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Home My WebLink About1491DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -3 -31.41 & 42 BOX 14 - _ .' JL . 01491 r, �7- BRUCE R- FOLEY LORETTA MOLINARI RN., M.S.N. Public Neclth "Director I-Aw. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, Now York 10509 Loan g a ATTENTION: 0 ADAM STIEBELING }GENE REED All information below niust be ful1Y completed prior to any scheduling. DATE: ENGINEER OR FIRM: PHONE #: D -7L(o Z 74P /0' Q REASON: DEEPS: PERCS: PUMP TEST: 0 ROAD /STREET: IM i C } � �P,�Q,� ! s-sn *Je f gy) TowN • �►�-c ,_ � T.AX M.�P #: 37,— 3 l SUBDIVISION: (3w? -to1-6 %Ir,E.& P0 LOT #: J. OWNER. O NYCDEF CRUERIA FOR JOINT REVIEW AND WITNESSING OF SOIL TESTING YVS 0 D Nn W Proposed SSTS within the drainage basin of West Branch or Boyds Corner Reservoirs. Proposed SSTS within 500 feet of a reservoirtrese�oir. stem or- control lake. _ a V' pi oposed SSTS within 200 feet of a watercourse or a DEC wetland. Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required. 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 answeredy.Z 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 WIC-DEP. 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. n (f FOR COUNTY USE ONLY DATE o`' + ` TTXF: 1 /2 ZeR Eve �EGT h�c- eewt,?) 3rE ?IzA".910CD To 2eD .4,44 so75 TIN (FTELDTES-1) bwk e KALE IN 1110 OP AN'1NCN 23 ' 38.70 AC. CAL f' �d AC. .96 AC. . -. •.A 6.01 AC. .33 as Ar 91T,10 / 41 2 0 L46AC. F 30.91 AC. 15 '9 -'-'L C. AC. 4, - e 16 r N• q .4611. 1 �r `V ' V� CAL. I ✓f\ 15 57.9s5 AC. CAL. tea: ,�,�,• yt6 \s / � 1 i� C _ - - - -- R/0 23.2 -39 65.56 59 7 63 n. ry ^a °I.92 AC. 2. s4e.e1 30.91 AC. CAL ' /Lg('92 AC s 3 VZes 1.91 AC: 62� , 60 2.a2 Ac. q � a / f a 20 19 1 102.89 AC ' 19 not 249 @ W-n '16 � 1 AC. E34 AL p .. .// • is f3 .46 At 1 1246.7 4T.T 44.69 I TAI 7•`�A, / % 1 9.55 AC. _ 0 26915 Iola j?fu 8 / sw T w 4.00 AC. 9y�6 b pta y 4$6.0 C. CAL. / 2y,6- ]44.02 4� N/ I 12 . �► 71.91 A 14 I 75.97 AC. c HrO e4 4.49 AC. �5 3.09 AC 3.79�AC. 4�f f 4.45 AC. 7.76 AC. 16 s •oo �a26TyAAC. 2.OT AC. �, 6 T. BRUCE R. FOLEY Public Health Director._.- LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director ,..., .. Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road / Brewster, New York 10509 Environmental Health (845)278-.6130 Fax(845)278-7921 Nursing Services (845)278-6558 WIC (845)278-6678 Fax(845)278-6085 Early Intervention (845)279-6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Date: To: St5S 1 Ino- za ®SSA From: Gene D. Reed Putnam County Department of Health Fax #: 77,-S -03S-6 No. Pages 3 (Including cover sheet) /For your information 4/ Please respond For your review Attached as requested As discussed Notes/Messages Please call 2 P,4 �Tzz.6 *5 Lo?"S In the event of transmission /reception difficulties, please contact this office at (845) 278 -6130 ext. 2261. 0 Q. SENDING CONFIRMATION DATE AUG-19 -2002 MON 08:44 NAME PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 919147730355 PAGES : 3/3 START TIME : AUG-19 08:42 ELAPSED TIME : 01'49" MODE : ECM RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... P q I BHltM F_ FOLEY « LORMA MOUNAW R_Ni Msac i P.Nr 9.0 Dbv— W Associate A&M. Ha *h D4atw D...cry ej Paae.a .f�Mr DEPARTMENT OF HEALTH I Geaava Road - Brewster, Now. York 10509 AVOIfb'_4T FOREFJ.D_ _VT[ G ATTENTION: a ADA?S STIEBELI G )if GENB BEEO An information below must be f dlY completed prior to any scheduling. DATRZAs/" 7, ENGOMORMM: _SyXpi/E..J 1.ei,-.f PHONE BG�o- (aG2 -Zbl�' REASON: _ -DEEPS: _Z.;.- P.ZM:lV..._ PUMP TM*, o TOWN_ LAXr�7g..�sor) TAXMAYp: 3f/-' 3 -�� .. SUBDIVISION: �yQ iat af>FA_f 1vogmA _ LOTA J, 11 12 OWNER AwrfiaN+••, I�f 74, 0am" Td • �CTIFPr'R,L'j'BRiA FOR TOINT RRVTFW A�WiTNECft1VC:fIFifl[fr_?aTINC- Y�3 NO Proposed 5S'TS within the drainage basin of West Broach or Hoc, ds Comer Besewe(re. Proposed SSTS within 500 feet of a reservai r. reservoir stem or central taste. jQ Proposed SSTS within 200 feet of a watercourse or s DEC wetland. 0 >( Proposed SST'S design flaw greater than 1000 gallons/day or SPDPS Permit requited. O tQ Proposed SM for a Commerical Project. It is the responsibility of the design professional to provide the above information prior to soil testing. This Deparbnett will 4m mine the NYCDEP project status (Jam! or Ddnttcd) based on the response. If you answered la to any of the questions. NYCDEP Dune whams the sell testing. This Department will coordinate a mutually suitable dme far field testing with the PCDOH, the Design Prafmional and \YCVEP. If a project has been determined to be Delegated based an,tbe above response and that subsequent information indicates NYCDEP Is required to witaas the soil tamgb it will be the sole responsibility of the design professional to schedule re- witumdng of the son testing with NYCDEP. r00. eOlme.060NLY anal9 y W 3D tee; 7T1 $-76vE 11_0a W- toraD M ?RVP1MMb Yo br Ace loss PAJ -w 5awy Q!liyfSSi) M, ......-PUTNAM COUNT-Y-liEPARTMENT--OF-HEAL-TH------, DIVISION OF ENVIRONMENTAL HEALTH SERVICES�� DESIGN DATA SHEET -:SUBSURFACE SEWAGE TREATMENT SYSTEM Owner. Address Located at (Street) Eyusz: A&g� ZZ, Tax Map Block :3 Lot (indicate nearest cross street) Municipality "73 Watershed 10flD SOIL PERCOLATION TEST DATA Date of Pre-soaking 9'%2 Date of Percolation Test NOTES: 1. Tests to be reneated at. same death until annroximatelv eaual nercolation rates are obtained at each -percolation test hole. (i.e. ..5 I min for 1-30 ' min/inch,-g 2'mm*' for 31-60 min/inch) All data tobe submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 ...... __ ........... .. .... ... -:-: -NDM. P 0 is ....... ..... ... ............. ... 3 4 /3 5 3 .2 2_ 3 4 5 1. 2 3 4 '5 NOTES: 1. Tests to be reneated at. same death until annroximatelv eaual nercolation rates are obtained at each -percolation test hole. (i.e. ..5 I min for 1-30 ' min/inch,-g 2'mm*' for 31-60 min/inch) All data tobe submitted for review. 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 ountered Deep hole observations made by: G Z- 76, a 0,9!5,a- Date ?1,21-6-1&.2 Design Professional Name: Address: Signature: Design Professional's Seal 'PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM SECTION A. GENERAL INFORMATION Name of Project 3Z /Z Z. a %(CV) �',4Trc,�% County Site Location /t9MIJ*C�1� z„�gy o Z- !Z Building construction begun A10 Extent . Is property within NYC Watershed ? ................. dYes No SECT O • . TOPOGRAPHY (Please check all appropriate boxes) 1. Billy. .0 Rolling a Steep slope F__J Gentle slope Flat 2. Evidence of wetlands 0 Low area subject to flooding Bodies of water Drainage ditches 0 Rock outcrops R."Me rn 3. Property lines or comers evident ...................:.... ............................... 4. Do water courses exist on or adjoin the property? .......... :................. 5. Will these affect the design of the sewage system facilities ?............ 6. Do watershed regulations apply in this development ? ....................... 7 Will extensive grading be necessary?.................................................... 8. Will extensive fill be necessary for SSTS ? ............. 9. Do filled areas exist within the SSTS area? ........ ............................... Yes No Yes No Yes Q No Yes 0 No es r]JINO' _. -Yes - - =:... o Yes No If yes, what is the condition of the fill? SECTION.C. SOIL OBSE VATIO 10. Appearance of soil: ' Sand Gravel Loam Clay a Hardpan Mixture 11. Observed from: F__J Borings a Bank cut ffBackhoe excavations 12. Soil borings /excavations observed by i< 79_�G9 on d 2 13. Depth to groundwater VA&/ 5, Ca Os I,% _ v. on 14. Depth to mottling .4 /0Nf on 15. Are test holes representative of primary & reserve areas ...... ............................... 16. Soil percolation tests made by 4M on 17. Soil percolation tests witnessed by o4e P.z-,g. 9, on V SECTION D (on back) M Form ST -1 2 SECTION D. DRAINAGE.' 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? a Yes , No 19. Will groundwater or surface drainage require special consideration? ..................... HZs 20. Will gullies, ditches, etc., be filled and watercourses be relocated? X4..5 ✓� <... FTJ 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 ? ............... .......... F Yes dNo , Inspection data 22. Do adjacent wells and/or sewage systems exist? ..................... .....::........................ Yes F No 23. Additional comments _?P�� P 24. Site observer /inspector and title 6,' MZ i5 17 25. Date(s)- of observation(s)inspection(s) Ag 2:zp 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 rocklimp. - Depth to rock/imp. Depth to rock/imp. G.L. G.L. G.L. 0.5 .0.5 0.5 1.0 1.0 1.0 2.0 2.0. 2.0 3.0 1.0 3.0 4.0 4.0 4.0 5.0 5.0 . 5.0 6.0 6.0 6.0 7:0 8.0 9.0 10.0 7.0 7.0 8.0 8.0 9.0 10.0 9.0 . 10.0 Sheet _of� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEATLH SERVICES.. - - FIELD ACTIVITY REPORT. • F-1 ul i AnT)RF44: NJ 0A6L �VJ-,' Street Town . State Zip PERSON IN CHARGE OR TNTFRVTFWRT): ST��I Name and Title TYPE OF FACILITY: Signature and Title REPORT RFCF.TVF.T) RV: I acknowledge receipt of this report: . SIGNATURE: 02/96 Rev , f c . J 1 t =225-00 - �'"� 175.00 e 22e Off; '7 6.0 \ a Al . 30. i,'O� S 48 56-43 63 SS S 49 -4549 60 717 1 27 �ygOA/ � 145.95 '56 Sr5 W ......... _ .. 4.49. �