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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -4 -69 BOX 16 01732 ,` il-9 ' '. 01732 U PUTNAM COUNTY DEPARTMENT OF HEALTH D N -E�RONIVIEN AL HEALTH SERVICES INITIAL INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM SECTION A. GENERAL INFORMATION Name of Project (T)(V) County Site Location Building construction begun Extent Is property within NYC Watershed ? ................. F--J Yes F--J No SECTION B. TOPOGRAPHY (Pleas check all appropriate boxes) I. F-1 Hilly 0 Rolling Steep slope Gentle slope Flat 2. D Evidence of wetlands a Low area subject to flooding F--J Bodies of water Drainage ditches F--J Rock outcrops 3. Property lines or comers evident ....:.................. ............................... 0 Yes ENo 4. Do water courses exist on or adjoin the property? ............................ 0 Yes a No 5. Will these affect the design of the sewage system facilities ?............ a Yes No 2 6. Do watershed regulations apply in this development ? ....................... F71 Yes F-� No 7 Will extensive grading be necessary?..... ........................................... Yes n No ? 8. Will extensive fill be necessary for SSTS? ......... ............................... Yes No 7 , 9. Do filled areas exist within the SSTS area? ........ ............................... 0 Yes No If yes, what is the condition of the fill? SECTION C. SOIL OBSERVATIONS 10. Appearance of soil: ffsand ErGr avel Loam E] Clay [::]Hardpan D Mixture 11. Observed from: F-1 Borings a Bank cut 0 Backhoe excavations 12. Soil borings /excavations observed by ? on 13. Depth to groundwater on 14. Depth to mottling on 15. Are test holes representative of primary & reserve areas ......... .tYA..44)0........... Q Yes F-'� No 16. Soil percolation tests made by 1-/- A/, A(/cue`--s -ate. on Z -c7 17. Soil percolation tests witnessed by (::i� 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 [:? No 19. Will groundwater or surface drainage require special consideration? ..................... Yes a No . 20. Will gullies, ditches, etc., be filled and watercourses be relocated?.. .................... Yes �o SECTION E. REMARKS 21. If a common water supply is proposed, has an inspection been made of the existing or proposed source and facilities? ................................ ............................... No Yes 0 Inspection data 22. Do adjacent wells and/or sewage systems exist?... ... Q Yes '[No 23. Additional comments 24. Site observer /inspector and title 25. Date(s) of observation(s)inspection(s) 'z 9% Z) r e- = 1 e5 S ®►� / TEST PIT PROFILES Hole # Lot # Hole # Lot # Hole # Lot # Depth to water Depth to water Depth to water Depth to mott i nb Depth to moil -Ing 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 2.01 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 �O DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner 1t'1 Address OLD Rd, Located at (Street) g- f-, ;La- Tax Map 3 5- Block Lot to 6 (indicate nearest cross street) Municipality Watershed 73x6 SOIL PERCOLATION TEST DATA Date of Pre - soaking S /f / too Date of Percolation Test V 6 qr7 Hole io Ruh No .:. ate ;.,_ Mart. StopNLn) Ela se Time Surface (lncaes) Start .Stop Dropp 1n Ine7ies r 9.' 2 3% - 02 6 3 4 /0.6'e/ -i /.'19 2 S°° 29 3 /q —25- %y 3 4 5 as 3 �xPgn�tio It 3g �2-6 73% -2 6 Y •3 `7"elo -10 0 6 $ a-3 - 2 6 4 3 V 6 qr7 1 5 1 1 1 1 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 2 3% - 02 6 4 1 5 1 1 1 1 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 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. HOLE NO. HOLE NO. G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 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: Design Professional Name: Address: Signature: Design Professional's Seal Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES 4°-t- DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner l`? A y t f1 Address p G Z) `a, Located at (Street) oL a Rj o2�L -Tax Map 3 : Block # Lot _go2 (indicate nearest cross street) Municipality t6 ,- -H &g., �- Watershed A3 ©C gepCi& SOIL PERCOLATION TEST DATA Date of Pre - soaking 6 ,:z o loo Date of Percolation Test X I lo .:::..... . 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 -6U min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 1 ?"5-8 - /0 :08 /0 a7 3 3.3 2 /0:09 -10; /v Zzf - 7 3 PO: 2 0- /0130 /40 o'Z 7 3,3 4 5 2 /0;.35 -11,'v5 -3 O 3 -3 C) 4 5 1 2 3 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 -6U min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 _ r DEPTH..... G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3:5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 10.0' TEST PIT DATA T 2 DESCRIPTION OF SOILS ENCOUNTERED IN TEST DOLES HOLE NO. HOLE NO. HOLE NO. 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: Design Professional Name: Address: Signature: Resign Professional's Seal Date 1117 1 . , PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES -7 ..DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM _� 7Z Owner. MAM12 Address ol,7) ig Located at ( Street) .. Tax Map 3 -12' Block Lot % t/0 (indicate nearest cross street) Municipality_ P - Watershed Be5,<i 737zogh. ,4T r, - fi6'mal-y SOIL PERCOLATION TEST DATA Date of Pre-soaking a Z8Z'o 0 Date of Percolation Test S L? /0 0 * N&IA �D 'tree Ala e Time im U U &g ' :e c : ws ...... .... ... ..... ............ . ...... Start ng 7- 3'.07 2 3 '3,,35 —317 3 3 4 2 3 4 5 2 3 4 5 NOTES: 1. Tests to be reheated at same death until aimroximately equal percolation rates are obtained at each percolation test hole. (i.e. :5 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 t Sheet of� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL I1EATLII SERVICES FIELD ACTIVITY TIVITY REPORT AI)T)RFR4: ©L7 72d, Street Town State Zip PERSON IN CHARGE (1R TNTFRVTFWAi) l'7/iIJ Oz S/o n Name and Title TYPE OF FACILITY: !!A s % s, FINDINGS: I 02/96 Title: Rev. Torp 662 'IFNV-C�7 Ora -78. , P" oN JNV.� (WY IL. ZL + HAA ? F 15'. 0 I , Fi 1�7 V�r r-77. AIN TlWfbP,AK,y (U)WTI f V 1, r. lif 90',r, M•H. C>_ I ke,r pI I P / G73. 5 Z5 S 61 + cl 13 t -7 . .... INV 5T. JUN -09 -2000 08:44 AM HARRY W NICHOLS BRUCE R. FOLEY Public Health- QfiectorF- _.. .., 914 279 4567 P.02 LORETTA, °" °" iis9octaie Pu�llc 1t'eolthV Director Director of Patient Services DEPARTMENT OF BEAU' 1 Geneva Road Brewster, Now York 10504 REQUES1 FOR EIELD TESTING ATTENTION: a ADAM STIEBELIPrG I4ENE REED (S- --c-A^1 &a i9tJX tzS �I All information below must be U4 completed prior to any scheduling. DATE: (e -- cl - O0 ENGINEER OR FIRNI: I TQt' tvC. 'lr. 6 . PHONE t : „ 221? -121a REASON: ROAD /STREET: TOWN; A SUBDIVISION: OWNER: DEEPS: ❑ PERCS: A/0'PU1VIP TEST: D J TAX MAP #• _ 33' —� = LOT #: ,.._. YES NO ❑ - Proposed SSTS within the drainage basin of Nest Branch or Boyds Corner Reservoirs. Cl -. Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. n._. Proposed SSTS within 200 feet of a watercourse or a DEC wetland. o Proposed SSTS design flow.greater than 1000 allons /da orSPDES Per ;nit.rea�ear�.•_t:= e�:....:._ _.__-- •- -• - - -- - -. -- .' -� .. � .. o __�,•'�,� -- -- ..I'rcYosed• fivTs•for•irCtsttlnrercai" "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 answered Xcs to any of the questions, NYCDEP must witness the soil testing. This Departtnent will coordinate a mutually suitable time for field testing with 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. FOR COUNTY VSE ONLY DATE- TIME: rI 3AMM. (FIELDTEST) 8070 1291 Zb. . •lax �i / ` � 8 - L 35.06 • 244 L84 s J01 Ste, jaa 30 17.02 2M AC. 4.2 a 76 73 I 12 "Z ?- 66 Ar - 2.67 AC 82 1.61 At 222 AC 172 • IS 4.1 721.24 02 AC. i95.13 AC. 2.50 A 81 t rs hp K 0 Aza 77 I I. a • L59 Ate 80 0 7 ZOO& K 70 1.4I At La AL an AC. AC. CAL- .35 69 'Go 105.7 AC. Art. 5 'AC. I 241W 6 110.96 CAL. 100.17 An 66 4.95 AC. 63 44.52 AC. CAL. 16 57 24.58 AC. 9. 6; AC. CAL. 1� 55 19.3; 73?.76 AC. CAL. 0 .0140 311.40 2004.40 56 I I t AL 22.37 AC. CAL. 1. 1 1 53 31.7oAr- ~50 i I 358.50 54 02.541 tj J01 Ste, jaa 30 \1I At 64 CA c • 'A AC L CAL c 62 4.00 X 0 61 9 3.6; 3.1 1.02 At c 17.02 6 32 33 4 f 29L 16 lic • A 2.96 AC. k 274 At CAL- .35 \1I At 64 CA c • 'A AC L CAL c 62 4.00 X 0 61 9 3.6; 3.1 1.02 At c i i1 1 E •r r m �r R � +I � s ,0001 a,,[ NIOIA N JO "too'' NINOZI a w ; O 0 0 v1 • u U t'• i i • •o o 3 1 m ..•so! °e i+ a ry OD e a a o'S iJ CD i" rj r+rn 1 1R111[���0 r J^ 4 i JUN -09 -2000 08:45 AM HARRY W NICHOLS 914 279 4567 P.04 ol 0. ye 1 b�1. /� \Q /• // i ! I 1t _. — J G?- 1 v l` 9 1-• a~Q ���` �`� a._ �► ti rte' -�'' ° it s © � _ �a� *� " � _ _ ,• � I � � � lei � V' � ` V _ � - _ ��rt;tiiiu�tunmt +nyp anti�ni�nuau� � I,, � � ' �• ` �� .. I„ . �ti��►pepltl / q I o... Q rr - e �,•'� � 'fir � � � _ - �� ,; �. � � • � c� � V. „WWI_ -'� ;x�3�vr► PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES L° r DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner _ �,¢)/��Z Address . oG D R . (Street) 7Z-/; 2� Tax Map 3 5- Block _ Lot to Located at Street � (indicate nearest cross street) Municipality p,¢ �nsOq - Watershed 7306 572 ©ok Date of ins N 1 2 3 4 5 2 3 4 SOIL PERCOLATION TEST DATA o o Date of Percolation Test `Time: n. To'l - 9; 3;2 1 3 0 7' - %vi 4 3 1 3.0 119 O f - /0+'3 .� /l l -30 //11001- A 3 0 30 11�i' 921- + 9+y5- - 167!0_- //.167,; - Al 3 1)- 12, 37-- 4`©7 2 3 4 '1U Q_o 3� all 2 J /� .� /l l �+ 11�i' 921- �2 %-2-E% .3 6, aa/2-as% 3 1�", 1 1 5 1 1 1 1 1 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at 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 35.06 • J'z J4 GM83 82 M Ac a 2.50 AC. 1 61 p 578: MAL 77 2.59 AC. • 80 sit • Ll At TO La . • canal X OLD& L 1 1.21 2lW 105.� AC. Ac t GZ AI 66 rs 35. .00 AC AL rn via Los A of 25 _<_l 0. 13 31 .7 I7.02 k C 06 S"L17 AC Lot J, 32 .1.93 AC. C 1.90 A 5 a g 33 2.22 AC.. 9 ZqL lb 59 AC — 1, 3 1.14 AC. 20 1034 1.50 a 2.96 AC. 2.74 AC!! Cal. 35 671 • L45* Z 4 ol 65 OHO 7.22 JG 48 413 ;C. CAL CAL it S I 1 0 A I SCALE 0 n OF N HCH P/0 2T 1 1 227 P/0 24-1- 3.00 AC. ISO It 26 ir 12. 20 25 MAr- JAL AC. 45.70 AC. i O t • 24 1.84 \, -XI At AC. CAL. 11,155 2 ti 4 am 23 %4, 9.1 Ol 22 • At AC. ia. Ua At AID 4.3 to 4.2 LGG At 0 3.02 AC. ;'Acu* 7.97 C. At ni .94 6513 AC. C & •l o AR, 19 0.93 Aq�4 15 4.8; AC. % 11.35 N AC. ELM 1 1166: 8 CAL 5 In 110.96 AC. CAL. • 6 35.06 • J'z J4 GM83 82 M Ac a 2.50 AC. 1 61 p 578: MAL 77 2.59 AC. • 80 sit • Ll At TO La . • canal X OLD& L 1 1.21 2lW 105.� AC. Ac t GZ AI 66 rs 35. .00 AC AL rn via Los A of 25 _<_l 0. 13 31 .7 I7.02 k C 06 S"L17 AC Lot J, 32 .1.93 AC. C 1.90 A 5 a g 33 2.22 AC.. 9 ZqL lb 59 AC — 1, 3 1.14 AC. 20 1034 1.50 a 2.96 AC. 2.74 AC!! Cal. 35 671 • L45* Z 4 ol 65 OHO 7.22 JG 48 413 ;C. CAL CAL Sheet 0 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEATLTI SERVICES X' -1 YE L B T A---C T-1-VkTY,--- aE F 0 RNT A T)T-)Rp P, s: 947) 72.-1 PIA- ;Qr2E /7 Street Town State Zip PERSON IN CHARGE n'R TNTFRVTFWF.T)-. nege�z Name and Title TYPE OF FACELITY: FINDINGS: Signature and Title RFPn]RT RFCF.TVFT) BY: I acknowledge receipt of this report: SIGNATURE: 02/96 Title: Rev. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Go 7- DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Address Located at (Street) Tax Map Block _4 Lot v 69 (indicate nearest cross street) Municipality p,4TT I�Z& Watershed 230.6 SOIL PERCOLATION TEST DATA Date of Pre-soaking al 6. / ®o — Date of Percolation Test - S /' /o 0 prlm&yl 1 /0120-- ; 0-fy - 2 57 2 3 '17 4 /6 23 % -26 /a 5 2 3 a.laq 16 4,112 - 2.9% 6.3 4 /Z 5 2 3 4 1 1 5 1 1 1 1 1 1 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I min for 1-30 min/inch, --, 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 .j - 3 � - '.3, t 3s. t ryrNC 3 vw� ;' .. .�, 'JZ t.' .� . ?+k .; h 9 1 s �. ...b � ,ice, , r F t e L s Y -. - k v . z , a . rr F - f; R{, HL �' e t S -"a;. 5'k -.3� F,�y` SV .a�W.-•i a'JFi u "' a Y ' .' d !2 } 'i V'A: PN%+4L 573r Fhe 4 'E b -u: 4Y, -s} ��J � r p y i p)jj/� .. r r trt _ - -.' f a F P ; 4" ' G J`: S 4- x M `l �dd ' °� to t c �'� . / 1 -Cy� 1{ / _ } x _ _ _ K�# `= �, ®® °'oi. [ Q Ad .'�'} °fig i� oC:� - c1-.s `°" i oG s / � � �% ,_ {'F;/ ,moo 1 �{O !ham lU!.. F s ''a- `° �' .s' _ WnAwv �, s s wy. ,, z % 4 e "all Ana a ' G% ft C xfe i 1 } � ` - 5 J'.' 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