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HomeMy WebLinkAbout0615DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23. -2 -23 BOX 7 : �.. - Ir ir UL I 00615 PUTNAM COUNTY DEPARTMENT OF-HEALTH Go T DIVISION OF ENVIRONMENTAL HEALTH SERVICES oe DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner.. Address Located at (Street) 7- 11,o4E �, Tax Map 2.3 Block Lot (indicate . nearest cross street) Municipality Watershed SOIL PERCOLATION TEST DATA - Date of Pre-soaking 7 3 -o 0.2 Date'of Percolation Test ZZ31 A®g ;zq 0, 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 f6r 1-30 min/inch, :5 2 min for 31-60 min/inch) All data to bi submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 V: z .......... V/0 O ;Z0 0 .2 S c.,::>, 07-0 IA aj. -3 .4 -3 5 2 49 :57' 3 -30 /7 5 3 0' S 1712- 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 I min f6r 1-30 min/inch, :5 2 min for 31-60 min/inch) All data to bi submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 PVTNAM COMM- I)EPARTIVIENT OF REALJJI DIVISION OF.ENVIRON1VIENTAL HEATLH.'SERVTC-gs �. L �tlr Y04 FIELD ACTIVITY REPORT, NAMP /G d TPl v %¢ - : 3?�'�� ° � �i�r"r'cSc�cJ• 0 �.t�f! FMS. 01"�U-1 -A Street:Y . P .Town Stake Zip _ PERSON IN CHARGE° :: Y PvMM l ,R_M . RVTP -. , I�t : t� EV /V�i: ! t�atP; ,SlFl7 and- Title` :Dame TYPE OF FACILITY FINDINGS - .�,P•- -4&: S �i� r�ge����r .a. 7/ .:L= ��� r s c y 2 x x j Signature- and Title: I actcvuledge.rece pt ° -of this report ,.SIGNATURE: b2146 °, Title, ` 06/25/2002 11:41 FAX 845 2796769 e; BRUCE R. FOLEY Public Health Director PUTNAM ENGINEERING -► PUT CO HEALTH 01001 /001 DEPARTMENT QE HEALTH I Geneva Road Brewster, Now York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Palient Services ATTENTION: ❑ ADAM STIEBELINGY XGENEREED All inforniatiOl below must be 101 completed prior to any scheduling. DATE: ENGINEER OR FIRM: � t PHONE #: REASON: D ,) : '.-PE S: PUMP TEST: ❑ ROAD /S'T'REET: TOWN: i �. J fC % -�`: 'art, ».': TAX MAP #• _ -7 SUBDIVISION: LOT #: OWNER: YES NO ❑ Proposed SSTS within the drainage basin of West Branch or Boyds Corner Reservoirs. ❑ Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. ❑ Proposed SSTS within 200 feet of a watercourse or a DEC wetland. ❑ '� , Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required. ❑ Proposed SSTS for a 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 answered ya 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 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- witnessiH g of the soil testing with NYCDEP. FOR COUNTY USE ONLY DATE L�3 0� , ..� i 30 TIMB• fd � MELDTfiST) .__. . �r.w.r. rn ITI�l1M /"`r11 IAITV r1C�f1OTMCAIT r1C D 1 PUTNAM COUN'T'Y DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL /COMMERCL41 SITE INSPECTION FORM SECTION A. ,GENERAL INFORMATION Name of Project ©AXOunty Site Location �j�� -N ,�% /Wi�i?/t/5 T�� T/� `� 3 Building construction begun 410 Extent -�"`- Is pro erty within NYC Watershed ? .................✓Yes F_71 No SECTION B. TOPOGRAPHY (Please check all appropriate., boxes) 1... - - Rolling Steep slope .. _.. Gentle slope — = -- Flat -- ----------------- 2. F-1 Evidence of wetlands Low area subject to flooding 0 Bodies of water 0 Drainage ditches Rock outcrops 3. Property lines or comers evident ....................... —4—.Do-water courses exisl�on or adjoui the property? ............. 5.. Will these. affect the design of the sewage system facilities ?............ —6. --Do watershed regulations apply m this development ?..- ::::....:.- :......... -7 Will extensive grading be necessary?.::::...... ...:. 8. .Will extensive fill be necessary for SSTS? ......... ............................... 9. Do filled areas exist within the SSTS area? ........ ............................... = . - ' If yes, what ..is -.the condition of the fill? SECTION C. SOIL OBSERVATIONS Appearance of soil:: Sand Gravel a Loam F. Clay a Hardpan Mixture _ ... -- 11. Observed from: F-1 Borings Bank cut 0 Backhoe excavations Yes Yes Yes Yes D - Yes - dYes 0 Yes © N No No 0 -- o N �No No Ef No .12. Soil borings /excavations observed by 13. Depth to groundwater 14. Depth to mottling on on on 15: Are test holes representative of primary & reserve areas ...... ............................. ... F-� Yes ❑ No 16. Soil percolation tests made by T6,7N.4W 0 on -3 17. Soil percolation tests witnessed by j:lz�_ `OC- aj? . P, G, H_ 2 on ` SECTION D (on back) _Form ST i 2 SECTION D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? Yes [::� No 19. Will groundwater or surface drainage require special consideration? ..................... D Yes F_� No 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? .......................... F� Yes ✓i 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? ................................ ............................... Yes, EK Inspection data 22. Do adjacent wells and/or sewage systems exist ?:::::.. : :. -- - - --- - .. -_ . ffy ...................................es No 23. Additional comments 24. Site observer /inspector and title 7 'e6l) - I 25. Dates) of observation(s)inspection(s) 7 S'/ A2 Z TEST PTT PROFILES - -- -- Hole # Lot # _- ._dole # . - - -- . - -- -Lot # - Hole - 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 rockl'unp. 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