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HomeMy WebLinkAbout4750DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 91.26 -1 -36 BOX 36 Los IN TI J6 v! 1116 04750 PUTNAM COUNTY HEALTH DEPARTMENT e.: DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE TREATMENT *SYSTEM REPAIR ❑ 19 Repair Permit issued in last 5 years.. ❑ Not in Watershed ❑ ❑ Repair within Boyd's Corners, W. Branch or Croton Falls Res. ❑ Delegated ❑ ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION d/1 I niq< Pk(-e- TOWN fVf yttc x lit TM # , _ I 3(p OWNER'S NAME -0O&uef-,�, + 6t+t LLn VkU PHONE# Iiy- I L4-765 MAILING ADDRESS 5 AIFL -14I CIL L APPLICANT Q Wt At— tL Name & Relationship (i.e., owner, tenant, contractor) � v DATE FACILITY TYPE PCHD COMPLAINT # C �d l PROPOSED INSTALLER ` ,/� �,�[1j a1- �j PHONE # ��� 7��i ��/01 _k�y.�t�� ADDRESS yt r ,,4 -P /REGISTRATION /LICENSE # G 3SSa �ax elIK.736 Proposal (include a separate sketch,locating the house, property lines, all adjacent wells within 200 —el 31 feet of repair and the location of existing and proposed system) NOTE: The Department may require submittal of proposal from licensed professional depending on the nature and extent of the repair. I n��J &&;4,0 /000 Sc.11mn 5�r iL c1t�- end- yew �i�pfl � _ —,��.. .r _ .. , _•U i.. ., i.__ J t S Pr0V?f -, /�(,�uscU ��� f�COlf bra sw elrF7l'ti� /Sew a ham( ) 1, as owner,agree to the conditio tate rr this form SIGNATURE (owner) I, the septic installer, agree to comply with the 65 Li "E7C- DATE /Z -11-.6-7 of this permit for the septic system repair -S1GF1A1'tJRE �! � � TITLE nz�1�& Y;- :. ,r.. } -DATE (installer) Proposal approved with the following conditions: 1 Procurement of any Town Permit, if applicable. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing: (./ a. Owner's name, Site Street Name, Town and Tax Map number b. Location of installed components tied to two fixed points c. System description (e.g., 1250 gal. Concrete septic tank, etc.) d. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and conditions 4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the completed SSTS repair will function. 05.' No completed work is to be backfilled until authorization to do so has been obtained from the Department. INTERNAL USE ONLY Z7Approv ,dc re Proposal Denied t7v- X .3 /(7 t09 Date Repair proposal is in compliance with applicable codes Yes COPIES: PCHD; Owner; Installer PC -RP 99ML (a t71®7 Miration Date 0�- No ❑ Rev. 2/07 g{� r � � � � � � Page No. of Pages ,711I� 8 LEONAR ®1 & SON CONSTRUCTION, INC. OWNER: LOUIS LEONARDI 6- CAROLYN DRIVE � C0RTLANI: -j I.ARI k X4—M7- ' 4.. - 014) 736-9010 LIC. #WC- 3112 -H90 ® WC- SEPTIC LIC. #00067 o LIC. #PC -560 (CERTIFIED) PROPOSAL SUBMITTED TO PHONE DATE 1 ! z-11 STREET JOBNAME CITY, STATE and ZIP CODE JOB LOCATION cos ARCHITECT I DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: RO \3 C-,10, ............................................................................................................................................................. ............................... ky--I �kb (J(,' &—I/ ............... ................................................................................................................................:..................................................................... ........... .................. ................. .._...... ....:.............. ............. . ............ ........... .. w�� ....:............................. ....................::- .......� � ..................................... I .......... I ................................................ ............................... .................. ............................ EASE NOTE: 'SYSTEM LONGEVITY IS NOT GUARANTEED UNLESS DESIGNED BY A LICENSED PROFESSIONAL ENGINEER.' 'TANK TO BE PUMPED BY OTHERS AND PAID SEPARATELY! 'NO LANDSCAPING RESTORATION. OTHER THAN GRADING DISTURBED AREAS IS INCLUDED UNLESS SPECIFICALLY STATED' We FroPOSP hereby to furnish material and labor — complete in accordance with above specifications, for the sum of: dollars ($ ). Payment to be made as follows: A FINANCE CHARGE OF 1 %% PER MONTH WILL BE ADDED TO ALL UNPAID BALANCES. CUSTOMER IS RESPONSIBLE FOR ANY AND ALL COLLECTION FEES. All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications Authorizeda r =• L� ' involving extra costs will be executed only upon written orders, and will become an extra Signature charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Note: This proposal may be. Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within Arreptanrie of Proposal— The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified. Payment will be made as outlined above. Date of Acceptance: Signature days. Sleet of PUTNAM COUNTY DEPARTMENT OF HEALTH =;��� .E:,�Y` iii° xfi�t��" �P�' v�fi�0i `�i�'P�- �cl��:�Z��P.� €��m�•:.. _ �. �i�:: �:: "�r�:c- �.:- .,_.- a::- :: -_s�. FIELD ACTIVITY. REPORT AT It A-0• �VA, Tel; ADDRFCC' Street Town State Zip PERSON IN CHARGE O k, (/C&A/4CI -4 l C'4 v/0 Name and Title TYPE OF FACILITY: FINDINGS:— ��' j ...1 V-� E � � 4 .� � J• i �L,L try � L c a rl � W � � A O•,/ C-�a • qr- •- :w.••- • � -.-drw -. �. �.ti.. vses �• _Vm _- _.e __... .. .. -... ..,...,y_ ..... M -�- .�.. -� .. - -.... .. .-.. �.r or•..?., ._. -.o �.. �..�, v Signature and Title REPORT IREr-FIV -D RY• I acknowledge receipt of this report: SIGNATURE: 02/96 Rev. Title: . | | m A AS BUILT DRAWING V - aJn r's 0C)o 5016 Lot— 3 6 Leopardi & Son Construction, Inc. 6 Carolyn Dr. Cortlandt Manor 10567 (914) 736-9010 RvrpIVY .500 . A I 11A Iw Date: Po-vck 200(g ! w f 1 cr i�G.:6.e : ?�•a. ::; = d, ..Tl. .:•C. �y�`t- (s, . 4' �ake �' ,1 jCele i 1 f POWHATTEN �� Ij �' "f � CRANBERR Rp ,. INTp A L S IN AN N YS ® /Y HARRII ( I 2 SO T �-r M AL, 1 O r3 O O` S ¢ o r WASFIINCi NORTH ST Z BREE 0 00 ER 2 D ✓ O i D 4 S°DTM < 2 m FL O ARO ru 1®53' 15 Z / f1 DARTM O RD i f I ^ 20 POINT , ; oq °Gk P • �� q j �(O A6� r j x D OdLAWN Or 10 V l ��. .. � ....._, ._ o . .. -.. P v •'" t d- y • • ala �y � tap -q- -�a - ¢ Qr p(11N O y O P Zr t3 + S LA m N �a�a J t PCJ E �t7 u Ii 7�im CO z l ° 6P y1Q' LAKE DR 1 s alle 1 9 f I j _ g Jg 1 DECKER HCH ✓ J / u� O I OHNSON h V f �O 4 ¢ W MATHE rnj cm 1 ������^II� aI WIN K a2 P 14, W' W is ,t � tiP : f c� J K �VV RD ¢ O r "iENP�pO aGV AL m I L H v0 Li E t• o o� �:' { i Q U. F� W Ft E KINGS RD O O 1 n ;�. FOR ADJOINING AREA SEE HAGSTROM'S WESTCHESTER COUNTY ATLAS 11 C) Hagstrom Map Company. Inc. 101 d w ems( - DUP-Y- /Iour &- � v �Pftue4f IN- +r-e /,/C) �� 5y 0 / SHERLITA AMLER, MD, MS,.FAAP Commissioner of Health _ ::1 tt: y�j�k �v 'W .i Z�•% .aF'.: �i�;r. �Y F.�t��.4 .. > :4.,+ :. j.'F+K. }_ ILORIET rA MOLINARI, RN,'MSN Associate Commissioner of Health Robert J. Randall; PE 1551 Cross Road Mohegan Lake, NY 10547 Dear Mr. Randall: ROBERT J. BONDI p County�r E�x.ecutim `ai.:�y 1�.. p•: g�w•. �" -;f'r .N4 A.PY^azP Q. a. Y.�.::.;�%S. ,tY :wi. ROBERT MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH I. Geneva Road, Brewster, New York 10509 February 29, 2008 Re: Proposed SSTS Repair — Murphy 5 Melnick Place (T) Putnam Valley, TM# 91.26 -1 -36 This office has received and reviewed the most recent set of plans for the above - mentioned project. We would like to.offer the following comments for your review and consideration. i The Eljen detail should be labeled -and a plan view should be provided.- /. The detail is for a bed system but the site plan appears to be for a trench layout. Please clarify. /3. A design data sheet si gned and stamped by a licensed professional engineer is= required. 4. 5- It e;3. z= is'.to -'o,e nrovi e d �c�,sb()rvn. iin;t e.s to l lan.. �: ___ . .� � .':. _�, : �: .- •: 5. Details for the follovlving components are required. a. Plastic septic tank b. Plastic junctio box C. Silt fence . �/ _ /6. Calculations showing how the eljen layout was determined. are to be provided on the,, plans. `J7. :The tax map number should be provided on the plans. This office will. continue its review upon consideration of the above - mentioned comments. Please feel free to contact me at est. 2157 if any questions arise. . j j Veg truly yours t. 1 Joseph S. Paravati, Jr. - Assistant Public Health Engineer JSP/kly Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Servides (845) 278 -6558. Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 - Early Intervention/Preschool (845) 278 -6014 Fax (845) 278-6648 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health :- ..;.v—LPP..ET -T-A .MOi:iNARI, RN,, iY1SN. Associate Commissioner of Health Robert J. Randall, PE 1551 Cross Road Mohegan Lake, NY 10547 Dear Mr: Randall: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health February 29, 2008 Re: Proposed SSTS Repair — Murphy 5 Melnick Place (T) Putnam Valley, TM# 91.26 -1 -36 This office has received and reviewed the most recent set of plans for the above - mentioned project. We would like to offer the following comments for your review and consideration. 1. The Eljen detail should be labeled and a plan view should be provided. _. 2. The detail is for a bed system __ but _.. the site plan appears to be for a trench layout.. Please clarify. 3. A design data sheet signed and stamped by a licensed professional engineer is required. 4. Silt fence is to be and.sbown-on. the- site•pl_an: °'5. ' r7etaiis iur the foi owing components are required. a. Plastic septic tank b. Plastic junction box C. Silt fence 6. Calculations showing how the eljen layout was determined are to be provided on the plans. 7. The tax map number should be provided on the plans. This office will continue its review upon consideration of the above - mentioned comments. Please feel free to contact me at est. 2157 if any questions arise. JSP/kly Ver truly your Joseph S. Paravati, Jr. Assistant Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool(845)278 -6014 Fax(845)278 -6648 PUTNAM COUNTY DEPARTMENT OF HEALTH . DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET — SUBSURFACE SEWAGE TREATMENT SYSTEM Owner: 5kirlr°J Aur4h 4 Address: 121, Zak&— %96e,��ill � p5 �i Located at (street): �p ��lY�. Section: g /.Block Lot Municipality: �y+,ya -'k (/ fP�( �°�' Watershed: SOIL PERCOLATION TEST DATA Witnessed by: Date of Pre - soaking: Z 07 Date of Percolation Test: - o Hole No. Run No. Time Start — Stop Elapse Time (min.) Depth to water from ground surface (inches) Start - Stop Water level drop in inches Percolation Rate min/inch 1 2-& —Y: _. 2 O— Z.� Z©_ z-_', f 3 - —2 Zr�Z-4 1 2 4 5 1 2 3 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., < 1 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 66-97, pg 1 of 2 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES ��i. s..'a ra�a�J+'b �r. •Y.. ��La . <. .sf'^ -SG s�A-M.e .� .�j.1._s r6 c��''.a `i �:a �A :9F.;R,`.��or� "a..:•...n�. ^Mrs: V�+a:- «.e� ^:. X. Y- �C.,�:, :� _.�_.:2•�..i..,�.et4�ci�..G^+ . DEPTH HOLE NO HOLE NO HOLE NO HOLE NO HOLE NO G.L. o lVD 70 P �; o i l 0.5' GCC,Yl{ 1.0'� 1.5' . 2.0' 2.5' 3.0'' y -o 3.5' -iTl tit 4.0' ) S.O —� DD 5.5' rn EV 6.0' l�C� 6.5' 7.0' �- : -7.5' 8.0' 8.5' _ 9.0' •10.0' Indicate level at which groundwater is encountered p G r^©vxd 1dja4&Y E ne-ou Indicate level at which mottling is observed Indicate level to which water level rises after being encountered �AviS /-,00�c✓ Deep hole observations made by: Date 1 29 0 8 Design Professional Name: ' LAty�-r --is-, \z4--) � — Address: 45$ &D A Signature: 6 L0,01.1k Design ProfessionaO = Sea➢ k. 3ca -o7l 'PUTNAM COUNTY DEPARTMENT OF HEALTH INITIAL, INDIVIDUAL /COMMERCIAL SITE INSPECTION FORM SECTION A. GENERAL INFORMATION Name of Project M County Site Locatibri. Building construction begun All/V Is property within NYC Watersh6d? ... Yes No SECTION ,B.'TOPOGRAPHY (Please check all appropriate boxes) -IEuy - Rolling 0 Steep slope Gentle slope Flat' Ade�'e Bodies of -r. c' of wetlands Low area subject to flooding water,. ;Drainage ditch6s Rock- outcrops 3. Property lines or comers evident...; ..................................................... Yes. �-­No. 4. Do water courses exist on or adjoin the property? ............ ............. yes NO 5.- Will these affect the desip of the sewage system facilities? ............ =yes No 6.' Do watershed regulations apply in this development? ...... ................. Yes. ,'D<" No 7 Will extensive grading be necessary? . ........... .. Yes NO.-- 9 Will extensive fill be necessary for SSIS? .................... .................... Y eg 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. Appearnice of soil: Sand = Gravel rK7- Loam F7 Clay '=Har 4p an EZMixture 11. Observed -from: 0 Borings a Bank cut Bic! I= excavations 12. Soil borings/excavations observed by JS J>.e On 13. Depth'to groundwater 74- on, i I .14. Depth to mottling on I I (s Lvy 15. Are test holes representative of primary & reserve areas .................... Yes .= No 1,6. Soil percolation tests made by on 17. Soil percolation tests witnessed by on . SECTION D (on back) Form ST-1 • .y.�. .. � 3 s, .fir w. '1� •:V "•. e{' •':.�v'..c . 5 • .. :-i :..._ . �_ r.�' < . , ; ,ice -- SECTION D. YDR k]NAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? Yes No 19. Will groundwater or surface drainage re uire special consideration. Yes No gr g 4 sp ........ ..... 20. Will gullies, ditches, etc:, be filled and watercourses be relocated ? .......................... F7-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? ..................................... .Y.�.l.f�:........ F7 Yes F7 No Inspection data 22. Do adjacent wells and/or sewage systems exist? ..................... ........................ ........ Yes :No 23. Additional comments ao`�r �S ��� � �i�v�e<:� �2e�re- � ei�+• -� �` �'� < 5 S iJ-e� 24. Site observer /inspector and title 25. Date(s)-of pbservation(s)inspection(s) TEST PIT PRGF'iLES .Hole # Lot # Hole # 'Lot # <. Hole # Lot # Depth to water Depth to water ' - " : Depth Depth fo'motiling f 1J Depth to mottling Depth to mottling Depth to - rock/imp. ` ' Depth to rock/imp. Depth to rockhmp:. . G.L. ' '4. r3 G.L. G.L. 0.5 .0.5 0.5 1.0 - +7•' 1.0. 1.0 2.0 `` C �r'c`�` 2.0 1.0 3.0• 3.0 3.0 - 4.0 'Do & 0 4.0 4.0 5.0 5.0 • 5.0 . 6.0 �)O Le % 6.0 6.0 3 7.0 � 5 �� �- �� ;c l 7.0 - � 7.0 ve 8.4 � 9.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 3oa 7' 'PUTNAM COUNTY DE PAR'i`MMNT OF HEALTH y DIVf�ISIO_ N..QF..E•NVJR.OrNW_,N.T�A1L J. ALwT� EI-SERV]CC- /v{��f1a' - '. P...�{�..c I�sRCS't � w .+ tllatro.si� VaV -.K.. `t.1i. <Aa ' M • _ �V �' .. T- � l.I�.:.�a . -=T �..ils .. _... wr ..w�.a. e. •.,A: -.r. f'., Vf� :`. � " _•'•��.. �..w � �•../a .�•.+. INTTIAL INDIVIDUAL /COM ERCIAL SITE INSPECTION FORM SECTION A. GENERAL INFORMATION / �r � �2� p�5 0 Ko r A,) Name of Project Muuh-m (T)(V) County Site Location- ,� . /VLe, to,' *K Building construction begun de7 Extent ;. Is property within NYC Watershed ?........ .......... 0 Yes No SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. 'Hilly' . Rolling a Steep slope GEZ Gentle slope Flat ' 2. Evidence' of wetlands Low area subject to flooding Bodies of water. Drainage ditches Rock outcrops 3. Property lines or comers evident .................:..... ............................... Yes No 4.. 'Do water courses exist on or adjoin the'property? ............................ Q Yes a No 5. Will these affect the design of the sewage system facilities ?............ �. Yes No 6.. Do watershed regulations apply, in this development ? ....................... Yes No 7 Will extensive grading be necessary? ....................... ...... Yes No F WiTextensry -i-M17 be necessary for SST.S ? ...................... Yes No' 9. Do -filled areas exLJ within the SSTS area? ........ ................. ........ ...:.... . Yes., No If yes, what is the condition of the fill? SECTION C. SOIL OBSERVATIONS 10. Appearance of soil: a Sand = Gravel Loam F7 Clay ❑ Hardpan Mixture 11. Observed-from: Borings a Bank cut Back hoe excavations ; 12. Soil borings /excavations observed by JS P cti.,) 'oe on I I 13. Depth'to groundwater on' .14. Depth to mottling on f 15. Are test holes representative of.primary & reserve areas.. ... .. ............:.�.1,!/:�..... Yes 0 No 16.. Soil percolation tests made by on 17. Soil percolation tests witnessed by on SECTION D (on back) Form ST -1 ~ SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacen t areas? Yes No 19. Will oundwat„r or surface drama require special consideration. ....................... F7•Yes No gr '=age q sp � . 20. Will gullies, ditches, etc:, be filled and watercourses be relocated ? .......................... F7.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 ? ............... j .,. Yes F7 No ..................j(V. t. .... Inspection data / 22. Do adjacent wells and/or sewage systems exist? ..................... ............................... Yes -No 23. Additional continents CS l;IA 24. •Site observerJinspecior and title io , l rtlif 25, Date(s)•of ;observation(s )inspection(s) TEST PIT PROFILES .Hole T 1 Lot 9 Hole -Tur •Lot # Hole �9 Lot n Depth to water �' Depth to water - -- .... _ Dpth to %vatar - -- DeF #�: =t rccittling J/_ `_ ` +Depth to mottling Depth to mottling Depth to rock/imp. Depth to rock/imp. G.L. a.s . 0.5 1:0 - 3d 2.0 3.0' 3.0 4.0 30 ..'60 .ti���► 5 �4.Q 5.0w c:. �� 5.0 . 6.0'� ' �`i�.7 ��� 6.0 7.0 8.0 �,J(y �u 8.0 9.0 9.0 Depth to rock/imp. G.L. 0.5 w z.a 3.0 4.0 S.Q 6.0 7.0 8.0 9.0 10.0 10.0 10.0 JAN -09 -2008 03:24PM FROM - ENVIRONMENTAL HEALTH SHERLITA AMLER, MD, MS, FAAP Colninissioner of Health - ...'.'a.�'.� =i ::. -� t:.:Q -:3':a .•°sc7``o�+:.- ':%- ri =w'ia ii"'w. -.. :-► °a �'.T^% LORETTA MOLINARI, RN, MSN Associate Commissioner of Health 8452TOT921 T -159 P.001 /001 F -995 ROBERT J. BONDI .I . �:s��.: �' .•,-r a x- r,IV(� --.. ai •+rs"C iT�' -fd.i r•:.,; ..�i3... DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 REQUEST FOR FIELD TESTING ROBERT MORRIS, PE Director of Environntanta! Health All information below must be t'tilly completed prior to any scheduling. DATE: 1 ho ( e 8 ENGINEER OR FIRM: I` sm A LL PHONE #: 9t4- 5 ZB -16 40 PERSON TO CONTACT. P, o$Q-a -T RA-..j 6 -Alm ❑ NEW CONSTRUC'T'ION RrkE FAIR PROGRAM ❑ ADDITION PROGRAM REASON: DEEPS: e PERCS: ❑ PUMP TEST: ❑ ROAD /STREET: 5 TOWN: �t )��t1�llil, Cc�� t° �l TAX MAP #: SUBDIVISION- LOT #: 1- OWN-- �n i rim 1 �t u V' P Yl V/ T —� NYCDEP CRTTERIA FOR JOINT REVIEW AND WITNESSING OF SOIL TESTING YES N ❑ Proposed SSTS within the drainage basin of West Branch or Boyds Corner & Croton palls Reservoirs. _.... -' . � - rQ• Sl'� -�� -3 u \l!i n' -50040i't Ci9".t't':SBi'.Olrj reTeirG7r'Stii�171�r "COII�r01 1�llCr t ark . �• a.c� � - ^} o C�// Proposed SSTS within 200 feet of a watercourse or a DEC wetland. ❑ t;71 Proposed SSTS design flow greater than 1000 gallonsiday or SPDES Permit required. ❑ r9i Proposed SSTS for a Commercial Project. It is the responsibility of the design professional to provide the above information prior to soil testing. The Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered ves to any of the questions, NYCDEP must witness the soil tests. This Department will coordinate a mutually suitable time for field testing with 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 tests, 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: TIME: COMMENTS,. i iw. no.. nawTC:nnc.r�c Environmental licalth (845) 376 -6130 Fax 1845) 378 -7921 Water Supply Section (845) 225 -5186 Fax (94 5) 225-5418 Nursing Services (845) 278 -6558 Fax (845) 378 -6026 WIC (845) 378 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool(845)278 -6014 Fax(845)278.6648 Name and Title = TYPE OF FACILITY FINDINGS4 u'S�i1�S- i(,�^{ _ -_ . g 4. �'+ pu 'sd ►1f+'i ilk 11rl6 � L' eye ct rc� Alt t �-: L iv J J ! v / rC . -4 ,.r- ` 64i _ � p•� "' �A,�- -sue. .. j•. 0� tad':: . �• "]� ' -, s•c':.. - .. P:•r: - r:. q - .9c�'' :,.;, +:5...: � • -i•-�. .. J U 4 7 w • c�, .J .�'� J f f u U Scan cxa s+e4 Tawk ^ To IA-- dIIK'l a r 1 q o Il'I �R 1' ,ry 4 tee GAL. 40 L 1I { i nt V D r T. ti �� wwcx �j.►sa� . �scw. r .,_:., .. S 1 ° �3' Gov .�.w • . GD,�o � _ . R . "' � "'� MFLN(CV\ FLAe-E 15/j. l-1,11S 11 �_ 11� I _l SCAI,t I 1 "= l o' RANDALL ENGINEERINN. RESIGN' - ANALYSIS - INSPEOTNON"' . . •. �1S A16EITLIAA014PE- NT05Ylit .LR100d9,Nfi2111Y11E1b511:: +: 159191101E BR 809Ei111111M 1111054;1 W1052�1810 , 10 iAdA www.randallengineering.netti. PROB�EM"S 'SOILVEO Murphy Residence 5 Melmlck Place Lake Peekskill, (Putnam Valley) NY 1 •DATE: + -ims OFF i' _..,si....�a: _pirr� L.._._..... �� ,..v....fl '� 1 .�e..s.� s..r .... a _.. -� y ... ..... _ ._....-..�y