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HomeMy WebLinkAbout1492DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -3 -32 BOX 14 01492 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES �o r DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Zt7nao Address 6XROL W GC�i y Located at (Street) �vLz �T oGE Z®', Tax Map'3 1/ 'Block Lot 3.2 (indicate nearest cross street) Municipality !- X So --kJ Watershed 15 7-' ;9 /Z 14N6 Date of 3oa 1 2 3 4 5 2 3 4 5 1 2 3 4 5 1. Tests to be SOIL PERCOLATION TEST DATA 2 f o a- Date of Percolation Test --(� // 3rze a. —/0# /0/39 -1 /,4y Iris- #11#55 ,/0:02 10.: 3.2 - at same / A/ 2. _ 1% z� 30 30- l 1._ /7,/ 7 percolation rates are obtained at each percolation test hole. (i.e. s 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 30 a3- 2`f�5� / A/ 2. _ 1% z� 30 30- l 1._ /7,/ 7 percolation rates are obtained at each percolation test hole. (i.e. s 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 TEST PIT DATA 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE-NO. .. N- NO:` H : G.L. 1.0' 1.5' S " 2.5' 3.0' 35 .. c 5 rl . 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' .7.5' 8.0' 8.5' 9.0' r 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: a yi � ice. G, V, E-(, Date 401� Design Professional Name: Address: Signature: Design Professional's Seal Q �r 0 ®.z 05/01/2002 10:49 8456282807 JOEL GREENBERG PAGE 02 BRUCE R. FOLEY - • -• M•5 . _ Director.. , LUItFT'i'A htOLINARt R . ... _ ....... . �.' , ' • .:. r... _.., _ . Asaociatc . I'ublrc. _!lcadfl�, ... Director of Patient . Sersicea DEPARTMENT OF !(U'l ALTII Geneva Road Drewster, New York 105U9 ATTENTION: d AjDAAI STIEDELING XGENC RECD All information below must be fully coniltietctl prior to nny sriietitlling. 1)IVIT,: /•.1 /2002 ENGINEER Oil FIF01: JOEL GREENBERG, R.A. I'IIVNE #: 845 628 -6613 REA$ON: ROADISTREET: LLI DEUS! . N PERM ;b PUMP TEST: 0 CAROLYN WAY TOWN: PATTERSO)9 � � TAX MAIM SUBDIVISION: BURDICK GLEN NORTH 34 -3 -32 LUTH: 2 OWNER: ANTHONY RIZZO b!XQ EP CRITERIA FOR JOINT REVIEW II) WITNESSING OF-MLIESURG . YES NO ti Ill d � Proposed SS'rS witwrl the drainage basin of West Brnttcit or Ilovtis Corner Reservoirs. . -.- - Proposed SSTS within 500- feet of a lvtervoir, reservoir stem nr contrni nr hake.__.. i "Proposed 951'S vitiiin -200 fcet nf'� waCcrcoarsr. a Proposed SSTS design floe grenler titan low gallons./day ni- SPOES Permit required. Proposed SSTS for a Commerical Project. It is the responsibility of the design Iirofesslonnl to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Join( or Delegated) based on the response. If you aEnsweredyes, to.atty or tine questions, NYCDEP mast witness the soil testing, This Department will coordinate a tnutually suitable time for field testing with the 11CD0119 tine )Design PrOressianal and NYCDEP. If a project has been determined to hr lklegnted based on tine nitove res11011se Alit] then sltlycequent information indicates NYCDEI'to required to witness tile' soil testing, it will be the Sole responsibility of the design professional to scltedtile re- witreessing or the soil testing with NY COEP. FOR VIVI IT 115E flm' ' �a�.tr_terrrs: h z VIELDTEST) ©' APR -30 -2002 TUE 21:49 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 2 11/30/2001 14:04 84562B2807 JOEL GREENBERG PAGE 02 BRUCE R. F'OLEY 1_OREXI'A MOLINARI _ R.N_, M.S. __ ...... Public. rHfealth . Direcrot _ _. �+ - Arsdciato Public Ifcntfli '*DtredQF . _ Dfreelor of Partent Savices DEPAIt I *Mr,,N,r or, HEALTH I i Geneve Road Brewster, New York 10509 i I;ti —1 ILL11'S;,N( ATTENTION: d ADAAi STIBIU6 ING, XGENE iicgv All idormation below must be fi tly, eomtplc(ed prior to any sncciluling. 1)rYl'I�':. 1 /1 /2001 ENGINEE R OR FIRM: JOEL GREENBERG, R.A. ' 845 628 -6613 REASON: " DEEPS: - 0 PERCS: ]b PURIP TESi.: ra RUAINSTREE'r: CAROLYN WAY TOWN: PATTERSON '1';%X NIAr #: 34 -3 -32 SUBDIVISION: BURDICK GLEN NORTH LOTH: 2 0MIER: ANTHgPY RIZZO NY -CDEP L ;LUU-RIA FUtt JU112•1' ItEViirW AtLIJ Ul'I'NESSINC Ur SUII�I_L +'S'I'INts .., . YES NO C3 lg Proposed SSi•S Svithin tite drainnge basin of West Branch or Boyds Corner Reservoirs. 13 6 Proposed SSTS witliin 500 reel of s� y �cscrv� r,.l:rs.crvoir:s.tcni or_.controlarikeY 'Proposed SSTS within 201i feet of a watercourse or a 0170 netland. o 14 Proposed SSTS design flow grel(et, than 10110 gnNmtsIdny at-. SCI)ES Permit required. CI Proposed SSTS for a Commnee-ical Project. It is the responsibility of (lie design professiote;tl (o pro►•ide The above htfot•trt;tlion prior to soil testing. This Department will determine (he NVCUEP project status (Joint or Delegated) based on tite response. If you answered yes to.nmy of tite questions, NYCUITP must witness the soil testing. This Department will coordinate a mutually suitable time for wield testing with the ii +CDO11, the Design Professional and NYCDEP, If it project hits been determined to ha DeIcg -i(ed bnsed Pit floe above tcshnnsr. and thret oabsegeteitI information indicates NVCDEP it required to witness the soil testing, it mill be the sole responsibility of the design professional to schedule re- witnessing of the soil testitlg with NYCDEP. F-Olt a e)1►N1TY IISRtIN1.F' /� l 4'011�lt:NT'3• �� � . GiI1G !� fit/® 5 NOV -30 -2001 FRI 14:04 TEL:845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 2 11f01/2Q01 12:10 8456282807 JOEL GREENBERG PAGE 02 BRUCE R. FOLEY _ _...._ .. , public Kealth -Director P...- .._...—LORE Ti'A.._ 10LINAItt.R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPAR'rmENT OF HEALTI-1 l Geneva Road Brewster, New York 10509 U1 QU {'S"1' EM FIELD TES'T'ING ATTENTION: C ADAM STIEDEI,ING ]GENE REED All information below must be fully compacted ))1'101' to any schednling. DA'1'F: 11/1/2001 ENGINEER ORFIR L JOEL GREENBERG, R.A. I I[VNI; #: REASON: " DEEPS: -11 PERCS: ]b FUNIPTEST: n ROAMTREET: CAROLYN WAY TOWN: PATTERSON 845 628 -6613 TXXMAP#: 34 -3 -32 SUBDIVISION: BURDICK GLEN NORTH LOTH: 2 OWNER: ANTHONY RIZZO NYCUEE CEMTERIA FOR JOIN'IkEVIEtiV ANI)•3vcIrNESSING u1' S n- C L •I, 1'4 -uN . YES NO 0 M Proposed SSTS within the drainage basin of `Vest Branch or Boyds Cartier Reservoirs. _..:: .. -Q 1gl_. _._,-..Proposed SSTS within 500 feet of. n- rCSt3rvoie:, reservoir stem or control Inke. _ o v Proposed SSTS vikiiit) 200 feet of n watercourse or n DEC wetland. 17 lilt Proposed SSTS design fluiv greater than 1000 gallons /day or SI s rerntit required. o F1 Proposed SSTS for a Commerical Project. It is the responsibility of the design professional to provide the above infornt:ttion prior to soil testing. This Department will determine the NYCUEP project status (Joint or Delegated) based. on the response: If you answered yes to any of the questions, NYCUEP must witness the soil testing. This Department will coordinate a mutually suitable .time for field testing with the PCDOII, the Design Professional and NYCUEP. If it project has been determined to be Delegated based on the above response and then subsequent information indicates NYCUEP is required to witness the soil testing, it will be the sole responsibility of the design professianal to schedtile re- witnessing or the soil testing with NYCUEP. FOR TmE�'3 OF ICC DAM _U oxiMMUT (FMMTIEST) ITM E: JUL-19-2001 .14:14 BRUCE R. FOLEY Public malth Director P.02 LORETrA MOLINARI R.N., M.S.N. s;o0are Public .,Hcalik-Dot"Or.. Director of Patient Services DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 REQUEST FOR STING ATTENTION: El ADAM STIEBELING YGENE REED All information below must be 141-11 completed prior to any scheduling. DATE. 7118/01 ENGINEER OR FIRM: JOEL IAMU= c PHONE #: 628-6613" REASON! DEEPS: 1L. PERCS: JL PUMP TEST: c ROAD/STREET: CAROLYN WAY TOWN: PATrERSM TAX MM#: 34-3-32 SUBUMSION: B== GLW NOM LOT#: 2 OWNER: ANrHMY RTZZO NMEP CRITEMij FOR MINT REVIER AND WITNESSING OF SOIL YES NO 0 X Proposed SSTS within the drainage basin of West Branch or Boyds Corner'Reservoirs. 13 Proposed SSTS within 500 feet of a reservoir, reservoir stem or control take. 0 Proposed SSTS within 200 feet of a watercourse or a DEC wetland. 13. Proposed SSTS design (low greater than 100.0gallons/day or SPDES Permit required. Pro ..p#!ed$STS.!oir.a Commerical Project. It is the responsibility of the design professional to provide the above information prior to soil toting. This Department will determine. the NYCDEP project status (Joint or Delegated) based on the response. If you answered jLa to any of the qu"fions, NYCDEP most witness the toil testing. This Department will coordinate a mutually suitable time for field testing with . h 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. 3 Y ✓6C I- eAl pLe_��� t f C ON] A I FIff 5: r (FEELDTEST) FOR COUNTY USE ONLY I ?%J 7 / J 'VP 2 3 4 5 SCALE IN11100RANINCH i pp . S8 / P/0 23 2.10 - - - -- P/0 23 2 9 -- _ - -T -- r 3T ' n o•eA. / 3 / • 3i 4� ¢ 48 ;/• z3 2easz s r 36 �r4.68 AC t�e X41, AG / 3 3 250 Af� q 57 s rtz.� ' 2.83 ASdyo 1\'°m� mac,, • P`�lirp�i6+h, .� .S 50 ' 9 146 At. y90.6B 42 ,f'c r 2 e 62a0 $ 31 q• ar9 / �h � J 4.9.2 AC. 1 G '�) . 32 i :32 AC 4 4 3 �4 r 2 n6.e1 30.91 At JL7 PA. 51 e s • 29 473.39 55 y 9: 263 et yy �J 33� •Q 28 2.42 1.61 • ^ r j �l v fCd/ �A 1.41 1C4 �d� ' ��4� F �QD r ' _ . AC. '. CI - 18 •� i% 23 r , z� f�r ��. t� iAyci e 26 . 21 20 456 69 a I ? % 26 blyy J a 31 ai a • & c 59 AC. 295 249 .4�ti 5.18 AC. "°'°' 38.70 AC. CAL. �` '.� 16 -- 54 , o • 44h AC. AC. L34 A x - " 3a4.es f /A' s 24 r` 34 33 1.92 . ! 27 r $ �� ro . . n� 46 At • it 5.51 AC. _ 3is.69 �, ( •• 1.91 At 1.59 LA4 AG °I, 4, 4 AC.F tam too 10x AC. w la w C. & I 429.x2 La. A 36 22 G Imo- 93te 1 s A • j 224.93.4 3 53 1) 44.;0 AC. C I a 40 g e 37 3B v 1 19.50 AC. �� 2.45 AC.� 4.10 ACa 25.77 AC. CAL. I X 15 1622.32 woo 21 / 41 D2y60 57.9E'AC. CAL. I7B.69 214 is 1 00 A • ; `O 1.70 AC. 1 ' \ 1194.45 20 .4�/ 423. , 1 -_ �•' • g 519.6• .9AC.�+ 3.96.Afe f- 16. FOXA/bYC0A00 +u�.nd°� • `-•'.� T'\ % SFF Wv 94A 491.97 aq 5.89 AC. 7 zi i 15 �7 /9' 266 AC. 44 4 x 771 21 - A AL (� W At 34.84 AC. ' 1 ti 2.69 AC. 45 r _ % / a * N 814 fr j 2.70 AC. 46 a124 39 30 9.O0AC ion 3aI "I $ IBS /a 4.00 AC. 4, J 35.63 AC. 2e�s3 �Oye4 \ 1 ' ~ 48 / - Y 134rz9 , op �2++1q 194 At N1.99 164► JL \ 16111 24548 2 AC.;7 S. �s• fu 1146 '1.20 P %R '_� 3.36 At JL B IL I N6.295p 1 IAJ 31 112 `�• / 1 .� 1.13A 5. 1° - J r 240 AC./ / \ 34.13 m 9 / i� mi „� 67272 / its • x 6.81 AC.� • .� / • zs Ac 2 33 = 1 100 2 ( 47 AC. JL �.. tf 10� 3.01 At o "' y \ 12 •� m I 3.33 C. 694.32 11 Ac � iiI 4� I o 162 N o 53 I .92 4 28k,2 , &21$4 691. zr 54 v �.. YY • <e9 3.3I AC. 5.97 AC. 917.10 a 1 y1L1°�4 ' X63 Y 55 . 3.68 AC. / 1 ( AL / 53.51 AC. CAL. /34.17 2' *° t g 9.46AC. JL 14 75.97 AC. I A -- Dennis J. Sant Putnam County Clerk :P.ublic InforriLatian.Officer._- _ Application for Public Access to Records To: Records Tess Officer Check one: (—� 2 ❑ I will hand deliver myself Name of Agency ❑ Please submit to the specified —;:) �-7— department for me Address r Applicant Signature I HEREBY APPLY TO INSPECT THE FOLLOWING RECORD: �� PAi74 oAL �'T�� %�rJ2DlClL 6zf I Applicant ignatur Applicant Name (PRINT CLEARLY) Representing -AC FOR OFFICIAL USE ONLY: Date: DENNIS J. SANT Public Information Officer -7 c q < -t Mailftfg Ad ress /Phone Number ' DENIED Record of which this Agency is Legal Custodian cannot be found. -cord ' aintained ay this A ency. ' 2, 'oS I,, � ?, //*-� ignatu TAW Date YOU411AVE A RIGHT TO APPEA DENIAL OF THIS APPLICATION TO THE PUTNAM COUNTY EXECUINJE. Name Business Address WHO MUST FULLY EXPLAIN HIS REASONS FOR SUCH DENIAL IN WRITING SEVENS DAYS OF RECEIPT OF AN APPEAL. I HEREBY APPEAL: Signature Date X acknowledge receipt of this repott: SIGs AATW r e. , Titt . Rev PUTNAM COUNTY DEPARTMENT OF HEALTH [ t�N _O >]�I� VIRONM- EN-TA:L" HEA,L-T E� INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM . SECTION A. GENERAL INFORMATION Name of Project ,lz- 0O Site Location GA120z_ y_Al 1k//4_1(1_101 Building construction begun A_1 zi:-,7 Extent Is property within NYC Watershed ? ................. E��yes ❑ No SECTION B. TOPOGRAPHY (Please check all appropriat boxes) 1 ❑ Hilly ❑ Rolling Steep slope Gentle slope ❑ Flat ti . . About S ► 5 s.7S �?✓er 2. ❑Evidence of wetlands Low area subject to flooding ❑Bodies of water Drainage ditches Rock outcrops $ov1�P%r5. 3. Property lines or corners evident ....................... ............................... Yes ❑ No 4. Do water courses exist on or adjoin the property. Yes ' _N — - - .......... ❑ . 5. Will these affect the design of the sewage system facilities ?.........:.: o . Yes N ❑': 6. Do watershed regulations apply in this development ? ..............I......... Yes 7 Will extensive grading be necessary? ................. ........::.......:::...:.:...:: _..; -s_ �, No 8'.r Will extensive fill be necessary for SSTS? .............. ..........................::::: Yes ❑ 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: F71 San ❑ Gravel En Loam ❑ Clay ❑ Hardpan ❑ Mixture 11. Observed from: Borings Bank cut ❑ Backhoe excavations 12. Soil borings /excavations observed by 1Zr-0P `�� e, R H, on i� a o� 13. Depth to groundwater Al f g on 14. Depth to mottling /,//,9 on 15. Are test holes representative of primary & reserve areas ...... .................... .I.......... Yes No 16. Soil percolation tests made by on 17. Soil percolation tests witnessed by Li 706b on SECTION D (on back) Form ST -1 SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? Yes f!N 19. Will groundwater or surface drainage require. special consideration? ..................... a Yes 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? ......................... 0 Yes' SECTION E. REMARKS 21. If a common water supply is proposed, has an inspection been made of the existing or proposed source and facilities ? .............................. ....: Yes KNo Inspection data 22. Do adjacent cells and/or sewage systems exist ?....................... ?'h Yes ,� No ` . ..... 23. Additional comments 24._ Site observer /inspector and title 'Fro -P 25. Date(s) of observation(s)inspection(s) TEST PIT PROFILES Hole Lot Hole 9 Lot r Hole- Lot Depth V Depth to mottling Depth to mottling Iiepth to mottling Depth to rocklimp. Depth to rocklimp. -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 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