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HomeMy WebLinkAbout0945DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.40 -2 -25 BOX 10 lime to p 11 me i . .s .�- 00945 05/17/01 19:45 _ $RUCE' R. i:OLEY Public Health Director ATTENTION: PW SCOTT -3, 2787921 NO.003 006 ; . 7C A A. L4RE_ft4 'MOLINARI R.N., NUN. Associate Public H021th Drettar . Direcror of Panent Serv+ctt DEPARTMENT OF 1 EALTH 1 Geneva Road Brewster, New York 10509 . 0. 1 .a AI►AM STIEBELIriG AGENE REED All information below must 1►e hAL% completed prior to any scheduling. DAM 6_Z14&1 ENGINEER OR FIRM : -f : w• Sort jA:!C f ;� P C • PHONE a: gyS 97 d� :l I 1 O REASO�1: SEEPS: 1R PERCS: Ja PUMP TEST: o ROAD(STREET: Ho _EarL y4noyn TOWN: TAX MAP #: AT'- y0 -.A • 3 S" SUBDIVISION: LOT/#: ►`, OWNER: Jn scplit 6�'12.R -1 NYCDEP CRIT E 19 t FUR JOINT REVIEW AND WITNESSING OF SOIL. TESTING YES. Proposed SS IS within the drainage basin of West Branch or Soy& Corner Reservoirs. 13 Proposed S! TS within 500 feet of a reservoir, reservoir stem or control lake- 13 d Proposed S' TS within 200 feet of a ovatercoucse or..a DEQ we!Lgnd:...._ 0 �d Proposed S; TS design flow greater than 1400 oallonslday or SPDES Permit required. . O o' Proposed S: TS for a Commerical Project. - It is the responsibility of the design professional to provide the above information prior to soil testing. This Department will Jett rmine the NYCDEP project status (Joint or Delegated) based on the response. If you answemi ;A 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 u schedule re- witnessing of the soil testing with NYCDEP. 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'� �: !• : ; } i ;' r ;t t � /:�..'•�;'rcw_�, '• `--- '..♦.,^. .nile..I.r - -; ` � � - a...�� �.. =' ±}.. =� -� �f r ; f ? , 1 .'�. !t �t��, �:T•: .�,-4 is •11' — =` - `1� •p� � i. i. t , ,t ���� j,�'j :.; t''ltal _1( 3 S! ,.�' 1 i;' i �V.+�'�� �'. � '` I •i •.fi ZI ry 1.`:=._ , l .r �: `�l.. � /• .. i. �1` '� y I •( ii '.'•. l' h:, " i:.y��c °.. :'. ;•.�. ',�.. ,' •1n .: � R� M^ >•+ S r�: •,Yl- • 1.j�' ! t '' •1 �. •.. •R• ^'� �1. ,' . ,� 1 '�. �•� . jJ! .y iLiy)ta : ' .ti o= '� v .��.'.�, � .-.— . 7— ' •.) 1 . a • r ;'� I Pi S. . .� iT ''•.' �� a 1 .►�, t {l/.�l•�, q•.� � y 1,. 1�t fir. '''p �. i ^ 1 tl ' �T ,•�'iT-- �:•�f�:1� �,• � - li.�..i��• �j '��• •�: �•. .� •.• •t� �y�'' ••r � ie•�• jP Ate• � �� �'X im 5 DEPTH . G.L. 0.5' woL',�-er 5cep4p� Indicate level at wliich groundwater is encountered - - = =—t� Indicate level at which mottling is observed . _ -__ _. _Now _✓ _ _ Indicate level to :which water level rises after being encountered = ---- - -- - -- = - = -- - = - - = - == - - Dee hole observations made b : - �� I-F. P Y �, �. G _ Date T t__ t 1T_ Design Professional's Seal --_" COUNTY DEPARTMENT O]F HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM SECTION A. GENERAL INFORMATION 'Name of Project D,9rr�rzsoey County- vTNJai7 Site Location llowEx IKZ 2-67,# - _a5_ Building construction begun _` �/o Extent Is property within NYC Watershed ? .....:........... ffYes No SECTION B. TOPOGRAPHY (Please eck all appropria ores) r 1. F y 0 Rolling Steep, slope.: _ Gentle slope - a Flat Prna TIT- 2. Evidence of wetlands Low area subject to flooding Bodies of water Drainage, ditches _ F-71 Ro&outcrops - _ - 3. Property ':li.ne_ s or comers No Y 4. Do water courses exist on or adjoin the property? ...... - - Will "these affect the design of the sewage system facilities ?............ Yes_ No 6.. Do watershed regulations apply in this development ? ....................... Yes No 7 -:Will extensive grading be necessary? ...... ............................... Yes No - 11. �'Vill cxtei3sive nil tie necessary for SSTS ?.........� ...:................ Yes ! " No 9. Do filled areas exist within the SSTS area ?..: .::........................ Yes a No If yes, what is the condition of -the fill ?AO�P -S �r� ,2�Yal��i�t S ©ehist =� =- - - - - -- -- SECTION C -SOIL OBSE VATIONS _ - Fpm..... 10. Appearance of soil . Sand D Gravel . Loam Clay E] Hardpan F-1 Mixture 11. Observed from: Fl Borings F_� Bank cut Backhoe excavations 12. Soil borings /excavations, observed.by 5>-G. b& on 2.G o 13. Depth to groundwater 14. Depth to mottling - N�> on 15. Are. test holes representative of primary & reserve areas ...... .........................:..... Yes . 0 No 16. Soil percolation tests made by on .17. Soil percolation tests witnessed by SECTION D (on back) _ ---------- --------------- - - - - -- -Form ST-1---- - - - - -- ....... ti SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? Y E 19. Will groundwater or surface drainage require. special consideration?.. ..................Yes a No 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? ........................ Yes No SECTION E. REMARKS 21. If a common water supply is proposed, has an inspection been made of the existing or proposed source and facilities ? ................ . ............................... _ ... 0 Yes E No Inspection data 22: Do adjacent wells'and/or sewage systems exist ?....... ......................................... Yes 0 No - - - _ _ 23 Additional comments 'i5� &6d9L LS AIM 24. __Site _.observer /inspectorand title - - - 25. Date(s) of observation(s)inspection s 2 R, " - - TEST PIT PROFILES _--_.__._.__-.-_--_-_.- �_.--- _- ..__�_- __._.__.� - -_.._ =:Hole # - ­-Lot # Depth to water Depth to water - Depth_to water Depth tQ- mottling._ 'Depth Yo mottiing Depth to mottling Depth to rocklimp. Depth to rock/imp: ,Depth to rock/imp: ti SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? Y E 19. Will groundwater or surface drainage require. special consideration?.. ..................Yes a No 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? ........................ Yes No SECTION E. REMARKS 21. If a common water supply is proposed, has an inspection been made of the existing or proposed source and facilities ? ................ . ............................... _ ... 0 Yes E No Inspection data 22: Do adjacent wells'and/or sewage systems exist ?....... ......................................... Yes 0 No - - - _ _ 23 Additional comments 'i5� &6d9L LS AIM 24. __Site _.observer /inspectorand title - - - 25. Date(s) of observation(s)inspection s 2 R, " - - TEST PIT PROFILES Hole # Lot # Hole # :.,.- .> _.- .. _Lot # -. =:Hole # - ­-Lot # Depth to water Depth to water - Depth_to water Depth tQ- mottling._ 'Depth Yo mottiing Depth to mottling Depth to rocklimp. Depth to rock/imp: ,Depth to rock/imp: - - -- 0.5 _ _ . -------- -- -- - - - -- 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 . --------- - - - - -- - .....__..--- 100_ - . - - - - -- - - -_ _.. - -- 10.