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02891
Rev. .3
CE
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N.Y. 10.512
Engineer Must Provide
P.C.H.D. Permit #—
OF CONSTRUCTION CO14IPLLARCE FOR SEWAG9 DISPP-ca1. cYC e>? Vc. .
Locatedat WASt snares nr]ve
Owner /appllcantName Philip Keating Jrrly
MaWngAddress west Shore _Drive zip 10579
Putnam Valley NY
Town or Village
Tax Map lock�_Lot_]2.o-115
Subdivision Name eS hore s bdv.Leta 4
Date Permit issued 1 1 Z 2 7 Z 8 5
Separate Sewerage System built by Owner Address
Consisting of Gallon Septic Term and 500 LF of Leaching Treryches
Water Supply: Public Supply From Address
or: % Private Supply Drilled by N. Anderson Address Barger St. n Putnam Valley
Building Type One F am . Res. Has Erosion Control Been Completed? Yes NY 10579
Number of Bedrooms 5 Has Garbage Grinder Been Installed? ,x0
Other Requirements
I certify that the system(s) as listed serving the above premises w
of which are attached), and in accordance with the standards, rulee
Putnam County Department Of Health.
Date 12/28/87 certified
Address Muscoot NorzY
�
Any person occupying premises served by the above systems) shall pro
conditions resulting from such usage. Approval of the separate saws
available and the pproval of the private water supply shall become nu
subject to mo if tic range when, in the judgment of the Col
Date By
shown onjoe plans of the completed work ( copies
,,wAtJl t filed PIA, and the permit issued by the
License No. 11056
Gch action as may be necessary to se re the correction of any unsanitary
shall barn ull and void as loon s a pub!': sanitary sewer becomes
rhen a bl water supply be mes available. Such approvals are
f Heal c revo on, m flwtion of change Is nacas`aa,►
4S
Till
brhown, Medical Laboratory, Inc. -
321 Kear Street
Yorktown Heights, N. Y. 10598
(914) 245 -3203 .
ixiector: Albert H: Radovani A T. (ASCF )
LAB
Collection Station Used: /
Carmel Peekskill
Mt .
Kisco New c.t t v
Date Taken: 7Z, 'L? : °OV 1'/
Date Received: /ax -"
Date Reported: JUL. 3 b im
CU�s�- �'!2o ✓C, ZV. .�p/Y Collected B y:
Referred By:
Sample Source:
LABORATORY REPORT ON BACTERIOLOGICAL QUALITY OF WATER_
GENERAL BACTERIA.
Standard Plate Count per 1.0 ml q
(Agar plate @ 35 0C)
MEMBRANE FILTRATION TECHNIQUE (MFT)
Total Coliform per 100 ml Q
Fecal Coliform ner 100 ml
_ Fecal Streptococcus per 100 ml '
MOST PROBABLE NUMBER TECHNIQUE (MPN)
Total Coliform! MPN Index. ?per 10- 0._: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
NEW
YORK STATE
DRINKING
WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME
OF COLLECTION.
f
LEGEND
Albert H. Padovani, M.T. (ASCP), Director
RDS -
Recommend
Disinfect-
ing Water
Source
< - less than
TNTC =
Too Numerous Too
Count
. A OR
WLLL l.Vl "lI'LGltvly �rvni
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUTNAM COUNTY _ DEPARTMENT 0 AEALTH..
Office Use Only
11WELL LOCATION
STREET AOURESS: N /vl l W'61110 NUMBER:
�j, ..
WELL OWNER
NNE. AD- ss:
PRIVATE
❑ PUBLIC
USE OF WELL
1- primary
2 - secondary
j: R 1DEN IAL ❑ PUBLIC SUPPLY 0 AIR /COND. /HEAT P P O SANDONED
O BUSINESS ❑ FARM O TEST /OBSERVATION ❑ .OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY ❑
MOUNT OF USE
f
YIELD SOUGHT gpm. 1N0. PEOPLE SERVED 3 / EST. OF DAILY USAGEOTJ gal.
REASON FOR
DRILLING
EW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION
❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPTH DATA
WELL DEPTH f
'
LEVEL ft.
DATE MEASURED
DRILLING
EQUIPMENT
19,ROTARY ❑ COMPRESSED AIR PERCUSSION O DUG
0 WELL POINT ❑ CABLE PERCUSSION O OTHER (specify):
WELL TYPE
❑ SCREENED O OPEN END CASING. �Rl OPEN HOLE IN BEDROCK O OTHER.
CASING
DETAILS
TOTAL LENGTH ft
MATERIALS: ® STEEL O PLASTIC O OTHER
LENGTH.BELOW GRADE ft.
JOINTS: ❑ WELDED ® THREADED ❑ OTHER
DIAMETER in.
SEAL: ❑ CEMENT GROUT ❑ BENTONITE 10 OTHER
WEIGHT
PER FOOT 11K Ib. /ft.
DRIVE SHOEAf YES 0 KLINER:
O YES 13NO
SCREEN
DETAILS
DIAMETER (in)
'SLOT SIZE
LENGTH
(ft)
DEPTH TO SCREEN (it)
DEVELOPED?
FIRST
o YES ONO
GRAVEL PACK
O YES
❑ NO
GRAVEL
SIZE
DIAMETER
OF PACK in.
TOP
DEPTH ft.
80TTOM
DEPTH ft.
WELL YIELD TEST pumping
' If detailed
�
METH00: O PUMPED i tests were done is in-
COMPRESSED AIR formation attached?
O BAILED O OTHER i 0 YES 0 NO
1�1FLL LOG ff more detailed formation descriptions or sieve analyses
are available, please attach.
DEPTH FROM
SURFACE
water
Bear•
ing
well
D'a'
meter
FORMATION DESCRIPTION
poE,
ft.
ft
WELL DEPTH
ft.
DURATION
hr. min.
ORAWDOWN
ft.
YIELD
gpm.
Surface
`
WATER O CLEAR TEMP.
QUALITY O CLOUDY HARDNESS
O COLORED' ANALYZED? ❑ YES ONO
ANALYSIS ATTACHED? O YES O NO
STORAGE TANK: TYPE_.
CAPACITY GAL. .1 -0
PUMP INFORMATION ,
TYPE CAPACITY
MAKER. DEPTH 0
MODEL 2 VOL AGE'S HP
WELL DRI NAME DATE
ADORES `a���% %� Y GN-=RE
�a(J%
^a
PUTNF:M COUN'i'X DEPARZMENT OF HEALTH
DIVISION -OF ENVIRO i'AL_ F.EALTH_ SERVICES
Philip Keatinq Jr_
Owner or Purchaser of Building
Philip Keating Jr.
Building Constructed by
West Shore Drive
Location - Street
Town of Putnam Valley
Municipality
One Family Residence
Building Type
49 3 12.115
Section Block Lot
West Shore Acres
Subdivision Name
Lot #4
Subdivision Lot #
GUARA IEE OF SUBSURFACE SEVQAGE DISPOSAL 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 theretrD, 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 apt.?roval of the
' L., L. /_... J- 1.- l' 'I
o cu. a i Cr c7c{`�5' all'J
�,er i:11".�:Ca mac?. -vi �.�. �3 .:ri1C -Ion- ...:`TY } tea.: -^.^ -- f or t:7 .7....'�E 'C_... - LYJS�.. �:i - � r - � .
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.
Dated this 341 day of A/P tl 19,5 Signature
T
Title
v
General Contractor (Owner) - Signature
Corporation Name (if Corp.)
r.
Address
rev. 9/85
mk
Corporation Name (if Corp.)
West Shore Drive
Address
Putnam Valley, NY 10579
: 3
as . PUTNAM COUNTY :DEPART1VdEIVT OF �IEALTgI ENGINEER T0, PROVIDE PERMIT` #
ON CERT :FICATE F OMPLIAN-E
Division of fnvironmenial- Health.:Services Carmel N :Y )60 12 PERMIT
CONSTR CTION - PERMIT .FOR :SWAGE 'DISPOSAL. SYSTEM Putnam : Valley__. j
Town or illage
ter; .3t ar a7_ G �}3:'?
subdivision Wes Sho`r$. PiCr.e$ subd: ioE ii _ Renewal `Revision
—o _a
]Vh'' Philip -Keating,OSc -Lk._ ;Rd..r -
Owner /AddP €sa - - - - .Date OfPrevioas Approval
ut. a
Building Type >:One Fam o Res . 1_Ot. Area Fill Section only ❑
NUmb @r.Ot B @(ICOOmS Design Flow G /P /D lOQ;O P.C. R.` D bio£ificatiori Required i1
150.0
separate .`Sewerage::5ystem.ao cohsist of „ Gal. .Septic Tank and. °SOOriF' Of _,(f1e1dS .?. °. "!. O. C
To be constructed by Steve Ka'stuk Address Peeksk� 1 1 : <,' H I
,,
ollow Road
Water SuPPlyi Publir`SliPply °From
:Norman_ Anderson
Private Supply ,to be drilled by E
4dare-ss _ $aZ ger Strp%'t� F,� t -n am .`I�TY I n 5 79
Other Requirements 7•ft•:• CurtalII Dral -Il:
I represent _that .I am who_Ily. and completely.iespcinsibie for,the tlesIgnand location `of the, proposed system(s); lj that the separate sewage disposal system
above described will be constructed as shown on the approved amendment there_ o and in accordance with the standards,.rules and , regu a ions o e - u nam .
County Department of ._Health, -and that.on,completion'thereof a "Certficate' "of `Gonstruetlon'Compliance 'satisfactory_'fo' the Commissioner of. Health will "
be submittetl, fo ahe Department, ".and' a . written` guarantee ,will tie turmshed the owner, his successors; heirs or ass�gns:by the builder. that said builder wili
place in good operating condition rang part of said sewage ' disposal system:,during the period" tw,o (2) yeacs.immeiJiately following; the date of the isw
ance,'of the approval of -the Certificate oi. Construction Compliance` -of the "original system o .a y repays thereto 2)' hat the drilted;well: described above 1
will be- located as shown on -the approved plan'and 4Aafsaid welhwill be;insta in accordance it 'the standards, rul ':and regula i—f on3'. of, the,. Putnam ?
county oepartment of Health
r
11 1/85 ;
Date � : ., � .:� ,Si9netl ' � ` P E R.A. ' _
Address We se'.NO '
APPROVED FOR'CONSTRI`JCTlow This approval, expires one year from he to issue unless construction of the build has been undertaken and is
revocable for cause or may be amendetl o►'modiLed. when consi ed nec ssa y the: mmi
ssi of Health: Any, change r `alteration, of Construction I
requires' a new permit. Approved_ for posal of :domestic, tar swage and/ rrvate r .wpply only.
w-7- -'�.�`
Date BY Title
Rev. 6/85
PUTNAM COUNTY DEP.AFMENT OF HEALTH - DIVISION OF ENVIRONi ERML HEALTH SERVICES
INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS..
L FIE%D INSPECTION REPORT
DATE:
INSP
(Name of
INITIAL SITE Q+ I SPECTION (j
Wetlands on /or proximate to property. .........:....
Property liries or-corners found...''...*............'. :.
Can estimate house location ....'.z....
Will driveway 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 - D.H. 2 Lot
Depth to G.W. Depth to G.W.
Depth to rock Depth to rock
A
D.H. - Deep hole -
G.W _- Groundwater,
D.H_ 3 Lot
Depth to G.W. W >`
.Depth to rock
Soil Description
0 ft.
FINAL SITE INSPECTION
DATE:
INSP.BY: YES I NO
House SSDS located per approved plan... ......:.
Length of trench reasured _56o
Width of trench average _ 'De -
Slope of tile line and trench acceptable .........
Roam allowed for expansion trenches ...............
Over100 ft_ from watercourse ....................
Natural soil not stripped or SDS area
unnecessarlygraders ............................
10 ft. maintained fran property line, and
20 ft. from house ..............................
Distance well to SSDS (ft.) ......................
Number of bedrooms checks ........................
Stones, brush, stumps, rubble, etc., greater
than 15 ft. fran nearest trench................. .
15 ft. of peripheral soil horizontally
frantrench ..... .......................... <....
Boxes properly set ..............:................
Could surface runoff from driveway,:zoads,
ground surface, etc., channel near. SDS area....
Does lot drainage. appear OK-in area of SDS.....:,
t+ n iT T #+nm nl.V% f%V CTMV A ry- wlypif nT T?
MEN M
COMN�YTS .
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
John M. Simmons, M.D. I
Deputy Commissioner of Health - FIELD ACTIVITY REPORT.- Sheet ` of
INSPECTION
NAME Orig. Routine
n Orig. Complain
ADDRESS ` V Orig. Request
N&. Street M nicipality (T)(V)(C) Compliance
Complaint Comp
MAILING ADDRESS Final
P.O. Box Post Office Zip Code Group Illness
_ Construction
TELEPHONE
PERSON IN CHARGE
OR INTERVIEWED
C� Name and Title
DATE C �` TYPE FACILITY
TIME ARRIVED TIME LEFT
FINDINGS:
_ Reinspection
_ Field, Sampling Only
Field Conference
Other
Explain
INSPECTOR:
igna"ture and Title
PERSON IN CHARGE OR INTERVIEWED:
I acknowledge receipt of a copy of this SIGNATURE:
Field Activity Report ..................
TITLE:
TELEPHONE:
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Date 11/1/85
Re: Property of Mr. & Mrs.. Philip Keating
Located at West Shore Drive
(T) 49
Section - - - -- Block 3 Lot 12.115
Subdivision of West Shore Acres
Subdv. Lot # 4 Filed Map #
Gentlemen:
This letter is to authorize Joel L. Greenberg
Date
a duly licensed professional engineer or registered architect xx
(Indicate
to apply for a Construction Permit for a separate sewage system, to
serve the above noted property in accordance with the standards, rules
or regulations as promulagated 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
c� .iH %tl :n.►....a_ .S.tF'ei!t..i?3: co for, --ti - with- thc'_ - `rOv- 1sicns--of- Articic 11i, or... .....
147, Education Law
tary Code.
Countersigned:
P.E., R.A.,
Muscoot North
i,RFD #2.Bx 488
Address
Mahopac,NY 10541
628 -6613
Telephone
c Health Law, and the Putnam County Sani-
Very truly yours,
Sig
er of P I operty
Oscawana Lake Road
Address
Putnam Valley.NY 10579
Town
528 -3200
Telephone
• PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES.
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
DESIGN DATA SHEET - SEPARATE SLUAGE DISPOSAL SYSTEM FILE N0.
Owner Mr.
Located at
& Mrs. P. Keating Address Oscawana Lake Rd,Put. Val,NY 10579
(Street west Shore Dr. Sec. 49 Block 3 Lot _iii
n ica e nearest cross s eet
Municipality Putnam Valley Watershed Hudson Valley-
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME PERCOLATION PERCOLATION
Run Elapse. Depth to Water Water Level `
No. Time From Ground Surface in Inches Soil Rate
Start -Stop Min. Start Stop .Drop in. - Min. /in drop
Inches Inches Inches
PTH #11 •7:4.5'- 8:03 18 27 30 3 18/3 =6
2 8':04 ._8:22 18 27 30 3 18/3 =6
3 8 "23 . 8.41 18 in -i 1 R, / -a_r,
4 8:42 •9600 18 27 30 3 18/3 =6
5 9:01 9:19 18 27• 30 3 18/3 =6
PTH #9 1 7 . 'rin A - nR 1 R 98 30. 3 18,L3 -6
2 8:-09 8:27 18= 28 30 3 1•8/3=6�_�
3 8:28
8:46
18•
28 30 3 18/3 =6
4 8:47
9:05
18
28 30. 3 .18/8=6
Notes: 1) Tests'to be repeated at same depth until approximatelyy 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.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION
DESCRIPTION OF SOT.LS ENCOUNTERED IN TEST HOLES
-
DEPTH HOLE NO. DTH #1 HOLE NO. HOLE NO.
6" Sand & Stones
12"
_
18" n
24"
3
42"
48'!
54••
60"
INDICATE LEVEL'Ai' WHICH GROUND WATER IS *ENCOUNTERED NONE
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
5' -0"
TESTS MADE BY Joel L. Greenberg Date 10/1/85
-
Soil Rate Used 6 -7 Min/1 "Drop: S.D. Usable Area Provided
5000SF
No. of Bedrooms Septic Tank Capacity 150p_Gals.
: " xxx 3b��
Absorption Area •Provide By 500 h. F x24
e1.
7 Ft. Curtain Drain'
Name Joel L. Green- „e,rg.,
Address Mu_Groot No- R D #2 Bx 488 SEAL
Mahn? nn MV 1 (lgdl �
j 0I110,1-
110
-t
-
THIS .SPACE FOR USE BY HEALTH DEPARTP I T ONLY: o� NEB
Soil Rate Approved Sq. Ft /Cal.. Checked by
Date