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HomeMy WebLinkAbout1273DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.70 -1 -42 BOX 12 01273 .� L j, ,� , IN IN him J �Nir� IN �. IN ' IN IN IN A L J 2L 01273 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES' DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address —6 Ye,,�"oM --oz Located at.(Stteet)' Tax Map af-70 Block 1 Lot 410- (indicate nearest cross street) Municipality ;P,4fr0-K-60A1 Watershed j-: Date of Pre-soaking SOIL PERCOLATION TEST DATA AV percolation test hole. (i.e. g I min for 1-30 min/inch, -,q 2 min for 31-60 min/inch) All data to be submitted for review. V/- /- .. -... .. �-. Date of Percolation Test g��0/0 X., XX .. .. .... r X- ... Water. From r d Level Percolation :' x�me X, . . ... ............ ............................. . . . ............... .... . . . B'd . . ... op . .. nc lNLWInch ...... . ..................... � YA/Izo YOZIS5,5 O Z 6F 3 4 5 2 3 4, e�f e- 3 4 5 NOTES: I Tests to be repeated at same depth until approximately equal percolation rates are obtained at each 2. Depth measurements to be made from top of hole. Form DD-97 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: Date Design Professional Name: Address: Signature:. Desigq Professi TEST PIT DATA -2 DESCRIPTION OF SOILS ENCOUNTERED IN TESL' HOLES ._ .. . DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. 0.5' �.�Q ; ~54/W 1.0' �l c 2.0' 2-0 - 2.5' ;. 3.0' 3.5' r; 4.5' 5.0' 5.5'. 6.0' 6.5' 8.51 9.5' 10.0' _. 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: Date Design Professional Name: Address: Signature:. Desigq Professi ° PUTNAM 'COUNTY DEPARTMENT OF HEALTH DIVISION. OF ENVIRONMENT HEALTH SERVICES INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM SECTION A. GENERAL INFORMATION Name of Project �SaAl County Site Location S r,/ l ,ZT , -70 1 3/2 Building construction begun /(/© Extent Is property within NYC Watershed ? ................. Yes F__J No SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. Hilly Rolling Steep slope Gentle slope 0 Flat 2. F_� Evidence of wetlands 0 Low area subject to flooding F_� Bodies of water Drainage ditches dRock outcrops �. Property lines or comer - - rs evident ...................... � Yes ffNo 4. Do water courses exist on or adjoin the property? °!+l ..&,eN.X>. a Yes No 5. Will these affect the de 'sign of the sewage system facilities ?............ Yes ���No. 6. Do watershed regulations apply in this development ? ....................... Yes F_� No. 7 Will extensive grading be necessary? F_� Yes No _ ;8.,._.W.ill extensive fill be necessary'for SSTS? .: :.:............................ Yes a No 9. Do filled areas exist within the SSTS area? ....... ........... ..................... Yes No If yes, what is the condition of the fill? SECTION C. -SOIL OBSERVATIONS 10. Appearance of soil: and F__J Gravel . Loam Clay F_� Hardpan Q Mixture 11. Observed from: 0 Borings F_� Bank cut E�J Backhoe excavations 12. Soil borings /excavations observed by 13. Depth to groundwater , A� ,,V on 1 14. Depth to mottling AjoN on 15. Are test holes representative of primary & reserve areas ... :................................. I PGTZG . t � 'rIA14 c,41,1ve6;&6 D 16. Soil percolation tests made by pug, 1-o 5#9�Go� .�ozfs on 17. Soil percolation tests witnessed by - 6, 7 "TD fi G_ H,. on SECTION D (on back) I Form ST4 2 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 require. special consideration? ..................... F--J Yes No r 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? ......................... Yes MNo SEGTI ®N 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? ..................... ......................:........ Ef Yes No 23. Additional comments 24. Site observer /inspector and title 69d 'D Fn tft , G, tD 1� 25. Date(s) of observation(s)inspection(s) _0/ /a 8 LO TEST PIT PROFILES Hole # Lot # Hole # Lot # . Hole # Lot # Depth to water Depth to water . Depth to water Depth to mottling -Depth to mottluig - - Uepth to mottling Depth to rock/imp. Depth to rock/imp. Depth to rock/imp. G.L. G.L. G.L.. - a 0.5 0.5 0.5 1.0' 1.0 .1.0 2.0 2.0 2.01-- 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 05/18/01 09:46 BRUCE aL FOLEY Public health Director PW SCOTT 3 19142787921 DEPARTMENT OF 1 Geneva Road Brewster, Mew fork HEALTH I0509 LORE Eft MOLEdVARI R.N., M.S..N. Aisorinte Public Health Director Director of Patient Services 0 Al -AM STIEBEI,ING d GENE REED .All information below must l -env completed prior to any scheduling. DATE- 6' /ia ai ENGINEER OR RRM; —E . W. SCOTT ". 189!9& 0- C. PHONE #: REASON: DEEPS: ft PERCS: ,e PUMP TEST: o ROAD/STREET: 514 C. lm &)2 TOWN: E &M9 6e -ri TAX "fl: 25. 70 OWNER: J ®5 =-rl$ RgL& u, 6 'r % '� a .;. ,, „ u_ i; • �� DIES N7 0 Proposed SS I'S within the drainage basin of West Branch or Boyds Cotner Reservoirs. ® Proposed S! TS within 500 feet of a reservoir, reservoir stem or control lake.. 0 6/, Proposed S! TS within 200 feet of a watercourse or a DEC wetland. 0 Proposed S:,TS design flow greater than 1000 gallons /day or SPDES Kermit required. 0 c Proposed S.' TS for a Commerical Project. It is the responsibility of tht design professional to provide the above information prior to soil testing,. This Department will deta ravine the NYCIDEP project status (Joint or (Delegated) based on the response. If you answercc = to any of the questions, NYCDEP must wetness the soil tcsting. This Department will coordinate: a mutually suitable time for field testing with the PCDOH, the Design Professional and NYCIDE.P. If a project has been determined to be Delegated based on the above response and these subsequent information indicates NYC DEP is required to witness the soil testing, it will be the sole responsibility of the design professional tc schedule re- witnessing of the soil testing with NYCDEP. rr I(,/ /5—FOR COUNTY USE ONLY DAYS: (FMLDTEST) 004q Cram. berry Mountain ,- \INildlife Management Cc 2 o LI � �. p e� a ----- I 68 i RD 22 �P _•f� N 1 mviland • 164 i 65 ''I T 9' $ - „3 R v 'A, • u..,t . Epp DENin ,t r C Hainss T i Homers ''¢ o .� 0 0f 1F pry/pYN AT D �... 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