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Home My WebLink About1508DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -3 -58 BOX 14 01508 � rrm .I me J16 a '� ` 01508 V 12/01/2004 WED 17:50 FAX -- +4 PCHD i 11RUCF R. FOLEY Public health Director 0002/003 IV i.liltE'!•TA MnL1NARl RN., M.S.N. Associate Public Ifenith Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road ,Brewster, New York 10509 REQUEST FOR FIELD TESTING ATTENTION. d JOSEPH PARAVA U GENE REED All information below must be flill9 complctedip' for to any scheduling, DATE: i ?''Z ENGINECR VHlaIItM: �, ;�;►��•�" F"-tisG iuizzc<e -sod �G��_ PHONE #• REASON: DEEPS;: FERCS: itVW. TEST: a ROAD /STREET: ; ... •f� d k r.L1t�i..b�" /. Z y TOWN: ?iLa2%:J�. - TAX MAP *: 34. Gs� u SUBDIVISION:. �lamrs 4Ur�. 4'rJ rti�' ti +anti' �/� ?- LOT #; � C� OWNER: (3T21 Crlfi`7�n,j r.: = C- �4iL�►G U �JGiC -s u._? N' -�DEP CRITERIA FOR JOINT REVIEW AND NV1TNiSSING OF SOTI, T1FST1WG YES NO '❑ °,� ' ProlSosedSSTS'tvittiaintlie dir�inageljrsfiniif V1'rstBraacli orBoyds Comer Reservoir. • ' ° ""• ' ' ° ° �"° " ❑ Proposed SSTS within 500 feet of s.resci voir, reservoir stem or control lake. o Proposed SSTS ..within 200 fedbf a watcrcoucsc or a DEC wetland. ❑ Proposed SS'TS design slow greater than 1.000 gallonstday or SPDES Permit required.... 0 Proposed SS'1. for a.ComxonercialIroject:. ;. It is.tlte'responsibility of tbie 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.f if you answered ygs to:any. of tb(e questions, NYCDEP must witness the soil tests. This Department will coordinate a mutually suitable time for field testing with the Design Professional and NYCDEP. It a project has been determined to, bt Delegated based on,the above, response and then subsequent information indicates NYCDEP. is required. �>�vifiiess the soil tests, if wall be the sole responsibility of the design professional to schedule re-witnessine of the soil testing with NYCDEP• I t222 DAIR J f (F1EL.D IEST) . . DEC -1 -2004. WED 17:54 TEL:845- 278 -79H1 NAME:PUTNAM COUNTY DEPARTMENT OF P. 2 BRUCE R. FOLEY -.Public—Health, Director- LORE-17A MOLINARI RN., M.S.N. _� 4� -A_ ssociate Public Health Director - W � 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) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Date: - To: NL %4 E /9l .S 1G Fax #: 7 -7 -3 No. Pages (Including cover sheet) 0 From: Gene D. Reed Putnam County Department of Health -For our information Please respond _ For your review Attached as requested As discussed Notes/Messages ,e, G<i %e-� Please call S® C� �A e- In the event of transmission /reception difficulties, please contact this office at (845) 278 -6130 ext. 2261. SENDING CONFIRMATION DATE JAN -7 -2005 FRI 1240 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH' TEL 845 - 278 -7921 PHONE 919147730343 PAGES = 1/1 START TIME JAN -07 12:40 ELAPSED TIME : 00'22" MODE : ECM RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... a f BRUCE R FOI.aiY I..ORRITA MOLINARI R.N. W.N. Au6!(c Nmld RMeuw Auo—i Pelf P fkW 17svcla Director qJ Pmws Servkri DEPARTMENT OF HEALTH I aw"n Rosa Browssar, New York 1 1509 j ra•Iro•eeffiI nnM (845)178.600 F,, (W1171 NmJq Mevleer (815)278 -6958 WIC (849179 -,AI7t Fm (845)271.60AS rary,6arvmllr (A61)271.6014 P keq (1151;'71 W2 Fm(945)r8 -6648 • FAX COVER 5J�a;,�1: � Date: /��OS o..�/O�_ Z•it9i�/.Skt.Y.= - _ .. :• - a:_. 7 7� -�3. Y3.. ...._ .`.... - __. No. Pages (Including rover sliest) ' From! Cdalrl 12—d Putnam County Department of Health For your lnfortuaHon' respond For your review Attached w requested As discussed -- _ Please. raR Not- wMe"o' gel, A/$ 6✓ 7R�ntjz J- C��,�e e 'Dr. 4t/I; -h I2U:bNa ttnt • ' cC 1 In the event of transmhsion/reception difficulties: PlcA :r<::entnet this ORice at .. , (845) 278 -6130 elL 2261. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES G® DESIGN DATA SHEET- SUBSURFACE SEWAGE TREATMENT SYSTEM � >rOwner Address Located at (Street) Tax Map Block Lot (indicate nearest cross street) - Municipality Watershed SOIL PERCOLATION TEST DATA Date of Pre-soaking 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. 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 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: 45;� Date 1 m Design Professional Name: Address: Signature: Design Professional's Seal PUTNAM COUNTY DEPARTMENT OF HEALTH y DIVISION OF ENVIRONMENTAL HEALTH. SERVICES INITIAL. INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM SECTION A. GENERAL INFORMATION s . Name of Project '81KI" 2 1�v) it j�SO�l County PWW*iV Site Location 3 s'S Building ±construction begun Extent Is proper''ty within NYC Watershed ? .......:......... Yes No SECTION B. TOPOGRAPHY (Please check all appropri a boxes) 1. F7 ' ly .Rolling Steep slope Gentle.slope Flat 2... Evidence of wetlands Low area subject to flooding Bodies of water °r j Drainage ditches Rock outcrops 3. Property lines or corners evident ............... ........................ .............. :.. Q es No 4. Do water courses exist on or adjoin the property? ...:...........::...:........ Yes No 5. Will these affect the design of the sewage system facilities ?............ Yes No . o' a. 6. Do watershed regulations apply in this development ? ...............::...... Yes No 7 Will extensive grading be necessary? ................. ........:.......... :...:....:.. Yes ��INO 8. Will extensive fill be necessary for SS,TS ?.. ........... dYes...a o - -- -- - -. -- 9. Do filled areas exist within the SSTS area? ........ .....................::........ Yes No. If yes; what is the condition of the fill? SECTION. C: SOIL 7Sand VATIONS •a 10. Appearance of soil: a Gravel El Loam Clay =Hardpan a Mixture . 11. Observed from: 0 Borings Bank cut Backhoe excavations 12. Soil borings /excavations observed by on o 13. De thio p groundwater. 3 , 5 � � • on 14. Depthto mottling " on 15. Are test holes representative of primary & reserve areas ...... ................:.............. Yes No 16. Soil .percolation tests made by on 17.. Soil percolation tests witnessed by on , SECTION D (on back) Form ST -1 2 -SECTION D:" DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? a Yes -F7 No 7r 19. Will groundwater or surface drainage require special consideration? ...:..:.::........... s _ No ca 20. Will gulli , ditche ., be filled and watercourses be relocated ?..:... ::......:. :...:..... Yes Q No . SECTION E. RENL&RKS: 21. If a common water supply is proposed; has an inspection been made of the existing or proposed source and facilities? ................................ ............................... Yes ! No Inspection data 22. Do adjacent wells and/or sewage systems exist ?A?y� �. &Pg1 kl.dtlfI6 ElYes 0 No 23. Additional comments y 24. Site observer /inspector and title d .!5x , 6A , 25. Date(s)-of observation(s)inspection(s) 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 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' 3.4 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 I SILT FENCE (r m). REFER S SF F / / l M / e �_�_ --- I-_ - -- ___ _� • ' BASIN TO ACT A A S \ E / II • SEDIMENT HA51N DURING GON57X FHA✓E/ TC.6 — �- - - -- / B.C.6 i 'ORMNATER BASIN •� •� 41NTENANGE L _ J GESS PATH. TIO E DT FPR:Z r1o1W/ �/ tY P). REFER r B. C 6 1. mow— t I 2' / PRop, Sr STORY AREA -�— — '�. cam: ► �1 ' ` .' %' " ■ ' J _ II :OWILE (� 77.3 T. C 68017 .C.679.8 GRA// 679.8 II //