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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 3.20 -2 -81 BOX 2 II FE 1 gill .41 - 61' T1 , �6 N of E' �1 , IN 00132 T 00132 ���� � PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIAN �frQR:S GE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # P- 2- -01 Located at 10 1 W Ei 1 1 , � 6T Town or Village f N i -6� H Owner /Applicant Name DDArl KOLL o "i11' Tax Map r'21 ' -O Block 'L Lot 6e Formerly Subdivision Name � L56f Subd. Lot # t Mailing Address 16 Pdi:O-'r 1-t OL -OW � � i � i N7 Zip I V 1DJ Date Construction Permit Issued by PCHD o". i 0 i Separate Sewerage System built by G'*'O T W-0-9f' '6veue'%6 Address 15 WC-6i �to" -Ovj P' + eieW,s llrcrj Consisting of i �'60 Gallon Septic Tank and 40a L_f- ham'' TFeM CH Other Requirements: Water Sunnly: k Public Supply From T044 tf PV5�" 04 or: Private Supply Drilled by Address P4Tr -600 4i 1196 Address Building Type f Le 4 p ci-A GE Has erosion control been completed? Number of Bedrooms .' Has garbage grinder been installed? 10 r I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- bVilt plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County, Department of Health. Date: t 1 �'�'� �� Certified by _ P.E. ,X R.A. r Address L'0 (De 4-W`'T6—r n Professional) License # 1 Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals a subject to modification or change when, in the judgment of the Public Health Director, such revocati n odifica ' or change is necessary. By:, Title: JAL- Date: 1 L White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 n i- Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 Telephone (845) 2794003 Fax (845) 2794567 January 3, 2002 Robert Morris, P.E. Putnam County Health Department One Geneva Road Brewster, NY. 10509 RE: Individual SSTS - As -Built Dorset Hollow, Lot #1 101 West Street Town of Patterson Dear Robert: Enclosed are the following: 1. Five (:5)-,prints of Drawing SS -1, "As Built SSTS," dated 1 -3 -02. 2. "Certificate of Construction Compliance for SSTS," dated 1 -3 -0`. 3. "Guarantee of SSTS," dated 1 -3 -02. 4. Laboratory Report, dated 7- 12 -01. 5. E -911 Form. 6. Money Order for $200.00, Application Fee. We would appreciate your review, approval and issuance of the Permit at your earliest convenience. Very truly yours, 316 Harry W. ichols Jr., P.E. HWN:his 01- 026.01 2, '.4 ;C ' 6 r w p,.' Dr, PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Doter j-r o� -yo�1 6oi LpFP- 5 Owner or Purchaser of Building QQj --156 jko i_L ©\r-j G- Building Constructed by 1 a 1 V► JK '5 i P-EET Location -Street Rf��ipC�5 .1� r1-o IL j Tax Map PP�.-r e Block. Lot a�-/z� off TownNillage PQVDe'r }fi0i_1,oqj Subdivision Name Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system,..except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Date : Month Day �� Year ©P'�. Signatur . Title: Gener Contractor (Owner) - Sign re POP-69- i-ovuo°vj b) 4 -tev, Corporation Name (if corporation) _.. Address: 16 WU5 —t K" Ww%� State JA � Zip i05 QA D09-56 N ©u, W &L,00_6 Corporation Name (if corporation) Address: IS �aK K-UNJ 4 k& %D- State AS zip 10sol Form GS -97 NE NORTHEAST LABORATORY OF DANBURY LAB'S 39 MILL PLAIN ROAD - DANBURY, CT 06811 CT Cert: PH -0404 3 203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 www.NORTHEAST LABORATORIES.COM LABORATORY REPORT REPORT TO: DORSET HOLLOW ESTATES DATE SAMPLE COLLECTED: 7/12/2001 Attn:ALLAN J. FINN TIME COLLECTED: 8:00 A.M. 15 WEST HOLLOW ROAD COLLECTED BY: A. FINN BREWSTER, N.Y. 10509 DATE RECEIVED @ LAB: 7/12/2001 TESTED BY: LAB #11471 LAB I.D. #: JULY -159 REPORT DATE: 7/17/2001 SAMPLE SITE: SAMPLING POINT: SOURCE: TREATMENT: TEST PERFORMED BACTERIAL: Total Coliform (Bacteria) 114 ACCo9o1y� e U U - � < DORSET HOLLOW ESTATES, LOT #1 KITCHEN TAP WELL NONE RESULT: METHOD # MAXIMIUM CONTAMINANT LEVEL (MCL) [t, CHEMISTRY: Chlorine Residual ND ml = milliliter mg/L = milligrams per Liter COMMENTS: - Holding Times (were) met. per 100 ml SM 9222B 0 per 100 ml mg/L - ------ ND = none detected TNTC= Too Numerous To Count RESULTS BASED ON SAMPLES SUBMITTED: 7/12/2001 SAMPLE, AS TESTED ABOVE: X or MINOT POTABLE (PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) Laboratory Director •NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 CA. "< >f BRUCE R .FOLEY . _ LORETTA MOi:MAR1 RN., M.S.N. Public Health Director y�i+� G�� Associate Public.. Health Director Director of 'Patient Services DEPARTMENT OF HEALTH. . 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278.6170 Fez (914) 271.7921 . Nursing Services (914) 278.6558 WIC (914) 278.6678 .Fax (914) 278.6085 Early* raterveoff6a_(914)111'- 6014 Preschool (914) 2786082 FAX(914)279'-660 E911 ADDRESS 'VERIFICATION FORM 0 W HERS NAME: ��- 1 proLL6'W 00'100 C L r > TAX MAP NUMBER: �' �'� �•1 E911 ADDRESS: TOWN: AUTHORIZED TOWN OFFICIAL: (Signature) DATE: The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with-the application for a Certificate of Construction Compliance. (E911 VERFRM) r- Fj Ei n ;7 DIMENSION CHART (in feet) Number A B C 22.5. 13.5 2 .90 G6 3 91 52- 4 100 58 5 107 64. 6 113 69 7 118 86 8 : 1qz 80 9 136 79 10 130 67 11 87 56 1 93 60 13 100 65 14 106 71 15 92 94 16 86 91 17 80 89 18 71 88 S 9004700"E 64.35, A R E7A /S TREN�N yp) iq So' A 6 S TR E /3 CH ryp) 4 2. 3 -9 Ll BOX lo O Gj tZE)o GAL. SEPTIC I A N 14 C A .Q A QE fl�poM F .465 10 Lo 41 DELTA- 9 9 Putna P)p c PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # 42 U/ Located at /,Qj t.lc� i S IYL.� -'fir?" �17 Village I)A -M"2 M) Subdivision name +Vg i,j Subd. Lot # �_ Tax Map 3. Zo Block 'Z Lot Date Subdivision Approved I a qT Renewal Revision Owner /Applicant Name tA� Date of Previous Approval Mailing Address i 7 0 Zip (05-02 Amount of Fee Enclosed yzeU«J� A, (� 3oo. ov) Building Type e-er72 ; pZri fxs Lot Area , cJ 2. No. of Bedrooms_ 4L Design Flow GPD $-O-& Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of I P-6-0 gallon septic tank and --40o I- F' cNz- 4 °1 w 06- `TV-�9W �� 4 3' C7" e)� 1 ► w Other Requirements: To be constructed by Dow-,,, 6--F kloLxg, . y?,uo0, Address i E „J4�-,i-- t-yj� i20., !i2�k- '�`Rr�2, '��i,9 ew' v�tTm "cr4 —� Water Sunuly: Public Supply From .& otsW:1cq Address or: Private Supply Drilled by Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment s, sy tem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately followin&Af date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repa' t t Signed: P.E. R.A. Date D Address License # o,5-1 34(o_ APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified 4 co sidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permi . prove or discharge of domestic sanitary sews a only. By: Title: Date: f d 1 White copy - HD File; Yellow copy - 'Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH . DIVISION OF ENVIRONMEir"TAL HEALTH SERVICES FINAL SITE MSPECTION Date: .26 0l Street Location �/�sT Owner S i Inspecte y: ���n To«m -P�TT�zs�.✓ TM r Permit # Subdivision Lot # j 1. Sewage Systein Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. tiTatural soil not stripped... ..... d. Stone, brush, etc., greater than 15' from STS area....::::. e. 100' from water course / wetlands ...... ............................... II. SeNvage System a. Septic tank size - 1,000 ..... ...1,25 ........other................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft-Original soil between box & trenches e. Junction Box -properly set ........... ............................... f. t renc es Length required gag Length installed 2. Distance to watercourse measured -r-! oo Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 -1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface ........ :......... 7. Room allowed for expansion, -100% ......................... 8. Size of gravel 314 -1 Y2" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped .................................. :.................... g. Pump or Dosed Systems Size ot pump chamber ................ ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visuaVaudio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ..............:................ 6. Cycle witnessed by H.D.estimated flow /cycle.......:... III. House/Buildin a. house located per approved plans.. b. Number of bedrooms; ..................... a. Well located as per approved plans . ......................... ....... b. Distance from STS area measured ' ft ........... c. Casing 18" above grade ............... ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan. f. Curtain drain outfall protected & dir.to exist watercour g. Footing drains discharge away from STS area ............:. h. Surface water protection adequate.. . .. ............................. ,;) I BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278.6678 Fax (845) 278 - 6085 October 22, 2001 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Peder Scott, PE PW Scott Engineering 3871 Route 6 Brewster, New York 10509 /W,AO Re Dear Mr. Scott: Proposed SSTS: Dorset Hollow Builders Dorset Hollow Road, (T) Patterson TM# 3.20 -2 -81 Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. If percolation tests were not witnessed by a representative of the New York City Department of Environmental Protection on this lot, percolation tests must be witnessed by a representative of this %Department. ( 9: Iq! An application to abandon a water well (enclosure) must be submitted with the trench permit application. Provide the fill certification note and perc rate on the trench plan. Absorption trench detail is to note the use of dirt free crushed stone or washed gravel. Stand pipes are required at each end of the curtain drain five (5) feet to each side. Also provide stand pipe detail. 5. Provide the revision date on the trench plans. Upon receipt of a submission revised to reflect the above comments, this application will be considered further. Sincerely, Shawn Rogan an g Public Health Technician SR:cj enc. Application to Abandon a Water Well P. W. Scott email: pwscotte- rcn.com P.C. 3871 Route 6 (845) 278 -2110 Brewster. NY 10509 FAX (845) 278 -2166 October 26, 2001 Mr. Shawn Regan Putnam County Department of Health 4 Geneva Road Brewster, New York 10509 RE: Dorsett Hollow Estates Dear Shawn, The following is to addresses your memo of October 22, 2001. 1. The well was already abandoned by developer under separate permit. 2. Fill certificate note added. 3. Absorption trench already in place (see stone note: "Dust Free " ") 4. Stand pipes already in place with fill pad details. 5. Revision date noted Please accept revised plans. If you have any questions, please call. With regards, i �Peder W. Scott, P.E., R.A. President A R C H I T E C T U R E * E N G I N E E R I N G * S I T E P L A N N I N G t Y` W BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845)278-6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 November 15, 2001 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Peder Scott, PE PW Scott Engineering 3871 Route 6 Brewster, New York 10509 Re Dear Mr. Scott: Proposed SSTS: Dorset Hollow Builders Dorset Hollow Road, (T) Patterson TM# 3.20 -2 -81 Review of plans and other supporting documents submitted at this time relative to the above regarded project has Ir completed. Comments are offered as follows: 0 Fu atest r lsion of 10/22/01 lacks the date that the ROB fill was inspected (fill certification , Upon receipt of a submission revised to reflect the above comments, this application will be considered further. SR:cj Sincerel Shawn Rog Public Health Technician .UCE R FOLEY ,blie Health Director LORETTA MOLINARI RN., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York .10509 Environmental Health (845)278-6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845)278-6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 October 1, 2001 Harry \ ichols, PE Patterson Park, Suite 106 2050 Route 22 Brewster, New York 10509 Re: Field Inspection - Reilly Construction Garrity Boulevard, (T) Carmel Lot # 27, TM# 45 -2 -83 Dear IN-1r. Nichols: The above referenced separate sewage treatment system can be.backfilled. The following comments must be corrected in the field: 1. All comers of the system must be staked. 2.' Measurements indicate the fill for 100% expansion is insufficient in size. 3. The well was not found upon inspection. 4. Install silt fence below the house and drive fill area:: If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. Very truly yours, Gene D. Reed GDR:cj Environmental Health Engineering Aide P. W. SCOTT Engineering & Architecture, P.C. 3871 Route 6 BREWSTER, NY 10509 E -Mail: pws @bestweb.net (845) 278 -2110 FAX (845) 278,,-\\2166 TO C_ b �� 1 (2xa) --74 119"TVIEn O1P 4 0 UV9WL VVZ%1 DATE - JOB NO. ATTENTION` RE: WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via the following items: ❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION ` _M w THESE ARE TRANSMITTED as checked below: For approval (❑� For your use As requested ❑ For review and comment ❑ FORBIDS DUE REMARKS COPY TO ❑ Approved as submitted ❑ Approved as noted ❑ Returned for corrections u ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US SIGNED: If enclosures are not as noted, kindly notify us at once. e BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 iRETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 November 15, 2001 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Peder Scott, PE PW Scott Engineering 3871 Route 6 Brewster, New York 10509 Re: Proposed SSTS: Dorset Hollow Builders Dorset Hollow Road, (T) Patterson 1M# 3.20 -2 -81 Dear Mr. Scott: Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: Your latest revision of 10/22/01 lacks the date that the ROB fill was inspected (fill certification note). Upon receipt of a submission revised to reflect the above comments. this application will be considered further. SR:cj Sincerel Shawn Rog Public Health Technician PUTNAbi COUNTY DEPARTbIENT OF HEALTH _. DIVISION OF ENVIRO \fiIE \TAI HEALTH I\mlVlDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT 1� "mss . NAIviE OF O� NER: STREET LOCATION: _ p REVIEWED BY: R`1, OR, AS;:&ATE: Z © aoZ d I TAX MAP #: (CONFIRMED) l da —a- ~ o Y N DOCUINTENTS (ZjUPER,ITI APPLICATION "UWELL PERIN TT OR PWS LETTER . OF AUTHORIZATION DATA SHEET (DDS) LATE RESOLUTION UUUSHORT LUUPLANS- E SETS U(_--)EOUSE PLAN TWO SETS UUVARtkNCE REQ ST Y� N (REQUIRED DETAILS ON PLANS CONT'D) v(__ )HOUSE SEWER -'W' FT: 4 "0'; TYPE PIPE CAST IRON (ENO BENDS; MAX BENDS 450 W /CLEANOUT RENEWALS C__)()SIIE NOTE (NO CHANGE) FILL SYSTEMS U (___ll0HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE (_)(-_)FILL CS/ FILL NOTES 1 -5 ((_)FILL PRO & DIMENSIONS UUFILL Pi EXPANS A FILL GREA-7WR TFIA.N' 2 FEET °" ' • " • C�)LJCL RRIR UULEG &L SUBDIVISION O CER ICATION NOTE (�(�SUBDMSIO\ APPROVAL CHECKED UUDEPTH GAU UUPERC RATE (__)(•_)VOL. ON PLAN F RO.B., UNCLASSIFIED & Ili IPERVIOUS U(�FII,L REQUIRED DEPTH UUSEPARATION DISTA FROM TOE OF SLOPE U(,JCURTAIN DRAIN REQUIRED T uru GENERAL �(__)LF TRENCH PROVIDED '0 - 60FT MAX. (� LOCATED L-i NYC WATERSHED (/ EPAF. LLEL TO CONTOURS -- (_) A: S SUB-MITTED TO DEP - -- _. ()(-_)100% EXPANSION PROVIDED. "(,/)DETARMUST FREE CRUSHED STONE OR WASHED GRAVEL U(_,::�DEP APPROVAL, IF REQ'D ( (�� (GEOTEXTILE COVER (Z)(JDEEP TEST HOLES OBSERVED S SEPARATION DISTANCES ON PLAN - FRO-,VI SSTS (fJL—)PERCS TO BE WITNESSED ( (%U10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL (_Z )EX- APPROVAL, SSDS ADJ, LOTS , , (�(�., _0 TO FOUNDATION WALLS (__)(WETLANDS (TOWN/DEC PERbnT REQ'D ?) - 0100,40 WELL, 200' LN DLOD,150' TO PITS Q!�JUDATA ON DDS PLANS & PERMIT SAME ( (.& )100' TO STREAM, WATERCOURSE, LAKE (inc. ezpan) ( —J(-Z)PRE 1969 NEIGHBOR NOTIFICATION W WC _)50' TO CATCH BASIN, 35' STORbIDRAIN, PIPED WATEP (/,U10' TO WATER LINE (pits - 20') (�( _J100 YR FLOOD ELEVATION WQ200' v vU50' INTERMITTENT DRAINAGE COURSE SOIL TESTING LOTS >10 YEARS OLD /500' RESERVOIR, ETC. _ 150' GALLEY SYSTEM: REQUIRED DETAILS ON PLANS ( FjU200' / USEWAGE SYSTEM PLAN - (NORTH ARROW) S SEPTIC TANK • " - " (ZU10' FROM FOUNDATION; 50' TO WELL (./)UGRAVTIY FLOW W I (�UCONSTRUCTION NOTES 1 -15 _ ONS TO P ROPE(�UDESIGN D _ W �LOCA O ( J(_j2' CONTOURS EXLSMG & PROPOSED. =_ _�__.. _ ___ 0 O (�jUDRIVEWAY & SLOPES, CUT S SL (/U(UFOOThNG /GUTTER/CURTALN DRAINS ( (�'USLOPE IN SSTS AREA � 0 %) (!,(___)USDA SOIL TYPE BOUNDARIES' T TO 15%, IF REQUIRED O M *, PE/RA; NAME, ADDRESS, PHONE# SYSTEMS S ; �O'{- UUDOSE -00 E LUME/DOSE VOLUME NOTED ( ( -jDATUbi REFERENCE ((_)DETAIL E MAIN, (PIPE TYPE, ETC.) (j(__)LOCATION OF WATERCOURSES, PONDS UUPIT. AND -BOX SHOWN & DETAILED LAKES,WETLANDS WITHIN 200' OF P.L. U� jPROPOSED FINISH FLOOR AND CU.Ul DAY ORAGE ABOVE ALARM BASEMENT ELEVATIONS CURTAIN DRAIN tU U(�STANDPIPES, 5' BOTH SIDES, DETAIL WELLS & SSDS'S WAN 200' OF SSTS (Zj(-J PROPERTY METES & BOUNDS C_)(_)15' MIN to CDS-->5 %, 20'-4%, 25' -3 %, 35' -1 %,100 % -<1% / (___)(___)20' MLN to CD DISCHARGE /100' with 182 cons day discharge U(_ )10' MIN to NON -PERF RATED PIPE C05IbiENTS: (REVSHEET) PUTNAM COUNTY DEPARTMENT OF HEALTH 1 Geneva Road — Brewster, New York 10509 Date T0: FROM: For your information For signature For your files Referred for handling Attached as requested Returned as requested Please see me Read and return CO NTS • _ — _ Oro -� ►\J\ " &&4l--4 /a,:, Leery- /0 .. PUTNAM COUNTY DEPARTMENT OF HEALTH *-DI, VISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # d 101 West Street f " 4 Patterson Located at w Ton or Village Subdivision name Dorset Hollow 8 %%bd. Lot # I Date Subdivision Approved 1998 Tax Map 3.20 Block 2 Lot 8 1 Renewal Revision Owner /Applicant Name Dorset Hollow Builders Date of Previous Approval Mailing Address 15 West Hollow Road, Brewster, NY Amount of Fee Enclosed $300.00 Zip 10509 .Building Type Rea i d e n c e Lot Area 0 ' 9 2 No. of Bedrooms 4 Design Flow GPD 8'0 0 Fill Section Only _ e Depth J10 Volume / D' PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to P tof 1250 gallon septic tank and 410" Lf 10E- ,. Other Requirements: To be constructed by 8 o r s e t Hollow B u i l d e r s Address . 15 Patter - Water Sunnly: x Public Supply FromW $ter District or: Private Supply Drilled by West Hollow Rd., Brewster, NY Address Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment s sv tem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. i= Signed %" P.E. x R.A. Date �' /3/2000 : Address 3871 Route 6, Brewster, NY 10509 License# 059346 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatmeri s, stem has been completed and inspected by tMJP&� D and is revocable for cause or may be amended or modified when cozisidered necessary by the Public Heal4Qirec't6r. Any revision or alteration of the approved plan requires roved o ischar a of domevid�anit s e qnl ` anew permit E�cpp�` ' /Jyy7�Yy�)g ary ((�%%{W�JJ y. B Title., h Date: Y• White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 1+60 1+80 ADDRESS: 15 WEST HOLLOW ROAD BREWSTER, NY 10509 455 E911 # 101 WEST STREET T. M. #: 3.20-2-81 450 PROPERTY 101 WEST STREET ADDRESS: PATTERSON, NEW YORK 445 T"111.11im Counv of Health Dtv I:-. i ..1-1 r)f En%Tj,l OiX!. .:-alth APPRO'..T11 TO PLAC"'t FILI- 0i'lih ""I" Q :ti pp Ir— b avid f!,e [1114 oalth 440 L, � h 4 Signaturs A 120 1) RESERVED FOR PCHD APPROVAL STAMP Dwg. Title SEPTIC AREA, PLAN Project Title LOT 1 — DORSET HOLLOW ESTATES FORMALLY VAN CLEEF ESTATES Pro} No. Drawn by CYP Date 9-7-2000 Scale AS NOTED )f NEtj I.0 Dwg. No. ST 2 0) 3 -X--) u C2. Q.) U) CD CY) 0 0 0 CD CY) CY) 04 r C r) 0- CD C) (D Cn C> V N CD C: 0 0) 3 -X--) u C2. Q.) U) CD CY) 0 0 0 CD CY) CY) 04 /81 LVL POCKET I I I I I I 7'-4# 10' 7' -0' 7' -%' �. ReN f I I r\- -- i li �I I V - - -y I I I I iC V^POR I CoMP/\GTED I I D2PRE55 TOP OF FOUNp^TION S' I W^LL TO ^l-LOW SL^D TO I P ^SS OVER WALL W/ i 'DUR -O- W A\l ;e OR 10' POURED I I I V. POURED GONG. — I D ^RS CONTINUOUS i -- ------------------------- -- - - -1 I I --- - - - - -- -- ------------------------------------ I ----------------- j )R G^NTILEVEReD 5TS 1S' -1' 24' -0' :r �. PUTNAM COU1✓°TI DEPART'MNT OI• ITEA11TH HOUSE PLANS APPROVED FOR BEDROOM WLKL BEDP.0OMS ALL SC SEQUENT REVISIONJALTERATiONS TO THESE O PLA �' ST BE BMITTED TO THE PCDOS Y-4i'l-/, Interior errior design land pkwwthg These plans are an mtr rrmt of servioe and are the property of the architect. nfrnpements wi be prosecuted UREQ Contractor shat verify aI field cordtions end dnwaons and be responsible for field ft and zmmm quantity of work no allowances LL%UG m she" be made in WNW of the contractor for any error or moact on Ms W. P. W. SCOTT ` Engineering & Architecture, P.C. 3871 Route 6 BREWSTER, NY 10509 E -Mail: pws @bestweb.net (845) 278 -2110 FAX (845) 278 -2166 TO p C D d ft WE ARE SENDING YOU ;Sr Attached ❑ Under separate cover via • Shop drawings t&7 Prints ❑ Plans • Copy of letter ❑ Change order ❑ DATE o V o JOB NO. ATT NT N RQ J RE: ❑ Samples the following items: ❑ Specifications THESE ARE TRANSMITTED as checked uviuw. ❑ For approval • For your use • As requested ❑ For review and comment ❑ FOR BIDS DUE REMARKS • Approved as submitted • Approved as noted • Returned for corrections ❑ ❑ Resubmit copies for approval ❑ Submit copies for distribution ❑ Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US COPY TO SIGNED:.'A L If enclosures are not as noted, kindly notify us at once. 7 09/19/01 15:44 PW SCOTT 4 845- 278 -7921 N0.018 001 PUTNAM COUNTY DEPARTMENT OF HEALTH D1VIS10N OF ENVIRONMENTAL HEALTH SERVICES ATTENTION D ADAM `GENE REOUEST FOR EM AL . NS-P . TION For: Fill AII information must be Billy completed prior to any Trenches inspections being wade. PCHD Construction Pert it n to l (� Located: (T) M Owner /Applicant Name:. Hollow Th4 Block Lot 1 11 Formerly: _ Subdivision Name: %. Subdivision Lot # Is system fill completed? 55 Date: Is system complete? _ N O Is system constructed as : .)er plans? _ M Is well drilled? 1�5� Is wen located as per plans? Are erosion control measures in place? Date: — - - Date: I certify that the system(s) as listed, at the above premises has been constructed and I have inspected and verified their conq letion in accordance with the issued PCHD Construction Permit and approved plans and the Standards, Rules and Regulagesiggn f the Putnam County Department of Health. Date: qJ1 Certified by: PE � M X Profes sional Address, 7 rU . G�} z' j (_ o Lic. # O sl -J q 6 Comments: Form FIR -99 d BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 September 25, 2001 Peder Scott, P. E. PW Scott Engineering 3871 Route 6 Brewster, NY 10509 Re: Field Inspection: Dorset Hollow Builders West Street (T) Patterson Lot #1, TM #3.20 -2 -81 Dear Mr.. Scott: An inspection of the fill pad, at the above referenced project has been completed and appears sufficient. Trench plans must be submitted to this Department for final approval. Please note that field measurements by this Departmentin no way suggests the exact size, depth or location of the fill pad. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. Gene D. Reed Environmental Health Engineering Aide GDR/jp 16 BRUCE R. FOLEY Public Health Director DEPARTMENT OF . HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845)278-6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 January 11, 2001 Peder Scott, PE PW Scott Engineering 3871 Route 6 Brewster, New York 10509 Re: Proposed SSTS: Dorset Hollow Builders 101 West Street, Lot #1, TM# 3.20 -2 -81 Town of Patterson Dear Mr. Scott: Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: The construction of this sewage disposal system maybe subject to local wetlands regulations. You should contact local wetlands officials in this regard. If percolation tests were not witnessed by a representative of the New York City Department of Environmental Protection on this lot, percolation tests must be witnessed by a representative of this Deparment. 1. Provide fill certification note on the trench plans 2. Provide standpipes for groundwater monitoring at each end of the curtain drain, 5' up and down gradient. Also provide appropriate standpipe detail on the plans. Upon receipt of a submission revised to reflect the above comments, this application will be consid✓red further. Sincerely, Shawn Rogan Public Health Technician SR:cj BRUCE R. FOLEY Public Health Director January 10, 2001 DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORE-17A MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Peder Scott, PE PW Scott Engineering 3871 Route 6 Brewster, New York 10509 Dear Mr. Scott: Re: Dorset Hollow Builders, 101 West Street Dorset Hollow Estates, Lot #1, (T) Patterson Reservoir Basin - East Branch The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on January 5, 2001 is complete. The Department will notify you by January 30, 2001 of its determination. R The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. ❑ Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by Certified Mail, Return Receipt Requested. The notice would be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with Section 18 -23 (d) (6) of the New York City Department of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed complete, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Department of Environmental Protection regarding such activities to see if DEP review and approval is required. If you have any questions regarding this matter, please call me at (845) 278 -6130 ext. 2159. Sincerely, c Shawn Rogan Public Health Technician SR:cj PUTNAM COUNTY DEPARTMENT OF HEALTH DMSION OF ENVIRONMENTAL HEALTH LN- DIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SSHHEEE�T�FOR CONSTRUCTION PERMIT / NAME t y j& OF OWNER: STREET LOCATION: to REVIEWED BY: R`i: OR, AK S4ATE: 1 �d D• _TAX MAP ": (CONFIRMED) 3' 40 ~� y Y N DOCUMENTS APPLICATION -Y N (REQUIRED DETAILS ON PLANS CONT'D) L�( JHOUSE SEWER - W' .FT. 4 "0'; TYPE PIPE CAST IRON ��UPER�IIT U�VFELL PERMIT OR PWS LETTER (___�(_:!!�)NO BENDS; MAX BENDS 450 W /CLEANOUT (�(_)PC -97 (_)LETTER OF AUTHORIZATION , RENEWALS ��'bl E NOTE (NO CHANGE) 4)L JDESIGN DATA SHEET (DDS) FILL SYSTEMS ORATE RESOLUTION (_J(_JIO' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE (ZjUSHORT E.AF (d(_JFILL SPECS/ FILL NOTES 1 -5 4)LJPLAl`(S -THREE SETS (ZLJFILL PROFILE & DIMENSIONS (enLJHrOUSE PLANS - TWO SETS (�UFILL IN EXPANSION AREA LU, C ARL.k CE REQUEST ML GREATER MV2 FEET SUBDIVISION (Z(_-) CLAY BARRIER (�L JLEGXL SUBDIVISION (__)(FILL CERTIFICATION NOTEy ( /�( JSUBDTVISION APPROVAL CHECKED CZJ(_JDEPTH GAUGES (ZJ'UPERC RATE (�}UFILL REQUIRED DEPTH U� "OL. ON PLAN FOR RO.B., UNCLASSIFIED &Ili IPERVIOUS (QL_J CURTAIN DRAIN REQUIRED L DISTANCE FROM TOE OF SLOPE tt GENERAL THE C i U(__)LF TRENCH PROVIDED t?7� 60FT MAX. ()(�LOCATED Lv NYC WATERSHED (J�(_}PLANS SUBMITTED TO DEP (U�-- )PARALLEL S CONTOURS ,. 0(_)100% EXPANSION PROVIDED, LU(UDELE.GATED TO_PCHD__- - - -- (�/ DETAIL/DUST FREE'CRUSHED'STONE OR WASHED GRAVEL (_J(_/J- APPROVAL, IF REQ'D L(�GEOTEXTILE COVER (�jUDEEP TEST HOLES OBSERVED SEPARATION DISTANCES ON PLAN - FROM SSTS (Lj(�PERCS TO BE WTIir�SSED �(__ )10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL (�jL�EX- APPROVAL SSDS ADJ, LOTS (�(�20' TO F_ OUNDATION WALLS _ L j(�WETLANDS (TOWN/DEC PERMIT REQ'D ?) WELL, 200' IN DLOD, 150' TO PITS ((___)DATA ON DDS PLANS & PERMIT SAME �ZU100' TO STREAM, WATERCOURSE, LAKE (Inc. espan) ( _J(_,6PRE 1969 NEIGHBOR NOTIFICATION (.Z( j50' TO CATCH BASIN, 35' STORIYIDRAIN, PIPED WATER (UL4LETTER BI/ZBA 10' TO WATER LINE (pits - 20') (J�( _)I00 YR FLOOD ELEVATION W/I200' (�50' INTERMITTENT DRAINAGE COURSE ( J(ZJSOIL TESTING LOTS >10 YEARS OLD 2007500' RESERVOIR, ETC. 150' GALLEY SYSTEMS REQUIRED DETAILS ON PLANS (ZL ,SEWAGE SYSTEM PLAN - (NORTH ARROW) YC=jr9-?vlI?N TO LEDGE OUTCROP SEPTIC TANK ( /JLJSSDS HYDRAULIC PROFILE () (�10' FROM FOUNDATION; 50' TO WELL LQL JGRAVTTY FLOW - - - - - - -- WELL I (/JL�CONSTRUCTION NOTES 1 -15 (— )UDIMENSI PROPERTY LINES (Q( JDESIGN DATA: PERC & DEEP RESULTS _ _.. (- F RVICE CONNECTION L!�L U?' _CONTOURS EXISTING &PROPOSED L!�( DRIVEWAY & LO ,CUT -)ULOCATIO -" UUMIN 15'. T P O I LINE SLOPE OOTLYG %G T DRAINS SOIL :LOPE Lei SSTS AREA (S20 %) (,QL�USDA E BOUNDARIES (fj(___)TTTLE BLOCK; OWNERS NAME ADDRESS C_)(-UREGRADED TO 15 %, IF REQUIRED Tb1! , PE/RA; NAME, ADDRESS, PHONE# (�( OF DRAWINGIREVISION DOSE/PUMP SYSTEMS UUPUiVfP NOTES _JDATE (Zj( REFERENCE LU(UDOSE 75% PIP O ME/DOSE VOLUME NOTED _JDATUM (�(�LOCATION OF WATERCOURSES, PONDS :IN, C_)(—)DETAIL FOR CE (PIPE TYPE, ETC.) LAKES,WETLANDS WITHIN 200' OF P.L. - -UPIT AND D -B DETAILED ( �j(�PROPOSED FINISH FLOOR AND UU1 DAY STO GE ABOVE ALARM CURTAIN DRAIN . BASEMENT ELEVATIONS (Lj,(�WELLS & SSDS'S W/IN 200' OF SSTS L "STA 5' BOTH SIDES, DETAIL r o r o r o r_ 0 0 0 /o, /0, 25. /o, 35 1 /0,100 /o-< 11 (�(�PROPERTY METES & BOUNDS o 15 MIN to CDS= >5 20-4 -3 nH20'MhN to CD DISCHARGE /100' with 182 cons day discharge C./JU10' MIN to NON - PERFORATED PIPE C01NIMENTS: . (REVSHEET) r 'T� r^�-y?n• --^ate Cr - _ - - C .1 iC _ Cw�� .�,�G ��x'U /.s /":O�/ G:��.� ]r= :...�� j �� i %�.�-I'�'�/?%1✓N.r.ji! ,dr /� !,{/,Ui� GJ:iN <,1�;. S Z a %0605 at (St -aet) :"�..._'':__' err Pr1- r,- �_�o�.r •�ri+�:` -�;.�' G•Ro�-iln/ /• lzc:.� -+'1 ..s��V:V �T� =_.� ,� �T = Lam" % 7^^i �r%� ��'.' ' -�J .i:'�T�� ]7%: J.��m_ .:VC L►�� 3 ' 174= : 1. T s tza to b-- +ester• at saire de��"i =-, iz a=,..r. �, try egcz soil- =tes. - . are cb = e3 .at e-c:: .::iat =oz test hole- ' A!-' data t,^,' be for rev-4L-,q. 2. Zeoth mass.:-. ^_ t--s to be r;, ae -= o*,. t- -o cf hcle _ ate C-f= ?= ''`..j dt; C. ^_ Tes - -HOLD = ' =.;1°_ GiCL'I:C Sl:..�cC° .-.. ' .=es Sc--, 'ate st2z—.. St. OD DrC;0 .L.. 7 3 ' 174= : 1. T s tza to b-- +ester• at saire de��"i =-, iz a=,..r. �, try egcz soil- =tes. - . are cb = e3 .at e-c:: .::iat =oz test hole- ' A!-' data t,^,' be for rev-4L-,q. 2. Zeoth mass.:-. ^_ t--s to be r;, ae -= o*,. t- -o cf hcle _ co,Ac SF /SF � 9 6? 0 E L- sIF y 5p,0) 5f + 451.5 C - R_1 r R Oa %, , -1 f 4 OF p STf loulloN plpE TO SE CAPp 3 f 4 "� SpR_35 5�_� 1. STS 0_BO �� v= GURSA� DRAIN �- INV. 446.5 A- Fz UI GAL. TANK 1's`48 W w c� a U V) 0 z Q z U I I I o � X515 WEB L / v % 1 7 :\\ 41, A o�vti•r e / � �Je RhA \ \� / i � � V i$r oo' \\\ �N -- / \1 O _ Y ' CURTAIN it g' MIN. 0 aA PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at 101 West Street S Town or Village Subdivision name D o r s e t H o 11 o w E s5"ubd. Lot # Date Subdivision Approved 1998 Patterson Tax Map 3 •2 0 Block 2 Lot 8 1 Renewal Revision Owner /Applicant Name Dorset Hollow Builders Date of Previous Approval Mailing Address 15 West Hollow Road, Brewster, NY Amount of Fee Enclosed $300.00 Building Type Residence Zip 10509 Lot Area 0 .9 2 No. of Bedrooms 4 Design Flow GPD 8 0 0 o Fill Section Only _� Depth a Volume 11 p O PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to n A :u 1 n ft ! ^--r- - — . - f . / r- Other Requirements: of i 1 1 2 5 0 gallon septic tank and lt�G (-F L l._ To be constructed by Dorset Hollow Builders Address 15 West Hollow Rd., Brewster, NY Town of Patterson Water Supply: X Public Supply From W a t e r District Address or: Private Supply Drilled by Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: P.E. X R.A. Date 4/3/2000 Address 3871 Route 6, Brewster, NY 10509 License# 059346 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the i sewage treatm stem has been completed and inspected by the PCHD and is revocable for cause or may be amended or inodified wh n co sidered n cessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit,. proved ischarge of domestic sanitary se age only. 6 By: Title: / Date: �'1 o 1 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 ,' � ST .IT DADl Rt i�ril '�y S:; L07 , D Z-=_ —T_IC\ ' SC= ��v17��4 ✓ IN TDSf D'4 G.L. rf 7-oF5erL 3' T s_s�DrA tr ,RSA =ANb 4' - -44(f io L)TDI= 107M AT WE= aCfriNL 7, T 't IS NCCJNI?iM= 4 I1,TDICZ u:. TO VdIC:: Fuyi_::_ZV" -E- RISES. A�-, ml-ING -= D= HOLE 02SMWITICNS Da =- . DES.. IC I • Soil Rate used 6 _ 7 .24.in /1" Drco: S-D. lisa'_e ? -e P ov_c= Nc of ?roans y Septic Tani: C:-;,a ci v /Z 5 J cals . `T`,,rpe P� Absorptica 3:a P: ovided By y Ci L.R. ._ 24" wid:^ to ^.ch Otl`�er - Harm- / • �✓ 5:f 7T �.siG :NG��P /NG �d�r�y r�����c_ �3 c- .atL'� e q� � : �`�• - / Access :FR71 Pour; S SEAL ni , FO I • - .. r.I` a .. ... Soil Rate Approved s. :ft /gal. anec; ;,v Dare r `I':,ST -PIT D1,%M R "-ERE) '1J ' SC-. S yN T SST S0. _ D I'u Ec:z `1C. ::GIB. yo. CI: MI). G.�. /oc U ^' 44"? $,Wp W /4RAVWL w/ yr �i // i' l�e/ 3' ! ss�:kD -r;. r•�r� COR9C 9J/Yb 4' G' j Y , e i/SlD 81 - r 101 ingot, Y. _ _.. ... .... . 13' Ii�TDIG�T.r. I.t�lE+, AT ATFLC:: GRC1 1 M =— IS \=UL\ =R= - 4 LNDia =- =qm TO WHICH W- ATE'-. I+ ,VM i.ISES. AFTE.R E_-MIG `..:' UNTI —= DE:P fiOLr 02SFURVATIONS MADE BY: _ DP' �: DES. IGN Soil Rate Used 67 1,L, n /1" Drop: S.D. Usable ?se ?=-ovicc--A No" of E .:rOaTr. Segt c Tank Crr..aci ter /Z 5 y ga .s _ 'Tire Fes+ Absra lea Provided By LiCj L.F. 24" wiat. tc c: Other 3" Na SGcTl . uG:• t�G-".�i��N6�.,�,2c..�iT�-v�t�, ,natl:rc Nam W r ; Address X9'1/ Rocrr= 4 SEAT, • - fir;. THIS SPAG: MR USE BY IMALM. DFZ;1M=\?T CLMY; Soil Rate Aoprove -: W' . *ft /ga.1. Ci e ck, cd by ' Date r CT H=72- Z-7CNI !--T .:1...:::. --CZ It 2Z SRZ, ZV5 -3. Za s lo6oS yd 2 3 4 5 at sp-me a' Test- - t:z:) b-- e=--n eqcal so aze c:bta:,--ea a''t each pe'.r=latic,-n 4.0-- =evieq. -7 Is,341" cf ?ta--Sc—ml—lc (047- q VJ Da te .-E C 0 - -7, LrJ'I+� '4 se Leoz--. ��Z= Leve-L, T:Lme- Grci-,nd; Surface .=ez s t=- St 0-0 7_ M - ."•7- 2 3 ricnes imcnes 2 3 4 5 at sp-me a' Test- - t:z:) b-- e=--n eqcal so aze c:bta:,--ea a''t each pe'.r=latic,-n 4.0-- =evieq. -7 Is,341" I 7j -7, '4 7_ 2 3 33 4 2 3 4 5 at sp-me a' Test- - t:z:) b-- e=--n eqcal so aze c:bta:,--ea a''t each pe'.r=latic,-n 4.0-- =evieq. 14.16.4 (2/87) —Text 12 PROJECT I.D. NUMBER 617.21 •SEOR Appendix C State Environmental Duality Review SHORT ENVIRONMENTAL ASSESSMENT -FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR PROJECT NAME Dorset Hollow Builders F2. Dorset Hollow Estates 3. PROJECT LOCATION: (formally Van Cleef Estates) Municipality Patterson County P u t n a m 4. PRECISE LOCATION (Street address and road Intersections,. prominent landmarks, etc., or provide map) Lot I Dorset Hollow Estates (formally Van Cleef Estates) 5. IS PROPOSED ACTION: El New ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: Construction of subsurface sewage treatment system - for single- family resid'e.nce and connection to public water sppply. 7. AMOUNT OF LAND AFFECTED: Initially �$� acres Ultimately ��� acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? LI Yes ❑ No If No; descrlbe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ® Residential ❑ industrial ❑ Commercial 11 Agriculture ❑ Park /Forest/Open space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? ❑ Yes © No If yes, list agency(s) and- permit /approvals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ® Yes ❑ No If yes, list agency name and permit /approval Subdivision.approval from Town of Patterson Planning Board /PCDOH 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? ❑ Yes ® No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: W. S c o t t, P. E., R. A. Date: Signature: If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 PART II— ENVIRONMENTAL ASSESSMENT (To be completed by agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative declaration may be superseded by another involved agency. ❑ Yes ❑ No ' C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, of other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation of fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or Intensity of use of land or other natural resources? Explain briefly. C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not Identified In-C1-05? Explain briefly. C7. Other Impacts (including changes in use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly PART III— DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (aj setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) Irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ❑ Check. this box' if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency Print or Type Name of Responsible Officer in Leag Agency Title of Responsible Officer �)A'P �_r `i ,t W J; Signature of Responsible O icer in Lead Agency f� `' B Y I Sig'ntiW'teLdtiereparer (it ai ferent from responsible of icer Date N G &E DEVELOPMENT, LLC Gregg Macaluso 914 - 878 -4355 March 17, 2000 Robert Morris P.E. Putnam County Dept. of Health 4 Geneva Road' Brewster, NY 10509 Re: Dorset Hollow Estates Lot # 1 (formally Van Cleef Estates) Edward Bloes 914- 234 -2281 This letter is to serve as a notice that I as the contractor for the Dorset Hollow Water District, currently under construction, can provide adequate pressure to serve the proposed lots. This water plant shall be inspected and approved by PCDOH for use to meet the demand requirements for the subdivision. Very t o y..vours, Edward Bloe G &E Development PO BOX 352 BEDFORD, NY 10506 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Dorset Hollow Builders Located at 101 West Street TN Patterson Tax Map # 3,20 Block 2 Lot 8 1 Subdivisionof Dorset Hollow Estattes ( formally Van Cleef Estates) Subdivision Lot # 1 Filed Map # 2 7 7 1 Gentlemen: Date Filed 12/24/88 This letter is to authorize P e d e r W. B. c o t t, P. E., R. A. a duly licensed Professional Engineer X or Registered Architect -f,,_ to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, riles or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. Coun P.E., R.A., # 059346 Mailing Address 3871 Route 6 Brewster State New York Zip 10509 Telephone: (9 14) 278-2110 Mailing Address: Dorset Hollow Builders 15 West Hollow Road, Brewster State New York Zip 10509 Telephone: ( 9 1 4 ) 2 7 9 - 1 3 3 9 Form LA -97 P. W. SCOTT Engineering & Architecture, P.C. 3871 Route 6 BREWSTER, NY 10509 E -Mail: pws @bestweb.net (914) 278 -2110 FAX (914) 278 -2166 TO Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 WE ARE SENDING YOU CCAttached ❑ Under separate cover via ❑ Shop drawings Prints Plans ❑ Copy of letter ❑ Change order ❑ 12CTUM @17 M° H1@_ W0CTCTL & c DATE Z r roe No. 9 9 — 1 5 9 ATTENTION RE: Dorset Hollow Estates (formally Van Cleef Estates) Subsurface Sewage Treatment System (SSTS) 1 ❑ Samples the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION 1 Application for Approval of Plans (PC -97) 1 1 Construction Permit for Sewage Treatment System (CP -97) 1 1 I Letter of Authorization (LA -97) 1 2 Design Data Sheet (DD -97) 1 House Plans (2 sets) 2 1 Letter from G & E Development,LLC, Re: Public Water 1 1 Check 4r` 34�(lZ��� for the amount of $ t7r ,GD 1 1 I Short Form AF THESE ARE TRANSMITTED as checked below: ❑ For approval • For your use • As requested X] For review and comment ❑ FORBIDS DUE • Approved as submitted • Approved as noted ❑ Returned for corrections • Resubmit copies for approval • Submit copies for distribution • Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS List Continued: 4 1 Septic Site Plan Drawings 1 1 E911 Address Verification Form (E911 Verfrm) COPY TO SIGNED: If enclosures are not as noted, kindly notify us at once. BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (914) 278 - 6130 Fax (9.14) 278-7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 E911 ADDRESS VERIFICATION FORM OWNERS NAME: Dorset Hollow Builders Lot 1 TAX MAP NUMBER: 3 gn_2_Rl E911 ADDRESS: 101 West Street TOWN: Patterson AUTHORIZED TOWN OFFICIAL: (Signature) DATE: 2 j�Q a The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. (E911 VERFRM) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: Lot # I Dorset Hollow Builders 15 West Hollow Had Brewster, New York 10509 Dorset Hollow Estates 2. Name of project: (formally V anC 1 e e f E s tj3. Location TN: Patterson 4. Design Professional: Peder W. Scott, P.E. , R -5, Address: 3871 Route 6 6. Drainage Basin: East Branch Reservoir 7. Type of Project: X Private/Residential Food Service Apartments Institutional Office Building Realty Subdivision Brewster, NY 10509 Commercial Mobile Home Park Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Type II 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... 10. Has DEIS been completed and found acceptable by Lead Agency? ............... 11. Name of Lead Agency Town of Patterson Planning Board Exempt _ Unlisted X No N/A 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ......................................................... ............................... Yes:-. 13. If so, have plans been submitted to such authorities? ........ ............................... Yes- Subdivision 14. Has preliminary approval been granted by such authorities? Yes Date granted: 1998 15. Type of Sewage Treatment System Discharge ................. surface water X groundwater 16. If surface water discharge, what is the stream class designation? .................... N/A 17. Waters index number (surface) N/A 18. Is project located near a public water supply system? ....... ............................... Yes erviced 19. If yes, name of water supply Town of Patterson Distance to water supply by system 20. Is project site near a public sewage collection or treatment system? ................ No 21. Name of sewage system Individual Lots .Distance to sewage system JML+ 22. Date test holes observed 1! - I - 46 23. Name of Health Inspector M . B u d z i n s k i P.E. 24. Project design flow (gallons per day) ........................:........ ............................... 800 GPD 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... No 26. Has SPDES Application been submitted to local DEC office? N/A Form PC -97 N 27. Is any portion of this project located within a designated Town or State wetland? No 28. Wetlands ID Number .......................... ............................... ............................... N/A 29. Is Wetlands Permit required? ............... ....... Individual Lat ........................ ............................... No Has application been made to Town or Local DEC office? ............................... N/A 30. Does project require a DEC Stream Disturbance Permit? .. ............................... No 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No No 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination. Yes/No No DESCRIBE: 33. Is there a local master plan on file with the. Town or Village? ......................... Yes 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? Water`.only 35. Are any sewage treatment areas in excess of 15% slope? . ................................ No 36. , Tax Map ID Number .......................... ............................... Map 3. p Block Lot _ 37. Approved plans are to be returned to ..... Applicant X Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class misdemeanor pursuant to Sectiot,0: I.Pof the Penal Law.. SIGNATURES & OFFICIAL TITLES. Peder W. Scott, Agent for Applicant Mailing Address:.....:© :6'.�.�V...C.. Or 10 3871 Route 6 10509 Brewster, New York BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845)278-6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 January 11, 2001 Peder Scott, PE PW Scott Engineering 3871 Route 6 Brewster, New York 10509 Re: Proposed SSTS: Dorset Hollow Builders 101 West Street, Lot #1, TM# 3.20 -2 -81 Town of Patterson Dear Mr. Scott: Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. If percolation tests were not witnessed by a representative of the New York City Department of Environmental Protection on this lot, percolation tests must be witnessed by a representative of this Department. Provide fill certification note on the trench plans (AUzJW- q co-N FIA,-,)S Provide standpipes for groundwater monitoring at each end of the curtain drain, ' up and down gradient. Also provide appropriate standpipe detail on the plans. Upon receipt of a submission revised to reflect the above comments, this application will be considered further. Sincerely, Shawn Rogan Public Health Technician SR:cj