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Home My WebLink About0137DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 3.20 -2 -86 BOX 2 00137 y 40 III �•,�, T j � �, � ��- , T. �. 6. 00137 1 �\\ � PiJTNAlVI COUNTY DEPARTMENT OF HEALTH � DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE F ATMENT SYSTEM PCHD CONSTRUCTION PERMIT # F' 2 3 J9 P-00 Located at 100 Town or Village T�:�► ► -Yz-s �►�i Owner /Applicant Name r�;.p25Tax Map 5, ;�O Block Z Lot 54g, Formerly G Subdivision Name V & ti Gl.a--g >` 43 i7f'+n S Subd. 'Lot # `3 z Mailing Address i ' W e7i,-r- i-t-O t.,_,01k. 1~:I7 , . i3 2� srr�-�2 ; Nei Zip lo 5-n Date Construction Permit Issued by PCHD I 1 11 Separate Sewerage System built by Address Consisting of i c;L 5 Gallon Septic Tank and ioe, 1-.6 ar= ;2z{' t..J1oe' T" e,- -?j fc-3 Other Requirements: 7-0,":ieo ter-- Water Sup&: )( Public Supply From W&T -u-yz. u i Sic CY Address or: Private Supply Drilled by Address Building Type RE e, -, of w tp_ Has erosion control been completed? `-/ oe-t� 5 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 regulati of Date: , 1 ls� � O Q Certified by Address u!na ounty Department of Health. �� P.E. 4 R.A. Professional) y i b !EZM License # �� L43 (O 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 subject to modification or change when, in the judgment of the Public Health Director, such revocatio , m dificati change is necessary. �+ By: Title: Date: �d White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -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 Attached ❑ Under separate cover via _ ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ DATE DATE ATTENTION RE: Septic As —Built Dorset Hollow Estates — Lot (formally Van C1eef-Estates) 1 Certificate of Construction Compliance 3 the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION 1 1 Certificate of Construction Compliance 3 1 Guarantee of Subsurface Sewage Treatment System 3 1 As —Built Septic Plan ( Fee: $200.00 c! (f C�;(Urfi 7=�^ THESE ARE TRANSMITTED as checked below: '7 For approval X3 For your use ❑ As requested ❑ For review and comment ❑ FORBIDS 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: �' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Dorset Hollow Builders Owner or Purchaser of Building Dorset Hollow Builders Building Constructed by 100 W t3T- S NLTT— Location - Street -A, 2-0 Z 8 6 Tax Map Block Lot Patterson Town/Village Van Cleef Subdivision Subdivision Name Residence 3 3 _ Building Type Subdivision Lot m 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 mo 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 erate was caused by the willful or negligent act of the o upant o the building utilizing the vstem. Day Year Signatu Title: 0 wy\j ontractor (Uwnier)-,-�ignature 0Ci2SET AnLLC L,> Corporation Name (if corporation) Address: State Zip QoP,sE-c-' HoLLr_)UQ au i LC�zf�� Corporation Name (if corporation) Address: State Zip Form GS -97 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 (Q14) 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 OWNERS NAME: P 2-s cT t+n t--C e- 4 L7 i l-0 L-12,S TAX MAP NUMBER: Z, 0-o — 2 E911 ADDRESS: TOWN: AUTHORIZED TOWN OFFICIAL: (Signature) DATE: 111F, 2,!r" ma 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 VERFW 225.00.-- too aa, YN til l L T v 'oe � • yyS�i \ GOPPER� OACV i- I I 51;0 r;r °_� /.r„ \ -� /•f Ret� \ �� I 1 I 0 W 11 \ , \ ,, \ \f boa �6�, \\`\ f \ •1 ,1 ; ;� + � 1.. � 1 \ �l) _ ADO _ � � •�! � � \ I t \�,�•.:. � �— \ \` to ''� � \\ NFeo��' l� �\� � � ` III ail I 0 � I+ 1 I fF-4766 9. 6 0' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: 119a Inspecte y: G, Street Location �lcgT S ]�Er Owner !`7oRgEi NvL[.ow Z.UZ-7)AiV g Town Permit # J> W 2 3— f 9 TM # 3. Subdivision Lot # 3 3 "� —�?�lg „e " 1. Sewage System Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth 2 c. Natural 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 ...... ..1,250 .......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. n re'I iies T.—L-e—n—gth required !�g 2c-Z Length installed 2. Distance to watercourse measured-t-- / e,?,e5l 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' /2" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped ........................ ............................... g. Pump or Dosed Systems Size of 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. House/Buildin a. House located per approved plans ... ............................... b. Number of bedrooms .......................... ........................... - .. 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 & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................. ... i. Erosion control provided ................. ............................... Rev. 6/97 L 0 P 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 (914) 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 FAX COVER SHEET Date: To: R6FDk'2 S e--o % 7 Fax #: 2-76 — 1 2C A, /,07" i# S 3 Va. `lei Gll�sf 5°t. t�� e�Son From: Gene D. Reed Putnam County Department of Health For your information For your review As discussed No. Pages (Including cover sheet) Please respond Attached as requested Please call Notes/Messages 5� S S ®� O BA C k �/ Z- z. .� i u i ! .� ♦ � PATZ In the event of transmission /reception difficulties, please contact this office at (914) 278 -6130 ext. 2261. e PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION ADAM GENE REQUEST FO FINAL INSPECTIQN For: Fill All information must be fully completed prior to any Trenches inspections being made. PCI D Construction Permit # r a 5'4 7 Located: WE-6T 5 (T) (V) 9V-+te1r5'VA Owner /Applicant Name: I)oy'5e 4' K 0 TM S-ZQ Block 2— Lot .Ad Formerly: — Subdivision Name: VAM r, (A Subdivision Lot # Is system fill completed? YF,: Is system complete? 41Er Is system constructed as per plans?1 Is well drilled? Al Is well located as per plans? Are erosion control measures in place? Date: Date: Date: �Jr 1 certify that the system(s), as listed, at the above premises bas been constructed and I have inspected and verified their completion 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: Certified by: PE _)� RA)e,– Design Professional Address: Lic. # Form Flit -99 115 h�e_cQ M,e<onie *o ,ler,'(y -t-,h-e ?r.`or 4.- eve/ i� p�c +,m j reaee .9` May 10, 2000 Mr. Alan Finn Dorset Hollow Estates PO Box 352 Bedford, NY 10506 Re: Dorset Hollow Estates Lot #33 — As -Built Inspection Dear Alan: The following items must be corrected for the subject SSTS. Based upon field observations by representatives of P.W. Scott, P.E., R.A. 1) Two (2) feet of soil required between overflow junction box and field trenches to prevent percolation back into D -Box area. 2) Forty -five (45) degree bends are required between space tank and first overflow box_ 3) Pipes must be cut finish with inside face of overflow boxes. 4) End caps are required for all trenches. If you have any questions please do not hesitate to call. Best regards, Q'Ly' Peder W. Scott, P. E., R.A. President ARCH ITECTURE'ENGINEERING'SITE PLANNING ru Llgrana a %Pwxm a a . vc DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION 13 ADAM XGENE • Font = FOR FINAL INSPECTI For: Fill All information must be fully completed prior to any Trenches inspections being made. PCHD Construction Permit # , f a';' 'l Located: y44E3T 5 (T) (V) P*. +tew-5 A Owner /Applicant Name: De01-4- HOMO `tr TM 3► 20 Block 7— Lot Formerly: Subdivision Name: CSZAZ Subdivision Lot # Is s stem fill completed? - . Date: in Y Is system complete? ., Is system constructed as per plans? P, Is well drilled? Is well located as per plans? .Tjir Are erosion control measures in place? Date: Date: I cer* that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their completion 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: S7 0/0o— Certified by: PE -)�- RA)e,- ,P i Professional Address: S&T i P\ oxf-c (°j Comments: D C. sr Form FIR -99 ::JMJU / I KOUW O Brewster, NY May 10. 2000 Mr. Alan Finn Dorset Hollow Estates PO Box 352 Bedford, NY 10506 Re: Dorset Hollow Estates Lot #33 — As -Built Inspection ./, -/ -, v - • .v Dear.Alan: The following items must be corrected for the subject SSTS. Based upon field observations by representatives of P.W. Scott, P.E., R.A. 1) Two (2) feet of soil required between overflow junction box and field trenches to prevent percolation back into D -Box area. 2) Forty -five (45) degree bends are required between septic tank and first overflow box. 3) Pipes must be cut finish with inside face of overflow boxes. 4) End caps are required for all trenches. If you have any questions please do not hesitate to call. j Weder W. Scott, P. E., R.A. cc: Gene - PCDOH 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 Hoi�neNs� onion l ike 1 % 1 1 1 I 1 � I 1 % 1. I' 1 I' 1 I\ 3 I r 311 �p 116 ��•` N 4 6 `•� r• Br�k 1 ,I � 31 ' 12563 I ' j 41 -T I Mendel Pond 164 t { T Corners 0 NPR\ d .r rte✓ J aviiand 1011low 46 8 Q e. 0 5 Q teinbeck p I Corners '\ harles I ' F; 11 _1 1 � � � � � � .. =:1 r `\ rners 84 �i cue Area Mount Ebo Corporate \ rrter• -- •ES � i 63 G .. ` Akins 8 e��t� "!ci m '� i m 311 est ,r��f �o AV) tO Cr q Tn i Es r `• _ \V yR N 4 6 `•� r• Br�k 1 ,I � 31 ' 12563 I ' j 41 -T I Mendel Pond 164 t { T Corners 0 NPR\ d .r rte✓ J aviiand 1011low 46 8 Q e. 0 5 Q teinbeck p I Corners '\ harles I ' F; 11 _1 1 � � � � � � .. =:1 r `\ rners 84 �i cue Area Mount Ebo Corporate \ rrter• -- •ES � � PUTNAM COUNTY DEPARTMENT OF HEALTH Vo � DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWA _ MENT SYSTEM PERMIT # 3 Located at Town or Village Patterson Subdivision name V a n c 1 e e f Subd. Lot # 33 Date Subdivision Approved /cR Owner /Applicant Name Dorset Hollow Builders Tax Map 3 : 2 0 Block 2 Lot "� 8 �- Renewal Revision Date of Previous Approval Mailing Address 15 West Hollow Road, Brewster, New York Amount of Fee Enclosed $ 3 0 0.0 0 Building Type - R e s i d na c e Lot Area 1,0Ae.,No. of Bedrooms 4 Design Flow GPD Fill Section Only Separate Sewerage System to consist of Other Requirements: Depth Volume gallon septic tank and Zip 10509 To be constructed by Dorset Hollow Builders Address 15 West Hollow Rd., Brewster,NY Town of Patterson Water Sunoly: Public Supply From Water 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 y 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 r airs th to. Signed: P.E. X R.A. Date tkhl 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 w nsidere necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new perm. prov or discharge of domestic sanitary sewage only. By VA/1V Title: . Date: 11 if Al White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 BRUCE R. FOLEY Public Health Director DEPARTMENT OF 1 Geneva Road Brewster, New York I :IIr.11a IamI 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services - Environmental Health (914) 278 - 6130 Fax (914) 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 October 19, 1999 P.W. Scott Engineering 3871 Route 6 Brewster NY 10509 RE: Dorset Hollow Builders West Street, Lot #33 (T) Patterson, TM# 3.20 -2 -86 Reservoir Basin Dear Mr. Scott: The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on October 10, 1999 is complete. The Department will notify you by November 7, 1999 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. 0 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: P.W. Scott - October 19, 1999 -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 (914) 278 -6130 ext. 2166. V. t y yo Robert Morris, PE RM:tn Senior Public Health Engineer G &E DEVELOPMENT, LLC Gregg Macaluso 914 -878 -4355 October 21, 1999 Robert Morris P.E. Putnam County Dept of Health 4 Geneva Rd Brewster, NY 10509 Re: Van Cleef Estates — Subsurface Sewage Disposal Systems I 0-F 3 z> Edward Bloes 914 -234 -2281 This letter is to serve as a notice that I as the contractor for the Van Cleef water district, currently under construction, can provide adequate pressure to serve the proposed lots. This water plant shall be inspected and approve, j►by PCDOH for use to meet the demand requirements for the subdivision. Very Edward Bloes G &E Develop PO Bog 352 Bedford, NY 10506 BRUCE R. FOLEY Public Health Director DEPARTMENT OF 1 Geneva Road Brewster, New York HEALTH 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (914) 278 - 6130 Fax (914) 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 October 19, 1999 P.W. Scott Engineering 3 871 Route 6 Brewster NY 10509 Re: Proposed SSTS: Dorset Hollow Builders West Street, Lot #33 (T)Patterson, TM# 3.20 -2 -86 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 regards. 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) Street address is noted on Construction Permit Application is incorrect. 2) A letter from the owner of the Public Water Supply is to be submitted stating that water can be supplied to the property at adequate pressure. 3) PC -97 notes incorrect drainage basin. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Ve t yours, r �" v Robert Morris, P.E. RM:tn Senior Public Health Engineer LYC� L .r.'..'•iL Cale= ,aQUISIT'70N �,.- ,,2,.0 -- .�� .:25s _ S77- ,J- rNA'RO�y =�:t_ .�•r/� �.1/��r,.:- ,o,41as144y 3. ZO Z 14605 ZO zzrnt at 13. q- :.lcc. :+ t .. SQL ?H:Rcc l _-'n1 '�"_ . T MIA �rj=M � r ^. Sum .�!��J . id_'_"'= APP -r' =—i'.q Go r 33 �.: LS mot? cf ?_- }ScakL:g Date cf at:c n Test zlh-,//w yore, .; T �CCMr�TT�j pyITTC`i . RLM Zlz_ Se iepth rat- -- : eve—I No. GicL'. ^.G -,:=face. .Za --, aches Rate �T(=a 51.Gi ~1r��WD j "�a. 51 a .Ti Shoop Droo 7- -L �[SC'4 _PC:'les —inches 'inches _ 3 i17 .-?,!r- / 3 y i /o = 30 - %o Z/ Zy 3 3 2 /a-y3 — /0 23 I. Tests to be zap tz::� at sarne d& =`.h un t :_ zpL:..^sate? y �:zl. soii. are QtL3L e= .at e-- ch. s ',mss t hcl.a -' .'AL cater to* be fcr revieaa. 2_ l-epth, ;znaz, r^_ts to be t---o cf i:e? e. : LOr 3 DEPTH TEST PIT DATA HOLE M. / G.L. D TO BE SU''t_MITI'L''J WIM A SOILS ENCOUNTEItDD IN TEST HOLE M. Z. HOLE NO. 2' /31ZY. L44,0"), -<4A fD • Z I/. n .2'2 '' 3' 4' sdwr� 5' s' Satin 6' �lwK- P�ofito�yl r 8' 10' 11' 12' 14' INDICATE•' LDM AT WHICH GR=,Zk=1 IS a'!C0U=3Z:D - INDICATE L—.,,=' TO WHICH W =% LEVEL RISES A-F=— B=s1G =UNT= DEEP HOLE OBSERVATIONS MADE BY: /Yt . j3 u D -7-4 Nl s (L( DAME; to -,70 DESIN Soil Rate Used Min /1" Drop: S_D. Usable Area Provided No-. of Baal roans Septic Tank Capacity /Z gals. Type - Ca v . Absorption Area Provided By 333 L_F. 24" width trcndz 4 • Other Name � W �o7T ENG�NE�iP //✓G�.�,2i.NiT��t�vF�3 �Jrk� L ure � � "� r Address SEAL, 3F y/ urn 6 o "' '� z �0. 0 X46 J THIS SPACE FOR USE I3Y IMUTH DEPAMENT ONLY: Soil Rate Approved C".eckod'by Date 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 Putmam County: Dept. of Health 4 Geneva Road Brewster, New York 10509 WE ARE SENDING YOU )1 Attached ❑ Under separate cover via ❑ Shop drawings �4, Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ DA� + / f� JOB NO. ATTENN-Ti N RE: - �jC�� 57er7cS ,Z.oT � 3 Drawings ❑ Samples the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION J� Drawings Construction Permit for Sewage Treatment System (form CP % Letter of Authorization (form LA -970r CA -97) Design Data Sheet (form DO -97) Short Form EAF House Plans (2sets) Check for the amount of $ 3vp THESE ARE TRINSMITTED as checked below: ❑ or approval ❑ or your use ❑ As requested or review and comment ❑ .-FOR BIDS DUE REMARKS IPY TO ❑ 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 SIGNED: If enclosures are not as noted, kindly notify us at once. 97 14.16 -4 (2187) —Text 12 PROJECT I.D. NUMBER 617.21 SEAR Appendix .0 State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART i— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR 2. PROJECT NAME Dorset Hollow Builders Vancleef Estates 3. PROJECT LOCATION: Municipality Patterson County Putnam 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) Vancleef Subdivision - Access from Route 311 / Cornwall Hill Road' For Lot # ' 5. IS PROPOSED ACTION: lNew ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: Coristructio "n single lot septic - Connection to public water supply. 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? E3 Yes ❑ No If No; describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Q Residential ❑ Industrial ❑ Commercial ❑Agriculture ❑ Park/ForesUOpen 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.PB /PCDOH 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes [3No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE P.W. Scott, P.E., R.A. - r? Applicant /sponsor name: Date: Signature: - - �J 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 1 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 Lead Agency Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Preparer (if different trom responsible officer) JPUTNAM 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: Dorset Hollow Builders Lot fJ 3 "" 15 West Hollow Road Brewster, New York 10509 2. Name of project: Van Cleef Estates 3. Location TN: Patterson 4. Design Professional: Peder W. Scott, P.E., R.J5... Address: 3871 Route 6 6. Drainage Basin: L-,. Si- r: 2yZ } C'W Brewster, NY 10509 7• Type of Project: 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)? -1ype Status (check one) ....................... ............................... Type I Exempt Type II Unlisted x 9• Isa Draft Environmental Impact Statement (DEIS) required? ......................... No 10. Hls DEIS been completed and found acceptable by Lead Agency? ............... N/A 11 . Mme of Lead Agency Town of Patterson Planning Board 12. Is this project in an area under the control of local planning, zoning, or other (.fficials, ordinances? ......................................................... ............................... Ye §:.1 13. If so, have plans been submitted to such authorities? ........ ............................... Yes- Subdivision 14. Ras preliminary approval been granted by such authorities? Yes Date granted: 19198 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 19. Serviced If yes, name of water supply Town of Patterson Distance to water supply by system 20. 1, project site near a public sewage collection or treatment system? ................ No 21. Vame of sewage system . Individual Lots Distance to sewage system 22. Date test holes observed I1 //q 23. Name of Health Inspector A. 1,34)D 2.> tJ s /G( `--- -' 24.1koject design flow (gallons per day) .......... ............................... 800 GPD 2:5. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?... No 26. Has SPDES Application been submitted to local DEC office? .. N/A y', 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 Villages 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, �c Block Lot 8 6 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 A misdemeanor pursuant to Section,40.45 q f the Penal Law. SIGNATURES & OFFICiAL TITLES. Mailing Address: .... .....................I.......... Peder W. Scott Agent for Applicant 3871 Route 6 Brewster, New York 10509 e PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE:' Property of Dorset Hollow Builders Located at Vancleef Estates, Route 311 & Cornwall Hill Road T/`% Patterson Tax Map # 3.2 0 Subdivision of V a n c l e e f Block 2 Lot ice- 81�- Subdivision.ut #- 33 Filed Map_g...? 771 Date.FilecL._./ Gentlemen: This letter is to authorize P e d e r W. Scott 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 alCcordance 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. Very trul your , Peder W. Scott Countersigned: Signed: �` P.E., R.A., # 059341 (Owne tof Property) Dorset Ulow Builders Mailing Address 3 8 7 1 Route 6 Mailing Address: 15 W@Qt; _ 1)��: —REI Brewster, State New York Zip. 10509 Telephone: ( 9 1 4 ) 2 7 8- 2 1 1 0 State Telephone: Brewster NY 10509 Zip (914) 279 -1339 Form LA -97 w . W .. W �0� No, W AMA - I ,004 Ac, w _ McK �N', -28,781 27,-5,1 �9 pORCN A Ul /Z p O 1 12 .0 .o ^ Z Ic�i �W 1. 1 1 1 1 1 CON C; APRON 1 f?- 225,00' nor 0 LOCATION DESCRIPTION FROM POINT A B 1 ST 12,0 68,0 2 DB -1 28,0 77,6 3 DB -2 33,4 79,0 4 DB -3 39,5 81,6 -5 DB -4 45,4 83,8 6 DB -5 51,4 87..0 7 DB -6 57,0 9010 8 DB -7 63,5 93,8 9 TRENCH -1 58.5 27.2 10 TRENCH -2 61,0 31,5 11 TRENCH -3 65,0 37,2 12 TRENCH -4 69.0. 41,8 13 TRENCH -5 73.6 46,6 14 TRENCH -6. 77.8 53,6 15 TRENCW 7 83,9 60,0