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Home My WebLink About0135DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 3.20 -2 -84 BOX 2 A% ' *1I r, :661 l I ' -o re - r - r r �� , 00135 \. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION. COMPLIANCE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # P- I B- 0D M11. Located at, 10c, V��?i �T�� Town or Village PTiERS n Owner /Applicant Name � � ''' % \J -dpi Tax Map r0, Block Lot a4 Formerly Subdivision Name? Subd. Lot #� Mailing Address 1") v4F"b -f- Zip Jrj tb j Date Construction Permit Issued by PCHD .Separate Sewerage System built by Ed- lAt4 O �1UEV6 Address) 4eT WWI' �tPO Consisting of l �d-6 Gallon Septic Tank and��' �3N Other Requirements: Water Supply: .it Public Supply From TOWtJ Address P��-9 --600 NH � 5� or: Private Supply Drilled by Address Building Type Has erosion control been completed ?Gh Number of Bedrooms Has garbage grinder been installed? I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built 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 D t of Health. Date: Oi 1 �° I Certified by &az��Ivj Jj,,,7,? P.E. R.A. �tiG ,, pesi o' sion) • Address �e4 %%- ��','O� License # -I 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 uNect to modification or change when, in the judgment of the Public Health Director, such revocatio J , o ificati or change is necessary. B Title v� Date: ` &16 2-- By: , White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 6 DI :MENSION CHART (in feet) A B 18 q2 z 32 57.5 3 30 60 4 28.5 63 5 28 65.5 6 24 69 7 31 73 8 31 77 9 37 81 10 90 115 I I 98.5 116 Iz 88 lls 13 88 120 11 99.5 122 15 89 1 Z3.5 16 90 129.5 17 92 129 N 5 1J' 53 U0 Aw ut to I En r N 3'7.52 DEL? A- 85 *55.Os �b \ \p N 14° 29`00" E 6q.OV \\, C ST 4 6EpR00M s �ESt Al Cb P �P AG /lo X00{ / II l L_ 90.00. DIE L -rq, 22 SS' 06" STREE7- N 0 hA Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 ML� 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 #3 5 106 West Street Town of Patterson Dear Robert: Enclosed are the following: 1. Five (5) prints of Drawing SS -23, "As Built SSTS," dated 1 -3 -02. 2. "Certificate of Construction Compliance for SSTS," dated 1 -3 -02. 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, Harry W. Nic s Jr., HWN:his 01-026.35 si!;1 In REPORT TO: NORTHEAST LABORATORY of DANBURY 39 MILL PLAIN ROAD - DANBURY, CT 06811 CT Cert: PH -0404 203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 www.NORTHEAST LABORATORIES.COM LABORATORY REPORT 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 0 `N ACCog01ry �O e � U a = s SAMPLE SITE: DORSET HOLLOW ESTATES, LOT #35 SAMPLING POINT: KITCHEN TAP SOURCE: WELL TREATMENT: NONE TEST PERFORMED RESULT: METHOD # MAXIMIUM CONTAMINANT LEVEL (MCL) BACTERIAL: Total Coliform (Bacteria) 0 per 100 ml SM 9222B 0 per 100 ml CHEMISTRY: Chlorine Residual ND mg/L - - - - -- ml = milliliter mg/L = milligrams per Liter ND = none detected TNTC= Too Numerous To Count COMMENTS: - Holding Times (were) met. RESULTS BASED ON SAMPLES SUBMITTED: 7/12/2001 SAMPLE, AS TESTED ABOVE: XO OTABLE or AMNOT POTABLE (PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) Laboratory Director *NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 060370 (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM - 64- Owner or Purchaser of Building Tax Map Block Lot Novo j -kou.oN� bo r L,IN 6 P Building Constructed by 10�0 v� � i ls�V_6�e Location - Street TownNillage 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 o i3p of the building utilizing the system. Date n Day Year �- Signature: � - Title: Do?_615V IV-1wrluuIDw aili _QEK Ncot. w bjla Corporation Name (if corporation) Corporation Name (if corporation) Address: K' �XGW�, 1 State Zip 05M Address: �5+ `' ' ► I�Lt,crj (K., ;a- State N1 Zip 1013a� Form GS -97 BRUCE R FOLEY LORETTA MOLMARi-R.N., M.S.K. Public Health Director y4i+ �� Awociate Public Health Director . (;! . Director of Padent &rvkeu DEPARTMENT OF HEALTH 1 Geneva Road -- Brewster, New York 10509 Eavlrcameotal Health (914) 278.6170 Fax(914)278-7921 NurduS Servlea (914) 278.6338 WIC(914)278-6679 . Fax(914)278-6085 Early•loterrea&a (914)178•• 6014 Preuhool (914) 278.6082 Fax(914)17F-6643 _E911 ADDRESS VERIFICATION FORM OWNERS NAME: P*60- � %��LD 1 i'� o''5 L TAX MAP NUMBER: �' r� 1--. qA- E911 ADDRESS: TOWN: AUTHORIZED TOWN OFFICIAL: � ... .. (Signature) DATE: /Z PZ O� The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above force is completed, i.e., a legal E911 address is assigned by an authorized town official. This form, js to be. submitted with the application for a Certificate of Construction Compliance. (E911 VERF!" PUTNAI1i COUNTY DEPARTMENT OF HEALTH b - DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: / oL2 0� Inspecte y: Street Location u/,--S 57-, Owner 'Po7rsoT Town t''�Tr,�aso�v Permit # P—/6 — o o TM # 3. 2 o Subdivision Lot # 5-G- 1 . II Sewage Svstein Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... . Sewage System a. Septic tank size -1,000 ........ , 250.......other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. All out le at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. f. J ncti e� - properly set ........... ............................... T.—Ee'n—g-th required Length installed 2. Distance to watercourse measured —{-10 0 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 3/4 - 1' /z" diameter'clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped......... ................ ..........:.................... g. PumR or Dosed Systems 1. Size ot pump chamber ................ ............................... 2. Overflow tank ............................. ............................... .3. Alarm,.visual/ audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... .........................:..... 6.- Cycle witnessed by H.D.estimated flow /cycle.:......... III. HouseBuildin a. House located per approved plans ............ I ::.............. b. Number of bedrooms ...................... ..�7.. ................. . IV. Well 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 & dinto exist watercours g. Footing drains discharge away from STS area ............:.. h. Surface water protection adequate...:.......... ....: OCT -18 -2001 04:48. PM HARRY W NICHOLS _.._.., 914 279 4567 PUTNAM COUXTV DEPARTran OF STS DIYIIRION OY BNvmoxm NTALwALTS nTMCZS ATTEN'ITON UAW( GENE v i J 3' 3 .•0.nrtsaT �gffi�iA1_Q+tSPF;crtOK " For:. Pill All iaCotrnattaa mwt be Rtll�tomplctad prior to nay 7rQaohos inspeaioas betag made, n � (Va.,. 6 ze* Ju�..��Luwti PCHD CotMudoa Permit # Owner /Applicant Name• . Block Lot Subdiiioa Nivoa• Subdiviuoa Lot # ?z . Is ty1ttm fill completer Date: Is aYnam wmpletaZ Date: l ° , ! e Q1 .�..� +._ 1.1 rypem aol voted as pg pit"? -06 Is wet drilled? , "� �c�.�._...1_. Date: .1 �.. b �. ......:__ .. ' Is w4 located w por plans? Ara erosion control mavX0 in place? i ced:� times the ryptem(s), as Isted, at the above pretaisat W been oomntaiad ad I haw lorded and verified their complodon in aecordmee with the issued PCHD Consu Won Permit and approy'od plans and the Staadardi, Rules and Regulations of the htaata County Dtputmeat of Health - Date:..�.6 Certified by: pl3RA._. �D/esi uc. # �a �- 5 Co I Form M-99 ^ ^T +n �nn� rl u 1 � �. rata T'C9 • Oi1C_D7L]_7q�1 P. 01 r BRUCE R. FOLEY Public Health Director October 22, 2001 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 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Harry Nichols, PE Patterson Park, Suite 106 2050 Route 22 Brewster, New York 10509 Re: Field Inspection - Dorset Hollow Builders West Street, (T) Patterson Lot # 35, TM# 3.20 -2 -84 Dear Mr. Nichols: The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected in the field: No comments. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. Very truly yours, . '.4 --f% Z;? Gene D. Reed GDR:cj Environmental Health Engineering Aide SENDING CONFIRMATION DATE : OCT -22 -2001 MON 16:35 NAME : PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845 - 278 -7921 PHONE : 92794567 PAGES : 1/1 START TIME : OCT -22 16:33 ELAPSED TIME : 00'39" MODE : G3 RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... x BRACE B. FOLEY LORE1 rA MOLWAX 5).N.. M.9.N. Paerb Hedih Di,.Nd A—As P.h)ie Hee)rh Dbr Db6rlar aJ Pad" &14— DEPART Wr OF HEALTH 1 Geneva Road Brewster. New York 10509 car6.nNSU( 11.44 (945)271.6110 Fa(945)274.7931 ri.M.4 Atfd-(145)371.6"1 WC (343)279-"74 Fu(W)276 -66af 4Ar 1.0— . (945)171-6614 Fa(a41)271.6941 P—b.1 (945)277.6912 F.(946)222 -611) October 22,2001 Harry Nichols, PE Patterson Park, Suite 106 2050 Route 22 Brewster, New York 10509 Rc: Field Inspection - Dorset Hollow Buildora West Street, (T) Patterson Lot R 35, TM# 3.20 -2.94 Dcar w. Nichols: The above referenced separate sewage treatment system can be backfilled. The following comments must be oottscted in the field: No comments. If you have any further questions, please contact me at (845) 279-6130 azt. 2261. Very truly yours, 0, Gene D. Reed GDR:ej Environmental Health Engineering Aide IMIMiMVN'FIX M7Q71iM1A JNMIM7NJNM1M1M1M7MIM7M9MiM1 /i1NMMP7Mi!UiM1M7MSN S � 1 1• ®. I � r e /IY1/1HIi3YYIY Y71/YS flNS�/Y(IJYI�YfYYSifNrIlYTYYII' 711I N11iHNSNNiYYI 1% NSY11I- YNf iil' !.'Y\ill/YTYyfiI�TNYIilYF1JY'TI PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # '10-19-00 Em Locatedat 106 West Street Town or Village Patterson Subdivision names o r s e t H o 11 o w E s Subd. Lot # 3 5 Date Subdivision Approved 1998 Owner /Applicant Name Dorset Hollow Builders Tax Map 3.2 0 Block 2 Lot 8 4 Renewal Revision 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 . 9 2 a c No. of Bedrooms 4 Design Flow GPD 8 o o Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 24" wide trenches (7 rows Other Requirements: 1250 gallon septic tank and 406 L F of 58) and 100% reser To be constructed by Dorset Hollow Builders Address 15 Town of Patterson Water Supply: X Public Supply From Water District West Hollow Road, Brews 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 t 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 q- 3 ° -tOC�O Address 3871 - Roo e- � re, ��1��!`, /JY �v So�i License # 059346 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 considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe t. pprove r discharge of domestic sanitary sewage only. By: Title: / It v� Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 I 1 1 , NY 14.16.4 (2187) —Text 12 PROJECT I.D. NUMBER 617.21 SEAR Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicarit or Project sponsor) 1. APPLICANT /SPONSOR 2. PROJECT NAME Dorset Hollow Builders Dorset Hollow Estates 3. PROJECT LOCATION: (formally Van C 1 e e f Estates) Municipality Patterson. County Putnam 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) Lot X63.5 - Dorset Hollow Estates (formally Van Cleef Estates) 106 We ,5+ S4 -reef, PatCersoa 5. IS PROPOSED ACTION: t_1 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 supply. 7. AMOUNT OF LAND AFFECTED: 0. O r S� Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? L'J Yes ❑ No If No; describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ® Residential ❑ Industrial ❑ Commercial El Agriculture ❑ Park/ForesVOpen 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 FT 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 S_ubdivision.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 ,,JJ� Applicant /sponsor name P.W. Scott , P . E . , R.A. Date: 7'"3 °202D 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 617.6? 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, nolse levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or 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 Res ponsi Ie Of f icer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible of icer) Date 9 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 (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: TAX MAP NUMBER: E911 ADDRESS: TOWN: Dorset Hollow Builders Lot 35 3.20 -2 -84 106 West Street Patterson 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. (E91 I VERFRM) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Dorset Hollow Builders Located at 106 West Street TN Patterson Tax Map #3. 2 0 Block 2 Lot8 4 Subdivisionof Dorset Hollow Estates (formally Van Cleef Estates) Subdivision Lot # 35 Filed Map # 2 7 7 1 Gentlemen: I Date Filed 12/24/88 This letter is to authorize P e d e r W. Scott, P.E. , R. A. a duly licensed Professional Engineer x or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules 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. i Ve Countersigned: Signed: P.E., R.A., # 5 9 3 4 6 (owne f roperty) Mailing Address. 3 8 7 1 R o u t e 6 Brewster State New York Zip 10509 Telephone: ( 9 1 4 ) 2 7 8 — 2 1 1 0 Mailing Address Dorset Hollow Builders 15 West Hollow Road, Brewster State New York Telephone: Zip 10509 (914) 279 -1339 Form LA -97 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 # 35 (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 f6rse to meet the demand requirements for the subdivision. Very trulyAours, G &E Developrhent PO BOX 352 BEDFORD, NY 10506 TEST PIT DATA R7F '= TO BE SUia'11= W-LTE APPLT ^ATION e L7 DFSG'rlGt. �F SOILS IN TEST HC 3 DE<'T' HOLE NO _ / HOLE ND. Z- HOE M. 2 3' r 6' ,ene- 7r r 8' INDICATE LV7m AT GRCONIN= IS EN=U = -= - 4 INDICATE L= TO WHIGu WATT LBVzL.L RISES AFTER BEING -Z-N'C0UNT= D= HOLE OBSERVATIONS MADE BY: _ DA_TZ: DESI N Soil Rate Used 1-_5 Min/1" Drop: S.D. Usable Area Provided No. of Bedro= Septic Tank Capacity gals Absorption Area Provided By L.F. ., 24" width t=ench Other ' Name W. SCo7T �uGiNG- .°�P /NG�,.GQc.�iTti�r 9r_aturc Address SE`z1L . 'Aft �o. THIS SPCC: FOR USE BY ilr- M DEPA=1ENr ONLY: X3510 Soil Rate Approved sift /gal. ' G�ecticd by Date 3 1_. was :tea t...0 � = �y.-. at '"' G�a=-_h = `: a ;; e` r' ^a °' Y e"Z? 1 SC � � �s fie. �� r� .fit �G^ Lam.' roc t_C:1 j�.4r� t hc:,.e. All data- � 5u Liti.� for _eviera. t= be r-do ' t---o cf hale. 7r7 7. IOSOS 3. �O Z Zo �;:_:.� dt (Si =fit; �� /� c' GOx,y,,,/.s� � % •Q� ��'_ �3. ci =1�:_= 7 =.:,� � .. y .._- .�..rrr�,%•�T �-�� = S.^L�'�.� rr C �•(""'rT" YY� a_ L�_..:.:=mYS Late aff- :?=C : T:'S - . Hoiz- �'yZl .+ +} Dept- •- ^.V.,^. w Nat= �: % Pate -r :pe�ieL ` ° --."'..e5 .cCi '?Gbe t=--- Lr, Si=t SLU` D _7_1 :..Zz7 :'IC_1es _ che✓ 2 1"),6y -/a •iS :�S Z� Zy J.... S is 9•yy- %� -aC ;/� 2Z . z5� ..3.. •. y ;• . . i Z Z'Z ZS z 3 S 3 1_. was :tea t...0 � = �y.-. at '"' G�a=-_h = `: a ;; e` r' ^a °' Y e"Z? 1 SC � � �s fie. �� r� .fit �G^ Lam.' roc t_C:1 j�.4r� t hc:,.e. All data- � 5u Liti.� for _eviera. t= be r-do ' t---o cf hale. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL. HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWNER: STREET LOCATION: REVIEWED BY: RM, GR, AS, SRDATE: Y N DOCUMENTS UUPERMTT APPLICATION LL)C_)WELL PERMIT OR PWS LETTER C--)C___)PC -97 UC_ _)LETTER OF AUTHORIZATION U(_)DESIGN DATA SHEET (DDS) (—))CORPORATE RESOLUTION (_)C--)SHORT EAF L_)(_)PLANS -THREE SETS (__)C_)HOUSE PLANS - TWO SETS C__)(_)VARLANCE REQUEST SUBDIVISION C_)J_.)LEGAL SUBDIVISION DIVISION APPROYAL CHECKED C RATE , REQUIRED ___'�EPTH TAIN DRAIN REQUIRED GENERAL ATED IN NYC WATERSHED NS SUBMITTED TO DEP EGATED TO PCHD APPROVAL, IF REQ'D P TEST HOLES OBSERVED CS TO BE WITNESSED . :. SDS ADJ, LOTS OWN/DEC PERMIT REQ'D ?) kVANS & PERMIT SAME HBOR NOTIFICATION )LETTER BI/ZBA )100 YR. FLOOD. ELEVATION W/I200' )SOIL TESTING LOTS >10 YEARS OLD REQUIRED DETAILS ON PLANS )SEWAGE SYSTEM PLAN - (NORTH ARROW) )SSDS HYDRAULIC P )GRAVITY FLO DA RESULTS T CONTOURS EXISTING &.PROPOSED DRIVEWAY & SLOPES, CUT FOOTING /GUTTER/CURTAIN DRAINS USDA SOIL TYPE BOUNDARIES TITLE BLOCK; OWNERS NAME ADDRESS TM#, PE/RA; NAME, ADDRESS, PHONE# iDATE OF DRAWING/REVISION CL-,6(_)DATUM REFERENCE (__)OLOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. �,WELLS PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS & SSDS'S W/IN 200' OF SSTS (PROPERTY METES & BOUNDS COMMENTS: in v A yv"W r. _ TAX MAP (CONFIRINIED) Y N ( REOUIRED DETAILS ON PLANS CONT'Dl . HOUSE SEWER - %" FT. 4 "0'; TYPE PIPE CAST IRON (-LjUNO BENDS; MAX BENDS 450 W /CLEANOUT (-/RENEWALS -)(—)SITE (NO MANGE) FILL SYSTEMS 'AST TRENCH SLOPES 3:1 TO GRADE SPECS / FILL NOTES 1 -5 IN EXPAIW'ON AREA �D AR CLAY BARRIER (FILL CERTIFICATION NOTE C�DEPTH GAUGES VOL. ON PLAN FOR RO.B., UNCLASSIFIED & IMPERVIOUS (__)C_)SEPARATION DISTANCE FROM TOE OF SLOPE TR_ ENCH LF TRENCH PROVIDED 60FT MAX. �PARAL nUST ONTOURS 10(, PROVIDED DET E USHED STONE OR WASHED GRAVEL C_4(:f�'GEOTEXTME COVER / SEPARATION DISTANCES ON PLAN - FROM SSTS (�! 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL (�20' TO FOUNDATION WALLS ( 100' TO WELL, 200' IN DLOD, 150' TO PITS P100' TO STREAM, WATERCOURSE, LAKE (inc. expan) A,O' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATER LINE (pits - 20') 50' INTERMITTENT DRAINAGE COURSE .f�2007500' RESERVOK ETC. _ 150' GALLEY SYSTEMS ( _J10' MIN TO LEDGE OUTCROP � � SEPTIC TANK t_1 10' FROM FOUNDATION; 50' TO WELL WELL DIMENSIONS TO PROPERTY LINES LOCATION OF SERVICE CONNECTION ti1IN 15' TO PROPERTY LINE SLOPE ( SLOPE IN SSTS AREA (520 %) REGRADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS �) PUMP NOTES (_) DOSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED (_) DETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) (_) PIT AND D -BOX SHOWN & DETAILED 1 DAY STORAGE ABOVE ALARM CURTAIN DRAIN STANDPIPES, 5' BOTH SIDES, DETAIL x 15' MIN to CDS = >5 %, 20'4 %, 25' -3 %, 35' -1 %, 100 % - <1% 20' MIN to CD DISCHARGE /100' with 182 cons day discharge 10' MIN to NON - PERFORATED PIPE 0 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 • Shop drawings • Copy of letter [LIECTITFQ @113 DATE 3'3i- 000 JOB NO. 99- 159 ATTENTION RE: Dorset Hollow Estates (formally Van Cleef Estates) Subsurface Sewage Treatment System (SSTS) Application for Approval of Plans (PC -97) 1 1 Construction Permit for Sewage Treatment System (CP -97) CXAttached ❑ Under separate cover via the following items: ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Change order ❑ COPIES DATE NO. DESCRIPTION 1 Application for Approval of Plans (PC -97) 1 1 Construction Permit for Sewage Treatment System (CP -97) 1 1 Letter of Authorization (LA -97) ] 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 #y69- _j850o39 for the amount of $ -3oo.00 1 1 Short Form EAF THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ For your use ❑ As requested X7 For review and comment ❑ FOR BIDS 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. 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 # Dorset Hollow Builders 15 West Hollow Road .Brewster, New York 10509 porset Hollow Estates 2. Nameofproject: (formally VanCleef Est)3. LocationT/V: 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: 1.998 15. Type of Sewage Treatment System Discharge ................. surface water X groundwater 16. If surface water discharge, what is the stream class designation? .................... 17. Waters index number (surface) ........................................... ............................... N/A 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 supplyby 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 22. Date test holes observed i o- 8 - Q 6 23. Name of Health Inspector M. B u d z i n s k i P. E. 24. Project design flow (gallons per day) ................................. ............................... 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... 800 GPD No 26. Has SPDES Application been submitted to local DEC offices N/A . .......................... Form PC -97 27. Is any portion of this project located within a designated Town or State wetland? No J 28. Wetlands ID Number ........................................................... ............................... N/A 29. Is Wetlands Permit required? ...............Individual Lo.t ............................... ............................... Has application been made to Town or Local DEC office? ............................... No 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 2 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 p 2,,jo Bloc*k__A Lot eq 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 1 .,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 A misdemeanor pursuant to Section,M.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: Pe (fott Agent for Applicant Mailing Address 3871 Route 6 ............................... Brewster, New York 10509 I t� 1 r. 9 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 WE ARE SENDING YOU • Shop drawings • Copy of letter [LINUU M OCR 4 ]�G��44Lad DATE ATTENTION t U C. lee 1% Attached ❑ Under separate cover via the following items: ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Change order ❑ COPIES DATE NO. DESCRIPTION THESE ARE TRANSMITTED as checked below: J� For approval • For your use • As requested • For review and comment ❑ Approved as submitted ❑ Approved as noted ❑ Returned for corrections ❑ Resubmit ❑ Submit ❑ Return copies for approval copies for distribution corrected prints ❑ FORBIDS DUE ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS 2jC;,) -5 L,, ,e hee j !P Vr 5 � n S per co " -;'15 -nlr1 P G -0 I N 66'er CL-LeA l'pri. P 't'iJ lJ.J t7r'd J' CAS id:C�l�c fec� 1i� '1�1P �c t'�rtr' COPY TO Pro /C.V � � � I !ti;'YI.U'4 F" 7`c°SC/'✓ (Je /L 5 4J'E'E 1j gccj 4&_C / r ��f G !�['ti rt' l�!' S �C�E'iJ CJ1y ✓`P (� , 3 "7 M)^/ I Jil'GG! SIGNED: