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HomeMy WebLinkAbout0813DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 24. -2 -42 BOX 9 11 y,, , L, . ir - . me a INN B 00813 PUTNAM COUNTY DEPARTMENT OF.-HEALTH. DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET.- SUBSURFACE. SEWAGE.TREATME NT SYSTEM Owner ZC AAI--/ Located at (Street) Tax Mapj.-O' Block 01' Lot f,:V- (indicate nearest cross street) Municipality Watershed Fxs-r-, ti-(e -it SOIL PERCOLATION TEST DATA- Daieof Pre - soaking Date of Percolation Test 1 2-40 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I min f6r 1-30 min/inch, :5 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from to p of hole. Form DD-97 .0 ep a .:.:>.:< : o:: - , ter X-X t 11,', .......... .. ......... >.::.:::.:: roun A .:.:::;::.,St it- t :.xX. a j 3 _3 83,3 .4 3J 0_a-- 3,27 a2 5 ;2- 1 91,12 3 0 /a. 4 -1y 30 2 60 )74N 7 1 Y# 3 60. 17Y' 4 5 2 3 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I min f6r 1-30 min/inch, :5 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from to p of hole. Form DD-97 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IMTEST HOLES DEPTH HOLE NO. HOLE NO­.-' HOLE NO. G.L. Lo 2.0 2.5 3.01 151 4.01 4J 5.01, 6.01 &Ia4w, 6.15' 7.0' 7.51 8.01 8.5' .5 9.01. 9.51 10.01 lyef -7 r 2 Indicate. level. at which groundwater is. encountered Indicate level at which mottling is observed Indicate level to which water level rises after being-encountered Deep hole observations made by: �, D,1—(_ Date 4Z, 0 Design Professional. Name: . Address:- Signature: Design Professional' s'Seal x D11 q ply 9 PUTNAM COUNTY DEPARTMENT OF: HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM. Owner f3oc, 9A6_jAAj' Address 9�� _M?AAt,9 Z;,;/, Located at (Street) Tax Map .2� Block Z Lot 5V.-Z, (indicate nearest cross street) Municipality Watershed � 57- F_ .41 V4 R SOIL PERCOLATION TEST DATA- Date of Pre-soaking Zj�Cya Date of Percolation Test NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. :5 1 min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 Dep 't a to' t r Water Fro m "" eve I 'P erctftwq. No R N' Time t ... S Eta se ime "Surface Pr Inches ­-Hole Star. :Stogy n C )-1" 30 30 2 55 Y'k 40 3 4 2 '31(/57 a � /-:7. J C? 3 -3'4? 30 4 5 2 3 4 5- NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. :5 1 min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 DEPTH G.L. 0.5- 1.0' 2.0' " 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5'` 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN.TEST HOLES r HOLE NO. HOLE NO HOLE NO. , 9 2 Indicate level at which groundwater is encountered --- Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: Design Professional Name: Address: Signature: Design Professional's Seal i Date 5; i o , PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM SECTION A. GENERAL INFORMATION Name of Project '?>ue#.46ZO. & ) E� S©l✓ County T 1 /zA0/�i Site Location- Building construction begun AZ<p r Extent Is properly within NYC Watershed ? ................. Yes No SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. F Billy F- I Rolling 0 Steep slope F,/ Gentle slope 0 Flat 2. F--J Evidence of wetlands Drainage ditches F7 ? Low area subject to flooding Bodies of water !✓lA are Rock outcropss7-,z,g,,� . 3. Property lines or corners evident ....................... .............:................. Yes .4. Do water courses exist on or adjoin the property? ............................ Yes 5. Will these affect the design of the sewage system facilities ?............ Yes 6. Do watershed regulations apply in this development ? .......................Yes 7 Will extensive,grading_be necessary? .......................... —T7.Y.es 8. Will extensive fill be necessary for SSTS? ......... ............................... . E"Yes 9. Do filled areas exist within the SSTS area? ........ ............................... n Yes 0 No No 0 No No En-"No._. _ ..... _. _. 0 No . FNo If yes, what is the condition of the fill? _ SECTION C. SOIL OBSERVATIONS 10. Appearance of soil: � Sand � Gravel -Loam ❑ Clay � Hardpan Mixture 11. Observed from: F--]'Borings F--� Bank cut F--] Backhoe excavations 12. Soil borings /excavations observed by _ -4" 7 6jep 4. D, h', r on 13. Depth to groundwater -- C `' /lo% 0K 3 on 14. Depth to mottling ,2 ' 6 on 15. Are test holes representative of primary & reserve areas ...... /"�v ✓f'f� .............................. 16. Soil percolation tests made by C�%' Ica on 17. Soil percolation tests witnessed by 4�" 77 g5--- D p, C, P hf. on SECTION D (on back) 5, Form ST -1 2 SECTION D. DRAINAGE - - - 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? F_-] Yes [2fNo 19. Will groundwater or surface drainage require special consideration? ..................... ffYes a No 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? ......................... a Yes rZrNo SECTION E. REMARKS 21. If a common water supply is proposed; has an inspection been made of the existing or proposed source and facilities? ................................ ............................... F Yes ©No Inspection data 22. Do adjacent wells and/or sewage systems exist ?......... f:!? ......................... Yes a No 23. Additional comments 24. Site observer /inspector and title��� 25. Date(s) of observation(s)inspection(s) /2 1 /y g TEST PIT PROFILES Hole # Lot # Hole # 'Lot # Hole # Lot # Depth to water Depth'to water Depth to water Depth to mottling Depth to mottling Depth to mottling Depth -to rock/imp: - - Depth to rock/imp: Depth to roc imp. G.L. G.L. G.L. a 0.5 .0.5 0.5 1.0 1.0 1.0 2.0 2.0 2.0 3.0 3.0 3.0 4.0 4.0 4.0 5.0 5.0 5.0 6.0 6.0 6.0 7.0 7.0 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 05/01!02 12:02 p. r" ap=1 R. FOLEY PUblir Health Director pW SCOTT 4 845 -279 -7921 DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 • • ! t 11i i � .n LORETfA MOLINARI R.N., M.S.M. Assot:tate Public Neagh Director Director Of Patient Services ATTENTION: o AM M STIEBEYLI G GENE REED All information below must be fulLy completed prior to any scheduling. DATE: 1. ENGINEER OR VIRM; Q, / Cii.;_AC, PHONE #: ��8 � 11 y REA5ON: • DEl :PS: VL PERCS: )e PUMP T--EST: o ROAD /STREET: TOWN P — Qw1 - -- - - - TAX MAP"- 8l� t;. StMDIVISION: LOTS: OWNER: ISy -tJ NYCDEP CRITERIA FtM.IQINT RI ME`OV AND 'WYTNEMENG E SOIL TESTING YES NO G Proposed SSTS within the drainage basin of West Branch or Boyds Corner- Reservoirs:' ' o Proposed_5STS.,vithin 500-feet-of-a rtservoir, reservoir stem or control lake. - ❑ Proposed SSTS within 200 feet of a watercourse or a DEC wetland. ❑ Proposed SSTS t'esign flow greater than 1000 galionslday or SPDES Permit required. D 9 Proposed SSTS ()r a Commerical Project. It is the responsibility of the desi;;n professional to provide the above information prior to soil testing. This Department will determine: the NYCDEP project status (Joint or Delegated) based on the response. If you answered ;:" to any of the questions, NYCDEP must witness the soil testing. This Department will coordinate a m,tually suitable time for field testing with the PCDOH, the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil testing, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. _ FOR COUNTY USE ONLY eD COM. ,%(Z Ts.. (MLI DIEST) AIt3MC • DI 1T1,16M (^f11 IAITV r1,:00PTm;:WT n;7 P � -- -r N 960000 ---- -I -- -_ - TFO - _ .-' P/0 14-1-51 ° t8 7s4 �6 41 IW 40 e 4 nu y xoT.e s 4s�• 24.07 ' 84 VI 3zes. a l „�1� �. �o• `1� �i� Y"\ �• 42 � �+ 'cgs I) `� A B�� 18.38 AC CAL. • M9.97 s l !� I I � % 39 4.07 � / AL 22.17 AC. 38 233.91 207.70 4TO.OG B:B & �0 •'y37 Qr 43.1 a I A, 1 / 2 AL / Z 96 AC. CAL. 2j J 6z 9 J v 2 • I ' 44 . 43.2 161. x020 mGy 11.66AC. AL t AL i us7.s7 e � 36op 20412 203.1 ►4201 0440 6, 5° m J° i` 15o 1 9 0 o $ 214.2x45.1 I , / x J i 4.66 AC. BUJ. / ` JAL / _ 357.72 46 1 i J,/ e AL AL AL 34 * I 94.90 AC. I •� y 121.82 AC. 3.18 AG 1 I CAL 140x9 X47 "r d I -� 48 m _. .._ ..... .... -y ... t �- a9.oe g.. _ _ PI :31 AC• �sab•�s .. _ ._ ._ d I AL * n 1.62 ,A�C 49 I 32 1.36 ACS �`" 1 *,� q _ 11.33 AC 1.95 A31 V,,.a� �' f . /'/ /•� AL `` • ' Q A 30aa 8a C. I AL AL 29 �� �: 12.73 AC. + 5.51 '� \ \ \ `yyq. AC. 8`ti �� I \ AL Y 9 \ \ 6.03 AC. ? AL . 2T +`•.0 51'1 \ {p 32.50 AC. CAL. \ 12.47 AC. 'mot, ,53 1.15 et - - ' ; \ 8 s _ BSI AL 5sµ mMzs e 9 ` - - - 235100 ' I \ \ 26 i 10 \ \ Yom, ` AL \ \\' 26.47 AC. \\ / 1 4.97 AC CAL. n4s.is `, N \ J � r ' 1341.63 . SS I Y 14 ` 76.584 AC. I t�- 25 j 220.60 6T AC. : A- ' I I µ 11.72\AC. CAL. X56 J I 32.65 AC. Irtc. ' 29423 312 Y4 371.56 3071.9+ 361.57 ` 13 ez.1 AL '"' ' s 31E 4 792 AC. r ' � ,n - 1p 5.66 AC. cw 1 12 6a.,. 3.51, AC. CAL. 44 38.56 AC. ,� i 22 LTG AC. ° s AL ��� 12.14 AC, 623 / 2193 AC s IM.Ito PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner 1314A4121, 1-1-el Address gg:51: 2924P Located at (Street) At4VZ1-,4A1Z2 X&aD Tax Map .211, Block , 2- Lot 412- (indicate nearest cross street) Municipality rAM5VAI Watershed 5,4-sZ: F7AA16,q SOIL PERCOLATION TEST DATA Date of Pre - soaking 6 IJ6 a Date of Percolation Test - A3 ' -Z NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for-review.. 2.' Depth measurements to be made ftom top of hole. Form DD-97 . ........... ...... . . ............. ......... p r6ml S 0: A IX X: a. A st xv a LAL. 101100 - /Lill 20 ;L 2 7,3 3 2,/ 4 5 /0.131 30 20 22.4 ;z '14 2 - 1/.'02 3 C9 10 1;? 3 / /, 02 32 3O .20 n;— 4 5 2 3 4 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for-review.. 2.' Depth measurements to be made ftom top of hole. Form DD-97 DEPTH G.L. 0.5' 1.0' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' . 8.0' 8.5' 9.0' 10.0' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO. HOLE HOLE NO. 3 _ I MA i Indicate level at which groundwater is encountered !�,, 5 Indicate level at which mottling is observed Indicate level to which water level rises after being encountered �� S Deep hole observations made by: �', �e eR p, G, y, �4 _ Date 6//7/&3 Design Professional Name: Address: Signature: Design Professional's Seal ,I f'� 1. ✓44r 'PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM SECTION A. GENERAL INFORMATION Name of Project add D ,1-461 -L-0m 8Arr_,z:R5 o v County ROZZZ9,121 Site Location - e#31- 139AA14H 41, - ;7- Building construction begun Al O Extent �-- y Is property within NYC Watershed ? ................. [?T Yes No SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. 0 -Billy- .0 Rolling 0 teep slope . 7Gentle slope a Flat ' X80 2. Q Evidence of wetlands 71 Low area subl 'ect to flooding a- Bodies of water Drainage ditches a Rock.outcrops 3. Property lines or corners evident ....................... ............................... 0 es No 4. 'Do water courses exist on or adjoin the property? *Mi law blWW .w 5. Will these affect the design of the sewage system facilities ?............ Yes Yes No. No'f"2o�' 6. Do watershed regulations apply in this development ? ....................... EaYes F� No 7 Will extensive grading be necessary? ................. ............................... a Yes o 8. Will extensive fill be necessary for SSTS ?.......................... ................ Yes No' 9. Do filled areas exist within the SSTS area ? ....................................... 0 Yes No If yes, what is the condition of the fill? s SECTION C. SOIL OBSERVATIONS 10. Appearance of soil: Q Sand Q Gravel Loam Clay F7 Hardpan Mixture 11. Observed from: 0 Borings F7_J Bank cut ffBackhoe excavations 12. Soil borings/excavations observed by �, KF_F,'D �, /-� on a 13. Depth to groundwater A. 3 on 14. Depth to mottling 3 , S ' ,o(� 3 on 15. Are test holes representative of primary & reserve areas ...... ............................... 16. Soil percolation tests made byiV�/7"� ail jam, on 17. Soil percolation tests witnessed by e �FeE7 `P G, T?.f or SECTION D (on back) 0 Form ST -1 SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? Yes (No 19. Will groundwater or surface drainage requir6 special consideiation? ..................... Yes F-1 20. Will gullies, ditches, etc.-, be filled and watercourses be relocated? .......................... Yes dNoo SECTION E. REMARKS. 21. If a common water supply is proposed, has an inspection been made of the existing or proposed source and facilities? ...................................................... ......... FlYes �No Inspection data 22. Do adjacent wells and/or sewage systems exist? ........................................................ ElYes .-No 23. Additional comments A-x 115 1- 4e A y prg -t-A on 1y Alt, &Aee llltw 24.. Site observqr/fiMector and title e,, 12, t 25. Date(s)- of observation(s)inspection(s) fv //7 _3 TEST PIT. PROFILES Hole # Lot # Hole # 'Lot # Hole # Lot# Depth to water Depth to water Depth to water Depth to mottling Depth.to. mottling .,...--,-.Depth to mottling Depth to rock/imp. G.L. Depth to rock/imp. G.L. 0.5 .0.5 1.0 2.0 Depth to rock/imp. G.L. 0.5 1.0. 1.0 2.0 2'.0 3.0 3.0 4.0 4.0 5.0 5.0 - 3.0 4.0 5.0 6.0 6.0 6.0 7.0 8.0 9.0 10.0 7.0 8.0 7.0 8.0 9.0 9.0 10.0 10.0 e F, • 5Q °Ip�e 106. 6 N6RpL i 4rp6 s? IL a 0 M }O Zd T� a� M N 0 J �U Id r q � � J � m 4 p � U s+' c f / a Q / .5 °07 Iii "W 450.44.2' � Ivy A 0. Y. J � u a a m • Qa z 1 / NOTEi h/ r UVE ro ERROR ` I / 'MM SURVEY p CaA-ra uml4NO4 L / PFMPaRSeo 8 p A -Jr, Fcv-r FRO J . NEGB�BARK. fI I - ,j Ceri k"Non9 lndia'Q harao �. exww"s eed9 of prul iee for l 0 profeo9roeal Laid So? 11 5 J viii curvey 10.29 pftpered, ar e a evict' g n d r la�ng lost, Nl . 9 / 9 1 , 9- M gale pu Cer"iif 0616119 are Mt it' •99491 ti On y eopie9 fi°m il+e migloa z y v>tr9 Land Sorveyer't irked o Rg MA INS Op ^ 0 Copies. Srm"Or FOUND gr,ON � if .06.. "A ou"c _ •�� a violalt"l Eduq�;°„ Law, - 'TMe l.egt�en � a� 64underyreuld c ar ky eerTfied. h� Mno ra Ctfiifled tbi w.��.-0.. ', a s? IL a 0 M }O Zd T� a� M N 0 J �U Id r q � � J � m 4 p � U s+' c f / a Q / .5 °07 Iii "W 450.44.2' � Ivy A 0. Y. J � u a a m • Qa z 1 / NOTEi h/ r UVE ro ERROR ` I / 'MM SURVEY p CaA-ra uml4NO4 L / PFMPaRSeo 8 p A -Jr, Fcv-r FRO J . NEGB�BARK. fI I - ,j Ceri k"Non9 lndia'Q harao �. exww"s eed9 of prul iee for l 0 profeo9roeal Laid So? 11 5 J viii curvey 10.29 pftpered, ar e a evict' g n d r la�ng lost, Nl . 9 / 9 1 , 9- M gale pu Cer"iif 0616119 are Mt it' •99491 ti On y eopie9 fi°m il+e migloa z y v>tr9 Land Sorveyer't irked o Rg MA INS Op l• Copies. Srm"Or FOUND gr,ON � if In add41.9, U.&A6A8cd oN $uryeywjs Sall is _ •�� a violalt"l Eduq�;°„ Law, - 'TMe l.egt�en � a� 64underyreuld c ar ky eerTfied. h� ra Ctfiifled tbi w.��.-0.. ', JUN - 9-2003 12:36 FROM:INSITE ENGINEERING 8452259717 TO:2787921 P:1 /1 BRUCE R. FOLEY 'ublic Kealtb Director DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S,N, Associate Public Health Director Director of Patient Servtd a R -Ek -.�T- EORVID RSONCa ATTENTION: ra ADAM STIEBELING ❑ GENE REED All. information below must be Aft completed prior to any scheduling. DATE: Ct .hot(a WA-TC-oai e E ENGINEER OR FIRM: 1 Ns "''C�' PHONE #: Z7JS' 9C� iO REASON: DEEPS: X PERCS:;� PUMP TEST: o ROAMSTREET: 9)tl.-r TOWN: I TAX MAP# : Z-�"Z' SUBDIVISION: %1 (A LOTM OWNER: tl�Nt"'-t I> L.I C.- , .. YES NO u Proposed SSTS within the drainage basin of West Srancfi or Boyds Corner Reservoirs. U Proposed SSTS within 500 feet of A reservoir, reservoir stem or control Inke. ❑ Proposed SSTS within 200 feet of a watercourse or a DEC wetland. ❑ Proposed SSTS design flow greater than 1000 gallons/day or SPDES Permit required. 0 Proposed SSTS for a Commerical Project. It is the responsibility of the design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered na to any of the questions, NYCDEP must witness the soil testing. This Department will coordinate a mutually suitable time for field testing with the PCDOH, the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is.required to witness the soil testing, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. L16a FOR COUNTV IISEONI.V DATE: 3,'00 COMMENTS; (FIEiLDTEST) TIME! I a Anowledge. receipt of this 'report: SIGNATURE 02/96 Title;._ P/O 14-1-56 41 19210 a' 1 40 X_ 24.07 7 AL tn ?4F 42 A.S.. 18.38 AC CAL, 24.07, N, 39 22. I7 X 38 233.91 HER a 1. All� .,Ss A AL 37 4 43.1 GT 4.96 At CAL. AL 444 UT)AC;�� CAL. 2024. 44 11.66AC. T4 201 ti AL -440 ts At AL 214.zz 45.1 4.66 AC. 46 34 94.90 AC. 3.18 4 AC, 127.82 AC. CAL. 2 .;!ACI. 47 z O 0 7; 48 40 i AL AL 11.31 AC. \,s Y 5 32, 49 AL 11.33 AC -1.95 AC. AL At' lL 50 29 12.7; AC. 5.51 At' 9 AL At 603 A ,o 32.50 AC. CAL. 27 52 , 51 , -,J�.47 AC. A • L AL 54 10 26 AL AL 26.47 AC. 1145.75 14.97 AC) CAL. AL 14 25 t,A 76.;84 AC. 6. AC. 220.60 11.72 AC. CAL. - 56 32.6; AC. . 925 I IlT is Ac. AL 199.90 312 24 371.50 361.57 3071.94 23 . ?I AL rn Moo 7.92 AC. Q 12 5.66 AC. eft 0 11.0-1 . Ln I sit s ." I L„ A 3.5 1, AC. CAL. 44 38.56 AC. 22 22 b 31 12.14 AC. » 62.3 AL 2.8SAC. JAL 15 A 62.5 21 5.94 AC. 62.4 2.9AC,