A)"Ch th;S J;1- with in all - acprovatl/perrf I a ti !4ater b, .11f a rrivl- cordance Village/C" dri I) es,0 !-qu4iod 1: cati•oll is i. instti loci. MV o 01