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HomeMy WebLinkAbout2891DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62.13 -2 -15 BOX 24 I loom 1 . - All' i r No I ` • 1 1� .1 .1' '' all i IrV ?, 'r I 6 r Ll Voi r 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