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HomeMy WebLinkAbout0094DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631 - 589 -8100 3.19 -1 -21 BOX 2 J � F :6 I' 111•:1I PUTNAM COUNTY .DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner A 136A46 - Address I &A In ; l Located at (Street) ' Tax Map 3,1 q Block J_ Lot '(indicate nearest cross street) Municipality FA 7-7-4 OA) Watershed 6A75T - 13'?AL„1Gi-F SOIL PERCOLATION TEST DATA Date ofPre- soaking /Z .0 /c98 Date ,of Percolation Test S 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 38 -1:0 F� 3 %y 3 ,2;��- �:is 30 /8- �a�/ k3 %y 4 5 v2 z: �L3 /U ,a 2 le 3 X2:39° x 8 -.I 4 5 3 1 /,t q-1 3 3,7 2 4 5 L_ L NOTES: 1. Tests to be reheated 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' 1.01 1.51 2,0' 2.5' 3.0' 3.5' 4-.01. 4.51 5401.. 5.5-t 6.0' 6.51 7.0' 7.5' 8.01 8.5' 9.0' 9.51 16.01 TESYPIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES HOLE NO. HOLE NO. � HOLE NO. 2 O . . ( 7,01 -7. 0 F -7, o I -71 0, 1 Indicate level, at which groundwater �i& encountered Indicate level at which mottling is observed AJ QA)6 Indicate level -:to which water level rises after being encountered Deep hole observations made by: C" Date."/ Z og Design Professional Name: Address: Signature: Design Professional's Seal PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner .4;5,eAlz Address i3ga- -M¢ - 73 f Located at (Street) ' Tax Map 3 Block t Lot (indicate nearest cross street) Municipality _ PArrrjz�Aj Watershed 15.AIST- ]57ZA,&jr_f4 SOIL PERCOLATION TEST DATA Date of Pre-soaking 1Zj3 /CIS- Date -of Percolation Test .... ....... ... . :J. .. ... . ...... .. ........ round vel re imm ... ............ 'R -R` j"iffa ... ct:� tan. In..::...: ....... R.at" M wl1 :i:-N ............................. �:i;:.... ......... .. • 2 q 3 2 q3 -3 (3 /0 4 5 2 3 4 5 2 4 f I I 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 I 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. 1.01 1.5' 2.-0' 2.5' 3.01 3.5' 4:0'- 4.51 5:0' . . 5.51 6.0' 6.51 7401 .7.51 8.01 8.5' 9;0' 9.5' 16.01 TEST.PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES 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: Design Pr6fessional's Seil Date 2 NAM COUNTY DEPART I ME OF HEALTH Um OF,. E� N'T,7AL HEA. SERVICts V4LkL EsDIV0DUA.L�COMM,ERCLA'L'-. SITE TNSP CT.j(3. 'SE-CH _A` �3 Buildin g consftr . io t begun ent F e . S i4o'' 1 appropriate oxes� SE C T-j T. W -1 Steep; C) `Flat e. 2. blling FM I -y R lnd=6 of wet Low area subject to fl, offin di. e of ;Water Drainage ditches = R-6.0k outer up's. .3. Property ., lines ..or.corners evident. ............................................ ..E] 4: Do water courses east on.or 'Rd: J" I Pr ,.QPt 5. Will these affect 66 'de C)i 'sign the sewage system facilities?............ Y 0 6. 'no watershed regulations-apply. this developni .... ........... Yes No 7 Will extensive grading ''btiecess ary ........ .......................................... . Yes No 8. Will extonsive.4-111 be mecessaryfof S-S T8.9. ........................ ......... Yes No' 9. ......................... ........ Yes No If. Yes,,. whatis Xhe,tondiftoii d-the. fill ?' SECTMN,.,,C . SGEL;OBSERVATIO 10. AppeariAtce-of.50il:1 -Sand Crrav61 , Loam Clay Hardpan F7 MLxturi to koe excavations I I Observed from: nngg Bank cut adk.. 12. Soil -b'o;n�n'ggfe�,eiVitlo"n's"�bservtd..�b.- pli y 11.5cll F_ 4,7 RCAD R 7 13. Depth;t6groundwater ..on 14. Dtpthtb. 'm'o tlifig 15. Aretest holes repfeisentzifive of lirimary &reserve areas .................................... ...... 16. 'S6il percolation tests iiiAde by. on gyZZ Id,4ZIAZ P .17. Soil percolation tests witnessed -by CC- L>, � ..on SECTION D (on b.adk) I Form ST -1 : I 2 , V SECT -11ON . D AG 18. . tena"11. alter�th�atura3 riraina e,n this or ad acent areas Yes No Y g .: _�. - 19 Will groandwfier or' surface drainage require special tronsd`eTatloi ?"............ desI�1o. 0. mill gullies, ditohe etc , be: filled and watercourses lbe relocated ?..:,,:............. ... Yes ' No S eTII' ON I.4 "RE�I��tI�. 21. If a comzion *after supply is proposed, kias on inspection been made o -Jhe u., e sting` r proposed source and facilities . ...... ....................... ... EZN o Inspection -data 22: Do adjacent w.61.18 ai dlet,sew.age sytt -etas eanst ?.....: .i ....:.... ..................: .... Yes ;No 13. Additional comments' . 24. Site observer /nspettor and title 'D 25 . spectior(s) TEST PIT P.RoF Hole Lot:# Hole # Lot,- # Hale:# Lot Depth to water Depth to water Dep hto water Depthto mottling Depth to mottling Depth tonottlig Depth-to rock/imp. -Depth to rock/imp... Depth to. r9ck/ ip 0.5 ti5` 0.5 140 1:0 4:0 4:0 k0".. 5:0 5::.0 5D 6:0 6:0... ..6.0 . 7:0 70 7.0 8.0 8.0 8:0 9.0 9:0 9 U 10.0 10.0 10.0 Sheet__�--of�_ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEATLH SERVICES FIELD ACTIVITY REPORT NAME: )5 TPA: Aj 14 Street Town State Zip PERSON IN CHARGE _ OR TNTFRVTFWFT7: ZGJYAz /,k) / / S Name and Title TYPE OF FACILITY : B9©P SAT S, ,%O'Z S E—pAIMT� 5 c�7�u TLS FINDINGS: TN ,qPFC'TnR: TFT Signature and Title RFPORT RF('.FTVRi) RY: I acknowledge receipt of this report: SIGNATURE: 02/96 DEC -4 -2007 04:53P FROM:OUTDOOR CONCEPTS INC 845 -724 -4459 i . 1 ;L 10 `�1• WIRE PENCE ON LINE TO:92787921 P.2 1 � m Y f 109.4' / + m e1e'0 P OPANE x GARAGE TANK BARN —awo&— ff! � �M / ✓ I � p / / 1 ict • BARN C WfR£ FENCE � r, s33 I ! IL IN 13; k I +1 ` ISM L� l�I SHEDS IJ I PR PA 1 roe— V 0A 1� 6 IS J OLIO 11F 1 `,F��i� -i WELL tit +1 2Ya S" V 1 r r ,1 SW S. PN442) �� V l 4 Ci n�, .� ` (to2•s' ` t N, (8.1 031 13 PGRCN �� � ` JI � I GRAYSL / / 0 SsTs PLAT I--, \ LA1 No 14t(,�wG 4T(VIF / , i �1.6. \ ✓ � HANNAN �G (L.570. P.154) OLD FACE OF G. GENERALLY LINE J OCT -19 -2007 10:30A FROM:OUT000R CONCEPTS INC 845 - 724 -4459 TO:92787921 P.1 OCt-4 9-2007 08:44AM FROM -ENV I RONIENTAL HEALTH SHERLITA AMLEP, MD. MS, FAAP Commissioner of Health LORETTA MOLINARI* RN, MSN Associate Commissioner of Health 8462T6T921 T -647 P.001 /001 F -469 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10504 REQUEST FOR FIELD TES'WNG ROBERT1 BOND] County Fxerurive ROBERT MORRIS,, PE Director of Environmenud Health All information below must be fuUY completed prior to any scheduling. DATE: 10,11-o-7 ENGINEER. OR FIRM:_,] 0 +4 t A V-A tr O r'r _ PHONE Ih 000 PERSON TO CONTACT: ❑ NEW CONSTRUCTION REASON: ROAMTREET: 1k % 1 ❑ REPAIR PROGRAM M/ADDITION PROGRAM "F'RCS: 16E+o F(.ow F op_ A l? L DEEPS: "UMP TEST. ❑ KAp- MAP L.15 /tl/E5 7 S rut>l p TOWN: �ia7 7E� TAX MAP #: SUBI)"ION: rr LOT #: � -- OWNER:_ G r=5- TG 4 AgeN 6 - NYCDEP CRITERIAFOR JOINT R.EYMW, AND SSING F SOIL TESTING YES NO o W Proposed SETS within the drainage basin of West Branch or Lloyds Corner & Croton Fallsi Reservoirs. ❑ jr Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. o Proposed SSTS within 200 feet of a watercourse or aDEC wetland. p ,�r Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required. C3 A 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 answeredyea 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: CQMMENTS: e2o �o•roswrlo's ^Ta v Environmental Health (845) 278.6130 Fax (845) 278 -7921 Water Supply Section (845) 225.5186 Fax (849) 225 -3418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Homo Care Wax (845) 378 -6085 Early Intervention/Preschool(945)279 -6014 Fax(84S)27"648 P/0 3.15 -1 -2 4 I AC. 14 P/O3.15 -1 -31 P/O P/03.15.1 f ��4 13 - 3.15 -1 -30 1.29 ° z ° 140.0 _ - - 103.49_ - 47.5 - O 202 --------- _ — - — 24 2sts1- - -- -- _ 15 20_2 _- _____- ______ I _ - 7i - - - - � 23 12 79.92 21 t 22 79.03 2.50 AC. ------------ _ 66 17 .... 8 I . +_ B- -_ -_ $0 20 lia 7 $ m $ 16 8 J N o u nj1 � • b gt (n ;o 15 11a aO 5 4 3 in m 1.84 AC. CAL. 6 ;I ; EXEMPT EPISCOPAL CHURCH QP 25 33 2.05 A( ` 27 28 28 �OJ�� 29 30 31 84 4.95 AC. I i O / N � N �N // O