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HomeMy WebLinkAbout1730DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -4 -67.2 BOX 16 INS I so 91 r r7 I I I I !ir Lo ., T J ?�* 19M ■ � �;i. - z. .ti - rA 1 01730 MAY -22 -2003 08:41 AM HARRY W NICHOLS Public Health_. Director 914 279 4567 P.01 aa-08( ___._....�.R LORETTa 'MOLINARI RN.,_ M.s.H...- .z._....�.�.._.. Assoetate Public ffealth Director Dlrector of . Pattsat Servfca DEPARTMENT OF REA.LTU 1 Genova Road Brewster, New York 10509 .ATTENTION: to ADAM STIEBELI G ENE REED All information below must be &4 completed prior to any scheduling, y ENGIINEER OR 1~IRM: }. PHOi`lE #: A." q.-_¢oo 3 REASON: - DEEPS: o PERCS: PUMP TEST: a ROAD /STREET; R4 TOWN: _.._ `r TALC MAP #: SUBDIVISION: _ �.�+� -wt A2 2_r OWNER: NYCDEP CRITERIA FO VCM AND 3 j SSIN�`Q Qj�E53:1N YES NO 0 proposed SSTS .within the drainage basin of West Branch or B.oyds- Corner Reservoirs.—° - - ° ---p ° • � ����� �- �� �-- --F•roposed -SSTs S wirliin sOG feet "ot���eservoir; reservotr stein or control lake. 0 Proposed SSTS within 200 feet of a watercourse or a DEC wetland, o �y Proposed SSTS design flow greater than 1000 gallons/day-or SPDES Permit required. 0 eh Proposed SSTS for it 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 answeredya 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 it 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, FoR COUNTY USE ONLY DATE: � /'�,V 3 % 0 TINGE: a e? c (FIELDTEST) MOY- as -PRAT TWIT 017: SS T1=I :R45 -P7R -79x'1 NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 " a gin Sheet of * PUTNAM COUNTY DEPARTMENT OF HEALTH -- y , ,. �� - "jJISION OF E : W- MENTALM"EATLH L &EBCIV CES - FIELD ACTIVITY REPORT N�M� •• DEL °SOS � TPI: A�: % >/4 s _ '/ SOr9J A.1 Street:`: Town State Zip a PERSON IN CHARGE. m �. _ Name and Title TYPE OF FACILITY 5 , , - FINDINGS T2 .O��c�,�,1i►,�����1et,.�,P.�rt se�s�e.. � / � �Q�� /�.� -r..r� .�i�e`n�� Fc+.�'��CuT'r"�'.f� �?,C -�.m. ..-� t:C.'d' -'^'a+ tK.- c.c -�,�- -i2 i,' .._ �: �YaycY/C.2. C<,.,- = L.z'V. ` _ .:.t5'.,.. - � .,�'}�c -.� •' {w c ���� ._,. - t.:- +< -u,- -r r ., �•' - r "4,o- �.. - Z k .Wpprmp! .. e - Signature and Title R -'PnRT RFr-RTVP) RV: ` T. adknowledge, receiptof this report. SIGNATURE:. 02/98 Title; v� 'PUTNAM COUNTY DEPARTMENT OF HEALTH Y y DIVISION OF ENVIRONMENTAL_ HEA.LT INITIAL INDIVIDUAL/COMMERCIAL SITE INSPECTION FORM SECTION A. GENERAL INFORMATION Name of Project ill4E" D X1 �) PA7-7'6 iZSQAJ County 19V i A, ZAI Site Location- •D P6tq 3 Building construction begun 5, /Extent hlov5��n 4. Is property within NYC Wate Zed? ................... Yes , No SECTIONS.- TOPOGRAPHY (Please check all appropria boxes) 1. FI -Billy• •FI Rolling o Steep slope Gentle slope F7 Flat 2. 0 Evidence of wetlands a Low area subject to flooding Drainage ditches a Rock outcrops 3. Property lines or corners 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? ................. ............................ .... extensive-f ll be necessary for SS S ?:::: :: .. ....:::::::::::." ... . 9. Do filled areas exist within the SSTS area? ........ ........................ ........ If yes, what is the condition of the fill? SECTION C. SOIL OBSE ATIONS 10. Appearance of soil: Sand = Gravel Loam Clay =Hardpan a Mixture 11. Observed from: Borings Bank cut LEI Backhoe excavations 12. Soil borings /excavations observed by JZg96T 6,6 on /0 /1:!> o 13. Depth to groundwater 1 JV /V6 on .14. Depth to mottling 3 ' — �� on 15. Are test holes representative of primary & reserve areas ...... ............ .................... E Yes a No 16. Soil percolation tests made by 1/4 MZ1 kh : . %� �� on l ha ®5 17. Soil percolation tests witnessed by �� T'7 on �1 SECTION D (on back) 0 Bodies of water s No Yes a N F-1 /,e • No Yes Q No 0 Yes N des ` N 0 Yes No Form ST -1 .2 •x SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? Q Ye c2lo 19. Will groundwater or surface drainage require special consideration? ..................... Er es 20. Will gullies ditches etc.; be filled and watercourses be relocated ? ............... ........... a dZo� Ye s 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 No Inspection data 22. Do adjacent wells and/or sewage systems exist? ..................... ............................... es F__� No 23. Additional comments 24. - Site observer /inspector and title 25. Date(s)-of observation(s)inspection(s) zo TEST PIT PROFILES .Hole # Lot # Hole # 'Lot # Hole # Lot # Depth to water Depth to water Depth to water Depth to mot+.ting - - _ Depth to mottll -n 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, 3.0 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 . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Gm 7- Owner /V ,e/- s Address oL n 2 ©4 p Located at (Street) -Zfis 22 Tax Map 80 Block Lot _ELL (indicate nearest cross street) 7, 2 New Municipality Watershed Bz-anr2/< SOIL PERCOLATION TEST DATA Date of Pre - soaking G /7 ),:0'-3 Date of Percolation Test 6 2l ,0249 3 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 1 - 3® 2-11- .1-4 ;2- 15- 3 a.;� -3;13 3 /5- 4 5 1;.._.� tau °z : :... - - ....._. 2 5 -��' 3 8.3 4 5 1. 2 4 5 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 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' '5V , 6.0' 6.5' 7.0' 8.0' 8.5' 9 0' 9.5' 10.0' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. 4 . HOLE NO. S HOLE NO. C Indicate level at which groundwater is encountered ,A /oA/ Indicate level at which mottling is observed 3 ` �oG•ti ,tom . 7 ' Indicate level to which water level rises after being encountered Deep hole observations made by: 41, .�/.� fi � Date Design Professional Name: Address: Signature: Design Professional's Seal 2