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�� PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEAL,TH SERVICES
CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM
PCHD CONSTRUCTION PERMIT # V 41 ' 00
Located at 104 INE',T. 5 rP-r-E r Town or Village !t er-60H .
Owner /Applicant Name `� oi-1 -Q'� 4i,G Q-�j Tax Map Block Lot
Formerly Subdivision Name peg -S�f yaLl vJ t7 T E,
Subd. Lot #
Mailing Address 1rIEi li o 1-LOb� Ps0S�W �?i ECG i Zip 1 p�
Date Construction Permit Issued by PCHD
Separate Sewerage System built by pr956r Ho u.a0 130IP0 +5 Address 16 wvl i
Consisting of �2�i� Gallon Septic Tank and 4aa Lr Ae -5' T96rj�H
Other Requirements:
Water Sup" Public Supply From TOWM Or- i'�'1"r�W,O� Address
or: Private Supply Drilled by Address
Building Type 1246 Has erosion control been completed?
Number of Bedrooms Has garbage grinder been installed? N�
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 partment of Health.
Date: 0 i D� Certified by P.E. T R.A.
(Des Pn essional) ,5 6 .I z-
Address Zo�d ZZ ��57M. id 10 5�'i License # '"'
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 are bject to modification or change when, in the judgment of the Public Health Director, .such
revocation, mod• ication change is necessary.
B Al". Title: (0 Date:
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CC -97
v R
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 #34
104 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 ols Jr., P.E.
HWN:his
O1- 026.34
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner or Purchaser of Building Tax Map Block Lot
1�_CIT w i.�,Dllj P r_r11__r E PL-5 0 0
Building Constructed by TownNillage
Location -Street * 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 oc of the building utilizing the
stem. I
Date Da Year L�n�- Signature:
Title:
Gene�M gbAtractor (Owner) - Sign
Do 561- j-}0 LL ON bU I L, 0e�
Corporation Name (if corporation)
Address: W641— h0Lt iy'j f-Qq DI J�7_M
J
State N,I Zi p I 0 -0
DOR5EF ti-oi -i,ov�/ Rdii3Oa6
Corporation Name (if corporation)
Address: 16 Fbucd k,
State W
Zip (D '409
Form GS -97
RE
NORTHEAST LABORATORY OF DAN13URY
LABS 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
REPORT TO:
DORSET HOLLOW ESTATES
DATE SAMPLE COLLECTED:
7/12/2001
Atw: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
`S�0 J A C C Oq 4'P
U
U - a
SAMPLE SITE: DORSET HOLLOW ESTATES, LOT #34
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/1L - - - - --
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: OPOTABLE 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.
BRUCE R. FOLEY y LORMA MOLINAIU- R.N.,, M.S.N.
Public Health Director �G+ O� Avoelata Public Health . Director
Director of Podsnt Service.,
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
Eovlroamental Health (914)27S-6130 -Fax(914) 211.7921
Nursing Servica (914) 271.655E WIC (914) 278.667E , Fax (914) 278.6085
Early•Totervind6a (91 4) ;1t • 6014 . Preschool (914) 218-6OE2 Fax (911) I79• 664E
_
....!E211 ADDRESS VERIFICATION FORM
OWNERS NAME: Q� �}al.L�1r� ��1LO ���•�1
TAX MAP NUMBER: �?` �d ' Z $
E911 ADDRESS:
TOWN:
AUTHORIZED TOWN OFRTCIA -L:
(Signature)
DATE: 3 O Z
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.
DIMENSION CHART
(in feet)
Number
A
B
1
45
14
2
42
66
3
42
72
55
76.5,
5
61
82
6
67
87
7
73
93
8
79
98.5
9
84
104
10
112
112
11
107
106.5
12
103
101
13
9$
95
14
93.5
89
15
89
83
16
82
76
17
79
70
/-�Vbb
h
0
N,
O
Gp� PaK
9Q-
5
JL
�O
`p to so,ga
`CXPR= �= & TRF�CH �TYP)
9 1,
S f6
� � 6
�5
� 8
�3
9 iz
10
o� 22s.p0'
� R=
= 100.00 3,
Z5o Z-►�
5
WE, 10
Orl
al
v
M
0
OD
N
✓.7
SIT
PROPER
TAX MAI
PROJECT:
70WN OF E
CLIENT
.DO R5
i'
GREWST
PUTN AM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES_
FINAL SITE INSPECTION
Date: ,
Inspecte y: _4, l2EEp
Street Location Owner ��s�r ,tioLL�t� Bci /LDCrrs
Tom -P/{ iTEr? ,tl Permit # P : >�z/ —r�c7
�L — 96— Subdivision Lot # 3,4,�
1. SeNvage System' Area
COMMENTS
a. STS area located as per approved plans rTO'
�'�
...........................
b. Fill section - date of placement
,fix Y_
3:1 barrier Lgth. Width Avg.Dpth
c. \Tatural soil not stripped ...................................................
d. Stone, brush, etc., greater than 15' from STS area.....:.::.
e. 100' from water course / wetlands ...... ...............................
II. Sewage 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 ................. I A
2. Protected below frost ................ -
.
3. Minimum 2 ft.Orig'inal soil between box & trenches
e. Junction Box - properly set ........... ...............................
f. 1 ren" c es
I . Length required 6 & $p Length installed
2. Distance to watercourse measured -jam i e v Ft..........
3. Installed according to plan ......... ............................... 4
4. Slope of trench acceptable 1/16 1/32" /foot .
S.� l O ft` �frorri p po Brine 20' ft.= foundations:::` p_
6. Depth of trench <30 inches from surface ........ :..:......
7.—Room allowed for expansion, 100% .........................
AOeA
PSize of 3/4 -1 Y2" diameter clean
.gravel ....................
9. Depth of gravel in trench 12" minimum ...................
10. Pipe ends capped ........................ .......... ......................
g. PumD or Dosed Systems
1. ize o pump c am er ................ ...............................
2. Overflow tank ............................. ...............................
3. Alarm, visual/audio ..........:......... .......:.:.....................
4. Pump easily accessible, manhole to grade .................
5. First box baffled ....:.....:....:.......... ..............::...............
6: Cycle witnessed by H.D.estirnated flow /cycle.......:...
III. House/Buildin
" -"—
-:— -
a.� ouse oeated per,-approved plans =• - =.
b. Number of bedrooms .......................... �.�............
-- / <r
IV. Well
a.--Well located as per approved plans ..............
. ..................
.r-�
1'
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 watercourse
g. Footing drains discharge away from STS area ............:..
h. Surface water protection adequate... .. ................... .....:......
NOV -16 -2001 01:10 PM HARRY W NICHOLS 914 279 4567 P.03
PUT" CC= UAWM= OP SALTS
D IOrf OE = V W Mt nAL 10"TB bER'{% M
ATTEN' 014 U ADAM likan
• ' ^: ' tT_ R MWALL INAPMMnW For: , rdl
All iaibrotetloo mwt bst N11�►�ktod plot to ecy Treothoe ,.'.. � ,. ,�.
isupealoaa being made.
PCHD Cot>am .W a P ` mh 0 1 p
Lowed: 10 u
Owner /Applm dt;&W kM= 40LL00 A-U& s TM 3,20 $fit ? - •�I.ot ..,.
' FCrn"!ti - • ... i r.,... niwwu�. ��'•�4 Iw�d. � � i i ..r+w+.� . a. ��r
Sttbdmdon Lot S ...w..__w,...,
is system im eoeapi 0& bum. -- -�
is systim oompl w Deto: i i • - o t,�...�..,
Is eyuam conmdc e4 w a plate? �
Is well drilled A Due:
Is wdi loww m pot pleat? A
Are erosion control Man=
I wtifp that do ;j u listed, a do ilkm premises hu beea eaasfaveted ad Y hive live eted
and veriFiod- their ootapIda b eecotdttace wltb the brood PCiID Coamcdon Permit ad
approved pletu sod the Stsda!ds, Rutq end RepMoiu of the'Putum County Deputmeot of
Dstt{ ~d t CestlA+d by ` pE �f
DO PrOfCiitD�Li ~Y,•.
Mum
Cocaatvomsr
} Form 1'D"
EMM
ti
C,
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 (84'5) 278 - 6648
Preschool (845) 228 - 5912 Fax (845) 228 - 6113
November 28, 2001
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 # 34, TM# 3.20 -2 -85
Dear Mr. Nichols:
An inspection was made of the above referenced property. 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,
M--
Gene D. Reed
GDR:.cj Environmental Health Engineering Aide
r
WI1M1fYey ylOLtl/1%ri/47i / y:NV AY1![ 1l it1�( y( yyFl/ tiiil V( YNiiI V( YV1WIlf l/ t1/ 1i I17YIy1j'_(VVI1l1i4 "IGIYi/INFI it 1% I1I N[ HNl 1/ 117HVf17VIW [Nll[Y/1i1�lNRlYIL1liIIG �iliti3�lY[WTY67yy /i/YIi/Yrf�YY:
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM
PERMIT # T(' 00 =Z- O�
Located at 104 West Street Town or Village Patterson
Subdivision name Dorset H o 1.1 o w E gfibd. Lot # 34
Date Subdivision Approved
M.
Owner /Applicant Name Dorset Hollow Builders
Tax Map 3. 2 0 Block 2 Lot 8 5
Renewal Revision
Date of Previous Approval
Mailing Address 15 West Hollow Road, Brewster, NY
Amount of Fee Enclosed $300.00
Building Type Res i d e n c e Lot Area .92 No. of Bedrooms 4
Zip 10509
Design Flow GPD 8 0 0
Fill Section Only Depth Volume
PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED
Separate Sewerage System to consist of tl 1250 gallon septic tank and
Other Requirements:
To be constructed by Dorset Hollow Builders Address 15_
Town of Patterson
Water Sunaly: X Public Supply From Water District
West Hollow Rd.. Brewst
Address
or: Private Supply Drilled by Address
Prepresent 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
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 treatment system has,been completed and inspected by the PCHD and is revocable for cause or may be amended or
modified whe 7A, sidered n cessary by the Public Health Director. Any revision or alteration of the approved plan requires
a new pe t ove /d f ischarge of domestic sanitary e(wa a only.
By: r ^ Title J ^ Date: ,.
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CP -97
NY
BRUCE R. FOLEY
Public Health Director
LORETTA MOLrNARI 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:
Dorset Hollow Builders Lot 34
3.20 -2 -85
E911 ADDRESS: 104 West Street
TOWN: Patterson
AUTHORIZED TOWN OFFICIAL:
(Signature)
DATE:
a Ef DD
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 VERFRIvi)
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
August 29, 2000
PW Scott Engineering
3871 Route 6 1
Brewster NY 10541
Re: Proposed SSTS: Dorset Hollow Estates
West Street, Lot 934
(T) Patterson, TM# 3.20 -2 -85
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
Environmental Protection on this lot, percolation tests must be witnessed by a representative of this
Department.
1) Fill grading is shown off the property and onto Lot 33. Furthermore, the fill slope is
shown crossing the driveway on Lot 33. All fill should be within the boundaries of
Lot 34.
2) Fill is to be shown extending 10 feet horizontally past the edge of the trench and then
sloping 3:1 to grade.
3) The minimum depth of 2 feet of fill is to be provided for the entire SSTS, i.e., the
location of the trenches and 10 feet horizontally past trenches.
Receipt of a submission, revised to reflect the above comments, this application will be considered
further.
RM:tn
Ve ly your
Robert Morris, P.E.
Senior Public Health Engineer
.8
BRUCE R. FOLEY
Public Health Director
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
v
} Fa
UyJ�
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
PW Scott Engineering
3871 Route 6
Brewster NY 10541
RE: Dorset Hollow Estates
West Street, Lot 434
(T) Patterson, TM# 3.2 -2 -85
Reservoir Basin
Dear Mr. Scott:
August 29, 2000:
The Putnam County Department of Health (Department) has determined that the above referenced
application, including fee, and received by this Department on August 24, 2000 is complete. The
Department will notify you by September 19, 2000 of its determination..
® 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 should 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 NYC Dept. 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 Dept. of Environmental
Protection review and approval. of other aspects of a project, such as stormwater plans or the creation
Letter to: PW Scott Engineering - August 29, 2000
-2-
of impervious surfaces, and the project applicant should contact the Department of Environmental
Protection regarding such activities to see if Department of Environmental Protection review And
approval is required.
If you have any questions regarding this matter, please call me at (845) 278 -6130 ext. 2166;
Ve • ruly yours,
i 2
Robert Morris, PE
RM:tn Senior Public Health Engineer
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONN E \TAI HEALTH
INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS
RE V SHEET FOR CONSTRUCTION P E�R-b(IIIT
NAME OF OWNER: /" T
STREET LOCATION: /i
REVIEWED BY: RN R, AS, SRDATE: 7i TAX IvLA: (CONFIRMED)
/ DOC NTS Y i' (REQUIRED DETAILS ON PLANS CONT'D)
PERMIT APPLICATIO N i__)HOUSE SEWER - %- FT. 4 "0'; TYPE PIPE CAST IRON
�LL PERMIT OR P S LETTER---- UUN 0 BENDS; bLAX BENDS 45° W /CLEANOUT
C -97 / RENEWALS
LETTER OF AUTHORIZATION
DESIGN DATA SHEET (DDS)
CORPORATE RESOLUTION
SHORT EAF
PLANS -THREE SETS
HOUSE PLANS - TWO SETS
_)VARIANCE REQUEST
/ SUBDIVISION
Lki LEGAL SUBDIVISION
SUBDIVISION APPROVAL CHECKED
PERC RATE —%/
FILL REQUIRED DEPTH
( LJCURTAIN DRAk I REQUIRED
GENERAL
f / )LOCATED IN NYC WATERSHED
!(S SUBMTLTED TO DEP
EGATED TO PCHD
APPROVAL, IF REQ'D
P TEST HOLES OBSERVED
CS TO BE WITNESSED
- APPROVAL SSDS ADJ, LOTS
:TLANDS (TOWN/DEC PERMIT REQ'D ?)
.TA ON DDS PLANS & PERMIT SAME
E 1969 NEIGHBOR 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 PROFILE
GRAVITY FLOW
)NSTRUCTION NOTES 1 -15
3SIGN DATA: PERC & DEEP RESULTS
CONTOURS EXISTING & PROPOSED
AY & SLOPES, CUT
SOIL TYPE BOUNDARIES
U(_JTTFLE BLOCK; OWNERS NAME ADDRESS
TM #, PE/RA; NAME, ADDRESS, PHONE#
C /DATE OF DRAWING/REVISION
DATUM REFERENCE
(� LOCATION OF WATERCOURSES, PONDS
/LAKES,WETLANDS WITHIN 200' OF P.L
(_)(PROPOSED FINISH FLOOR AND
BASEMENT ELEVATIONS
WELLS & SSDS'S W/IN 200' OF SSTS
C�PROPERTY METES & BOUNDS
COMMENTS:
TRENCH SLOPES 3:1 TO GRADE
SFrC7 `ILL NOTES 1 -5
PROFILE & DIMENSIONS
IN EXPANSION AREA
FILL GREATER TH.4 - 2 FEET
CLAY BARRIER
IL CERTIFICATION NOTE
EPTH GAUGES
OL ON PLAT\ FOR R.O.B., UNCLASSIFIED & IMPERVIOUS
EPARATION DISTANCE FROM TOE OF SLOPE
R NC
F TRENCH PROVIDED 60FT MAX.
AR&LLEL TO CONTOURS
00% EXPANSION PROVIDED
lFTAIIJDUST FREE CRUSHED STONE OR WASHED GRAVEL
FEOTEXTILE COVER
SEPARATION DISTANCES ON PLAN - FROM SSTS
(� 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL
( 20' TO FOUNDATION WALLS
0)100' TO WELL, 200' Iii DLOD,150' TO PITS
100' TO STREAl-v1, WATERCOURSE, LAKE (inc. eipan)
L��0' TO CATCH BASIN, 35' STORAIDRAIN, PIPED WATER
10' TO WATER LINE (pits - 20') -
50' I\TERMIITTENT DRAINAGE COURSE
(!IJ 200' /500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS
C-,10' AIIN TO LEDGE OUTCROP
SEPTIC TANK
C_ld( _J10' FRO-,,I FOUNDATION; 50' TO WELL
WELL
C DLINIENSIONS TO PROPERTY LINES
(� LOCATION OF SERVICE CONNECTION
IIN 15' TO PROPERTY LINE
SLOPE
(_,SLOPE IN SSTS AREA 520 0%4)
C_ C_JREGRADED TO 15 %, IF REQUIRED
DOSE/PUMP SYSTEMS
UIIP NOTES
U DOSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED
C_JJ&JD ETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.)
TI AND D -BOX SHOWN & DETAILED
CJFCN1 DAY STORAGE ABOVE ALAM-A
CURTAIN DRAIN
ASTANDPIPES, 5' BOTH SIDES, DETAIL
15' MIN to CDS = >5 %, 20'4%,25'-3%,35'-l%, 100%-<I%
20' MIN to CD DISCHARGE /100' with 182 cons day discharge
(-__) 10' MLN to NON- PERFORATED PIPE
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 C(Attached ❑ Under separate cover via _
❑ Shop drawings ❑ Prints ❑ Plans
❑ Copy of letter ❑ Change order ❑
1AUCTIg n] 0 rL J CT ° LIV @W01TU1° Lam,
DATE n J�
Jos NO. 99— 1 5 9
ATTENTI N
DESCRIPTION
i
RE:
Dorset Hollow
/
Estates `0--
(formally Van
Cleef Estates)
Subsurface Sewage Treatment
System (SSTS)
Construction Permit for Sewage Treatment System (CP -97)
1
I
Letter of Authorization (LA -97)
❑ Samples
the following items:
❑ Specifications
COPIES
DATE
NO.
DESCRIPTION
i
Application for Approval of Plans (PC -97)
1
1
Construction Permit for Sewage Treatment System (CP -97)
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 # ,)K_(j>3 --8 or the amount of $
1
1
Short Form EAF
THESE ARE TRANSMITTED as checked below:
❑ For approval
• For your use
• As requested
X1 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: l/ — "
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 # 3q
Dorset Hollow Builders
15 Wett Hollow R6ad
Brewster, New York 10509
Dorset Hollow Estates
2. Name of project: ( f o rma 1 ly V anC 16e f Es t;3. Location T/V: Patterson
4. Design Professional: Peder W. Scott, P.E., R.-';1. Address: 3871 Route 6
6. Drainage Basin: East Branch Reservoir Brewster, NY 10509
7. Tvne of Proiect:
X . Private/Residential Food Service Commercial
Apartments Institutional Mobile Home Park
Office Building Realty Subdivision Other (specify)
8. Is this project subject to State Environmental Quality Review (SEQR)?
Type Status (check one) ....................... ............................... Type I Exempt
Type II Unlisted X
9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... No
10.
Has DEIS been completed and found acceptable by Lead Agency? ...............
N/A
11.
Name of Lead Agency Town of Patterson Planning Board
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
serviced
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
22.
Date test holes observed 1 y -9 - 9 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 cPD
25.
Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?...
No
26.
Has SPDES Application been submitted to local DEC offices
N/A
Form PC -97
2
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 Lo.t
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.;to Blocky Lot s
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.
1 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 210.45 of thetPenal Law.
SIGNATURES & OFFICL4L TITLES.
Peder - --d. Scott gent for Applicant
Mailing Address 3s� 1 Route 6
Brewster New York 10509 ,.F
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
LETTER OF AUTHORIZATION
RE: Property of Dorset Hollow Builders
Located at 104 West Street
TN Patterson Tax Map 3.20
Block 2 Lot 8 5
Subdivisionof Dorset Hollow Estate$ (formally Van Cle.ef Estates)
Subdivision Lot # 34
Gentlemen:
Filed Map # 2 7 7 1
This letter is to authorize P e d e r W. s. C o t t, P. E . , R.. A.
Date Filed 12/24/88
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 .
Count igned: Signed:
P.E., R.A., # 059346 (Owne P operty)
Mailing Address 3 8 7 1 Route 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
TEST PIT DATA Ri'
= To BE Suami g=-L App:: "'.TIcNT
DESC-=ION
uF SOILS aNC,OUNI'= IN TEST n0i .
1' l G��l/✓f
�/�l7'l
u�.yr� y SAID
Gv�y srti17 .
2'
3
SQNDY d.�r
5'
so.NE s�r
7'
r
81
91
11'
...._.. _. _..... ... ..... ...... .
'
INDIC= LT'S= AT WEII 5: GRCUN9,,',*9= IS a\=UL\IT -.ice -
4
INDICj= LEVEL TO w=C-H =v7EL RISES AE'TER BEING M=UNT...RED
D=. HOLE OBSERVATIONS MIME BY:
DAT' ,': 101-17919<
DESIGN
Soil Rate Used / ;$ Min/ -'
Drop: S.D. usable Axes P --ovide
No-. of Bedrooms _
Septic Tank Cacacitr gals. = PG N
Absorption Area Provided By L.F. :: 24" width t.endi
Other
Soil Rate Approved L. sq. ft /gal.' a.ecked by Date
CF HE=
ivy
:=`.ed at (St=eet; :zt / ..
i'h..:.ii _ �:I P/i �.�SOI�I j(G1'.�'" ae : GRDY ,lN'
!:at-- cL P ::--Scak:- -ng Date ct P==Iatica Test
COLT+
5
��,..... ,,��,,.....�
1,�� 9c n�1 `i �T(�'
C T,c ?r'.T�(J�j
,=MCCl a i -c
Llli.i i.rLC'.r'i5C^
{�
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(
. 7iC �..�..�r ri��.,.LL
i
}Car- .,.+������. '
LY(i. Tii�
GLI umd-
S=..:zLce.
in : -.ches
sci be
S t.i � S t ca mi a .
-
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roo :-I
1.'I��.rI ::. c-a
Inches
In ,1es
T%CIes
]. %�J:•UZ =ice �oI 'off
Z 2 /O 23 — /p Zo y
1. Ten= to be r asea.t,—� at nacre de; th =t:.r a =rcc =atzy ectal sail ==mss
- 4 rmo'A data :' s--
are cdt Ier :at erc._= :' L
fcr reviea. .
2_ dept;: e..:ta `a be tro clf. hcle_
5
3
1. Ten= to be r asea.t,—� at nacre de; th =t:.r a =rcc =atzy ectal sail ==mss
- 4 rmo'A data :' s--
are cdt Ier :at erc._= :' L
fcr reviea. .
2_ dept;: e..:ta `a be tro clf. hcle_
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 # 34
Edward Bloes
914- 234 -2281
(formally Van Cleef Estates)
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 tru[y yours,
Edward Bloe� ` _-
G&E Development
PO BOX 352 BEDFORD, NY 10506
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 # 34
(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 truv'yours,
Edward Bloe
G &E Develo ment
PO BOX 352 BEDFORD, NY 10506
14 -16.4 (2187) —Text 12
PROJECT I.D. NUMBER
617.21
Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor)
SEOR
1. APPLICANT /SPONSOR
2. PROJECT NAME
Dorset Hollow Builders
Dorset Hollow Estates
3. PROJECT LOCATION: (formally Van Cleef Estates)
Municipality Patterson. County P u t n am
4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map)
Lot # - Dorset Hollow Estates (formally Van Cleef Estates)
5. IS PROPOSED ACTION:
El New ❑ Expansion ❑ Mod ificationlalteratIon
6. DESCRIBE PROJECT BRIEFLY:
Construction of subsurface sewage treatment system -for single- family
resid'emce and connection to public water sgpply.
7. AMOUNT OF LAN I AFFECTED:
Initially� acres Ultimately acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
Yes ❑ No If No; describe briefly
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
® Residential ❑ Industrial ❑ Commercial ❑ 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-permitlapprovals
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 PERMITIAPPROVAL REQUIRE MODIFICATION?
❑ Yes ®No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
P• W. S c o t, P. E., R. A. - y ��
Applicant /sponsor 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 617.6? 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, 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 or 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-Cl-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 Leaa Agency
„I!"'
Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Orricer
Signature o Responsible Officer in Lead Agency Signature -oT-P-r-e-p-a-r-e-r-(-I ifferent rom= responsi le of icer)
OA