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HomeMy WebLinkAbout0139ALLEN BEALS, M.D., J.D. Commissioner of Health ROBERT MORRIS, P.E., MPH Director of Environmental Health May 27, 2014 Joseph Muccio 76 West Street Patterson, NY 12563 Dear Mr. Muccio: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 Re: Addition — A- 025 -13 76 West Street (T) Patterson, T.M. 3.20 -2 -89 MARYELLEN ODELL County Executive This Department has inspected the required installation for the secondary septic tank and found it to be in compliance. There are no further requirements to be addressed in relation to the septic system. Any permits or variances required under the jurisdiction of the Town of Patterson are the responsibility of the applicant. If you have any questions, please contact me at (845) 808 -1390 ext. 43261. Respectfully, -6 � t>' -1Z.:rk Gene D. Reed Senior Environmental Engineering Aide GDR:cw cc: BI (T) Patterson ALLEN BEALS, M.D., J.D. Commissioner of Health ROBERT MORRIS, P.E., MPH Director of Environmental Health May 15, 2014 Joseph Muccio 76 West Street Patterson, NY 12563 Dear Mr. Muccio: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 Re: Addition — A- 025 -13 No Increase in Number of Bedrooms 76 West Street (T) Patterson, T.M. 3.20 -2 -89 MARYELLEN ODELL County Executive This Department has received and reviewed the plans for the proposed addition to the above mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp from this Department dated May 15, 2014. The addition is approved with the following conditions: 1. A certificate of occupancy may not be issued for the bonus room until such time that the approved placement of a new septic tank has been completed and inspected by this Department. 2. The total number of bedrooms must remain at five without prior approval by this Department. 3. The area of the existing sewage disposal system and its expansion area must be maintained. 4. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc ... 5. The approval is for the modifications only and does not validate any construction shown as existing that has not obtained proper approvals from other agencies having jurisdiction. 6. This approval is valid for two (2) years and expires on May 15, 2016. Any permits or variances required under the jurisdiction of the Town of Patterson are the responsibility of the applicant. If you have any questions, please contact me at (845) 808 -1390 ext. 43261 Respectfully, Gene D. Reed Senior Environmental Engineering Aide GDR:cw cc: BI (T) Patterson Putnam County Department of Health Division of Environmental Health Services SSTS Repair - Final Site Inspection Date: v.. /� Inspected by: 17?Z d-5o ns 14 c., Installer: Street Location:�G ``�S �� Owner: ycC io l�.1'? c5 Town: -,R.,-. Repair Permit #: TM # 1. Type of System: Conventional O Alternate D Comments: 2. Septic Tank Yes No -N /A Comments a. Septic tank size -1,000 ... 1,250 ... giber .... �, /" b. Septic tank installed level ...................... c. 10' minimum from foundation .................. d. Distribution Box i. All outlets at same elevation (water tested) .. . ii. Protected below frost ............................. iii. Minimum 2 ft. Original soil between box & trenches e. Junction Box - properly set ........................:.. f. Trenches i. _System. completely opened for inspection ii. Length required Length installed iii. Pie slope checked .............................. . ... iv. Installed according to plan ..................... v. 10 ft. from property line - 20 ft -foundations ... vi. Size of gravel % - 1 %s " diameter clean ......... vii. Depth of gravel in trench 12" minimum ..... , ... viii. Ends ca pp ed .... ............................... R. Pump or Dosed Systems 3. Sewage System Area a. SSTS Area located as per approved plans b. Fill section - c, Distance from water course /wetlands 4. Overall Workmanship a. ' Boxes properly grouted and installed correctly ........... b.. All pipes flush with inside of box ......................... c. Backfill material contains stones <4" diameter ......... d. Curtain drain & standpipes installed according to plan e. _ Curtain drain outfall protected & dir to exist watercourse f. Footing drains discharge away from SSTS area ......... g. Erosion control provided ............................ Additional Comments: r.1 R1FS1 Rev - 011312 PUTNAM COUNTY HEALTH DEPARTMENT; ✓r DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR Internal Use Only PERMIT #�y ❑ Q( Repair Permit issued in last 5 years �X red U /Not in Watershed ❑ ®► Repair within Boyd's Comers, W. Branch or roton Falls Res. [g' Delegated ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION `jR. e TOWN �/�- ��,�5'�� TM # 3, 0 OWNER'S NAME JV—hJP-o vCClc, PHONE # MAILING ADDRESS %6 [,(/�.ST .S% 47%, APPLICANT J aSewll .IG000 d"v Name & Relationship (i.e., owner, tenant, contractor) DATE %D"�L- /r FACILITY TYPE PCHD COMPLAINT # PROPOSED INSTALLER C�eO�� Tsl� ZAX. AJ� a",� -t PHONE # ADDRESS !FY3 /-,9,eIYW-f 1%# /0• e4W,`.,1Vy REGISTRATION /LICENSE # f 0-5-1.62- Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed system) NOTE: The Department may require submittal of proposal from licensed professional depending on the nature and extent of the repair. /� i 4 K- a I, as owner,agree to the conditions stated on this form SIGNATURE S 9� ��Z TITLE o'er �1`6e— DATE (owner) I, the septic installer, agree to comply with the conditions of this permit for the septic system repair SIGNATURE J [�� TITLE o v< ' DATE S- /G (installer) Proposal approved with the following conditions: 1. Procurement of any Town Permit, if applicable. 2. Submission of as.built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing: a. Owner's name, Site Street Name, Town and Tax Map number b. Location of installed components tied to two fixed points c. System description (e.g., 1250 gal. Concrete septic tank, etc.) d. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and conditions 4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the completed SSTS repair will function. 5. No completed work is to be backfilled until authorization to do so has been obtained from the Department. IPA i CrInAL vor- %JM- T Proposal Approved Proposal Denied ❑ Inspector's Signature & Title Dat6 - Ex (ration ate Re air proposal is in compliance with a / applicable codes Yes S No ❑ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 ALLEN BEALS, M.D., J.D. Commissioner of Health ROBERT MORRIS, P.E., MPH Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 May 15, 2014 Phone # (845) 808 -1390 Fax # (845) 278 -7921 Joseph Muccio 76 West Street Patterson, NY 12563 Re: Addition— A- 025 -13 No Increase in Number of Bedrooms 76 West Street (T) Patterson, T.M. 3.20 -2 -89 Dear Mr. Muccio: MARYELLEN ODELL County Executive This Department has received and reviewed the plans for the proposed addition to the above mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp from this Department dated May 15, 2014. The addition is approved with the following conditions: 1. A certificate of occupancy may not be issued for the bonus room until such time that the approved placement of a new septic tank has been completed and inspected by this Department. 2. The total number of bedrooms must remain at five without prior approval by this Department. w. 3. The area of the existing sewage disposal system and its expansion. area must be maintained. 4. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc ... 5. The approval is for the modifications only and does not validate any construction shown as existing that has not obtained proper approvals from other agencies having jurisdiction. 6. This approval is valid for two (2) years and expires on May 15, 2016. Any permits or variances required under the jurisdiction of the Town of Patterson are the responsibility of the applicant. If you have any questions, please contact me at (845) 808 -1390 ext. 43261 Respectfully, V�->' Tz"4 Gene D. Reed Senior Environmental Engineering Aide GDR:cw cc: BI (T) Patterson GNIM, U,G,) pOI:GN 00, L- 166,52' avv c�q�iar I I?- A -r -r, r— -rz -e e ') --- - It N C:D lz Th - E: POTENTIAL I A f4BEDROOM 10 ju fnils-fet 3 POTENTIAL. BEDROOM 13 POTENTIAL POTENT' AL BEQROOM PEDROOM /'Iv C-c- CA/iF 19?,r,63 L15 e-I,) ,3 Avec, &,,// ld3 1-1 1AZ t�Ll 1 P TENTIAL DROOM 6 PUTNAM COUu NTYDEP "TMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOTA COUNT ONLY t> BEDROOMS ALL SUBSEQUENT REVISION/ALTERATIONS TO THESE HOUSE PLANS MUST BE SUBMITTED TO THE PCDOH FOR APPROVAL SIGNATURE &JITLE DAT lk 151 11 F-S 9 I 13 GAV-�--A,q-ef m iJb A A EN BEA1A 1VLD., J.D. ca�m er of mha h 6�. ROBERT MORRLS, P.E. DireftofRavhu=2mWHed& DEPARTMENT'OF HEALTH 1 Geneva Road, Brawsta, New York 10509 Telephone: (845) 80 8-1390; Fax: (845) 278 -7921 MARYELLEN OD&L Coudy ftecuba ri i" ADDITION APPLICATION RESIDENTIAL ONLY STREET / 0/257 S S % TOWN % tca,,l/ TAX MAP # -?,R -.�2 "(?9 NAME !�'%U GCi i C' PHONE, a� PCHD #'.t`:` 1 �� MAILING 7� L4' / S % / �y —ee j co w, . ADDRESS DESCRIPTION OF ADDITION ,�p,NU3" r, t'y"i �.,V,e *NUMBER OF EXISTING BEDROOMS A- NUMBER OF'PROPOSED NEW BEDROOMS * (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) * *Any addition. which is considered a bedroom requires formal approval of plans (Construction permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 1 Geneva Rd, Brewster", NY 10509, Phone: (845) 808 -1390. 1. Certified check or money order for $100.00. 2. Sketches of existing floor plan (drawn to scale, all living area including basement, to be shown and dimensioned and use of each room specified). (See Section 3.c of Bulletin HA '1) 3. Two set$ of proposed floor plans (drawn to scale — with name, street and tax map #) * Non- professional sketches are acceptable and preferred. (See Section 3.d of Bulletin HA -1) 4. Copy of survey showing all well and septic locations on the subject property to the best of your knowledge. Include date of installation known. Contact this office with any. questions. 5. Copy of Certificate of Occupancy from the .Town or Certification from the Building Department with legal bedroom count of dwelling. J.;c. O� bril 131'; 6-013 OFFICE USE ) P /` jl�t r% f'l J r y yip J y �7 it— f j`� c t/" jf(i�.+ r • SSW yr COMMENTS '�Zts' y+� � (�"�� � Li. v.n.,s ✓dam d "n��� t� j-^�rz Y' 3 5... f �' iv, w�, =,. mil% 1(S rr ALUNWALS, RD, J.D. ROBERT MORRIS, P.E. Director of Bnvuonmemal i%atth DEPARTMENT'OF HEALTH 1 Genm Road, Bm wsWr, New Yoik 10509 Telephone: (845) 80 9-1390; F= (845) 278 -7921 I MARYEI.I:E11T ODD Town Legal Bedroom Count & Proposed Addition Status Re: U Gf 1W. (Owner's Name) Tax Map # 3 . C;z O % Address: 7 6 Town: A So,,� Year Built: (;Le 06; According to records maintained by the Town, the above noted dwelling, is in compliance with Town Code..- YIP "mss' 16 12 a-ll Z e P `m p 5 Is not in compliance with Town Code. The Legal Bedroom Count is: This information has been obtained from: Certificate of Occupancy: i% r Other: The plans for the proposed addition are considered: a/ Addition to existing house only b6,0" Boom © V-er- 6wffe- Teardown and/or re -build allowed under Town Regulations B ' mg Inspector. Date 6. PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR Y _NQ1 I Internal Use Only PERMIT # � - C,6 4 - 1 ❑ 19, Repair Permit issued in last 5 years Ex eA E],/Not in Watershed ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. Y Delegated ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION TOWN /�/� -�o� TM # 3•eZD �7Z` OWNER'S NAME UGGaa PHONE # MAILING ADDRESS 26 /,(%ST S% PM -4aN, -y /car�3 APPLICANT Name & Relationship (i.e., owner, tenant, contractor) DATE' FACILITY TYPE PCHD COMPLAINT # PROPOSED INSTALLER �eO/�2 /I. /yj)je�/��,y .?.2. �. � PHONE ADDRESS !FY3AMAW /%i11 AO. Cd(W it/ ( REGISTRATION /LICENSE # f I0011- Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed system) NOTE: The Department may require submittal of proposal from licensed professional depending on the nature and extent of the repair. A I, as owner,agree to the conditions stated on this form SIGNATURE TITLE rl—Wee— DATE - (owner) ZT l I, the septic installer, agree to comply with the conditions of this permit for the septic system repair SIGNATURE TITLE DATE S'-- %6 (installer) Proposal aporoved with the following conditions: 1. Procurement of any Town Permit, if applicable. 2: Submission of as.built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing: a. Owner's name, Site Street Name, Town and Tax Map number b. Location of installed components tied to two fixed points c. System description (e.g., 1250 gal. Concrete septic tank, etc.) d. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and conditions 4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the completed SSTS repair will function. 5. No completed work is to be backfilled, until authorization to do so has been obtained from the Department. INI tPINAL Ubt UNLT Proposal Approved 1W Proposal Denied ❑ Inspector's, Signature & Title Datd Ex (ration Oate Repair proposal is in compliance with applicable codes Yes C No 0 COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 V PUTNAM COUNTY HEALTH ,DEPARTMENT ® . b. DIVISION OF ENVIRONMENTAL HEALTH SERVICES - i Ci POSAL FOR SEWAGE TREATMENT SYSTEM REPAIR `4 ISM YES NO Internal Use Only PERMIT # -/ ❑ � Repair Permit issued in last 5 years ❑ J Not in Watershed C1 Repair within Boyd's Comers, W. Branch. or Croton Falls Res. , Delegated 11 Repair within 200 ft. of a watercourse or DEC- maDDed wetland ❑ Joint Review SITE LOCATION TOVIIN 1�7�,ec.,✓ TM # -3•a0 ' oZ ' �� OWNER'S NAME J"U.se411 ,/�%cc>� PHONE MAILING ADDRESS 2-9 U105 -7— s'7-- /%V7-- Gtsb,--, -,v y /a Sa3 APPLICANT �% D,S -�i✓i� /�%L(GG.+a/�� Name & Relationship (i.e., owner, tenant, contractor) DATE -dill I zwa FACILITY TYPE PROPOSED INSTALLER.G,p„or4jL 4_ � ADDRESS pp PCHD COMPLAINT # �c t6 i PHONE # $145-.225 9--5'22 FREGISTRATION /LICENSE # 101&— Jd 5a, Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed system) NOTE: The Department may require submittal of proposal from licensed professional depending on the I, as owner,agree to the conditions stated on this form SIGNATURE` - TITLE dtv DATE / /-!7 (owner) I, the septic installer, agree to comply with the conditions of this permit for the septic system repair SIGNATURE _ y/_, TITLE DATE &L-3 (installer) Proposal approved with the following conditions: 1. Procurement of any Town Permit, if applicable. 2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing: a. Owner's name, Site Street Name, Town and Tax Map number b. Location of installed components tied to two fixed points c. System description (e.g., 1250 gal. Concrete septic tank, etc.) d. Installers' name and phone number 3. System repair to'be performed in accordance with the above proposal and conditions 4. The proposed SSTS, repair is considered a best fit design and there is no guarantee to the duration at which the completed SSTS repair will function. 5. No completed work is to be backfilled until authorization to do so has been obtained from the Department. Proposal Approved Proposal Denied ❑ Inspector's Signature & Title Dat / Ekoiratiorf Date Repair proposal is in compliance with applicable codes Yes No ❑ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 3� • S 7- K---:/-7 5,UU' I.- 166,52 o , 0o► 11,19 �Of NO. .AMA s 40,117 1 -m 0921 AC,f 0 L Ol O 17 CLAIM, rorl, f QN K---:/-7 5,UU' I.- 166,52 o , 0o► 11,19 It G, L '),If All L c" II ggyy II u z is "l o, 28 w • �Vf - e n� A• X01' No; 31 LOf -NO, cy AAA =40.117 ��- AM&— 0.921 AC.t e� Xof No ��aPoSCCQ' 3 00 -Soo � 09 O CLAIM, CU.CJ TORCH ry � - �.S 13 �--- S � =275,00 _ - Delta =34° �UGG� fl - r s� , is rt.,F.. ✓�i y...R M. :,. , SEPTIC AREA PLAN SCALE:1 " =30' - PUTNAM COUNTY DEPARTMENT OF HEALTH �. DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPICIANCE FOR SEWAGE TREATMENT SYSTEM PCIID CONSTRUCTION PERMIT # P- < c •- q _ , / ; f Located at„ C t :" C ..., ". Town or Village Patterson Owner /Applicant Name Dorset Hollow B u i l d e r sTax Map a.Q Block c� Lot ? °� Formerly Van Cleef Estates Subdivision Name Dorset Hollow Estates. Subd. Lot # .., Mailing Address 15. West Hollow Road, Brewster, NY Date Construction Permit Issued by PCHD k% tiz Zip 10509 Separate Sewerage System built by D o r s e t Hollow Sa i t d e r s Address 15 west Hollow Road Brewster, NY Consisting. of 1250 Gallon .Septic Tank and L F of 24" wide trenches and 100X.reserve. -Other Re uireme. Town of Patterd'on Water SuDDIV: X Public Supply From Hater A i s t r i e t Address or:. Private: Supply Drilled by Building: Type Residence Address Has erosion control been completed? Yes lqun3ber of Bedrooms 4 Has garbage grinder been installed? No 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), ' cordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regul ion of the P County Department of Health. Date: CQ b a Certified'by P.E. X R.A. V ign P & s Rai) 3871 387T.-Route b $rew ter, Address License # 059346 Any person occupying premises served by the above systems) 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 subject to modification or, change, when, in' the judgment. of the Public Health Director, such revocati m dificatio r change is necessary. By.. Title: Date: d, �-� White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Foam CC -97 PUTNAM* COUNTY DEPARTMENT OF HEALTH ' DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # _z-�) 4�' Located at Yee rl Subdivision name. 9.an c 1 e e f Subd. Lot # 3 0 Date Subdivision Approved 'f Owner /Applicant. Name g;,< i Town or " "Village i�a 4 t e r s o n Tax Map 3.2 0 Block 2 Lot '24- Renewal Revision Date of Previous Approval Mailing ess o.t g Add i !x" � . ;::'.:. �.?- �..;' Ta_..6; i� t:) Ds jt.:.r e:,) ; i'�-); _�(�,jN Zip 10') C„f.^ 5 45. Amount.of Fee Enclosed:,'. $300.'00 BuildingType Re a idenc a Lot Area , ��-c. No. of Bedrooms Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS RE UIRED WHEN FILL IS COMPLETED Separate Sewerage stem to. consist of gallon septic tank and ')C. ,.� a✓ i,�c.` - ` r,'f �i �,,. !r : �._� J t! 1 c.� tJ 4� : J r:� �,::;,> �... �'. tJ .:Other Requirements: To be constructed by Dorset Hollow Builders Address 15 West Hollow Rd., Brewster, Town of Patterson Water Supply: Public Supply From W a t e r D i s t r 16 t Address 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 wwage`treatme'nt.s s�tem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof. a "Certificate of Construction Compliance' satisfactory to the Public Health irector will be submitted to the a Department, and a written guarantee will be furnished the owner, his:successors; heirassigns, by the builder, that said builder. will place in good operating condition any part of said sewage treatment system durir►g the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Constriction Compliance of the original system. or any repairs thereto. Signed: P.E. .'X R..A. Daie Address 3871 Rou.t,e 6, Brewster, NY 1.0509 License# 0544346 APPROVED' FOR. CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatmen stem has been completed and inspected byAe,PCHD .Andkip fetocable for cause or may be amended or modified ..t —o idered.ne sary by the Public Health Dliebtd Any revision or'alteration of the approved plan requires a new permit: roved fo charge of domestic sanitary- sewage only. w Title. Date: By: . White copy - HD File; Yellow copy Building Inspector; Pink copy - Owner; Orangecopy - Design Professional Form CP -97 NY CERTIFICATE OF OCCUPANCY AND COMPLIANCE 2723 3 goWn of fattmovit, Ntfa 'ork V )W 2006 DATE ISSUED Aug: t �16, THIS IS TO CERTIFY THAT------R0-A-set -H,0tt0w guitdeAs ON THE PROPERTY OF Same LOCATED ON 76 Wezt StAeet HAS BEEN SUBSTANTIALLY CONS - TR�VCTED TO THE REQUIRE M- ENTS- OF T14E BUILDING CODE, ZOINMG. ORD AWE .AND LOCAL LAM OF THE TOWP4 OF PATTERSOKNEW YOFW A M-- MAY BE OCCUPIED AND USED AS— Single Famity Dwetting wlWood Deak Rultding Permit Dated ... Permit No. .9�9A .... AppficatiGn No. ...2495............ S,F,�oTjON 3.20 . ........ Bt 2- LOT................. 89 (.Otd TM - I -5 -3) ................. BLOCK ....................... ............... D.Lol 0 301 $ 25..00 V BUILDING INSPECTOR I 0 PUTNAM COUNTY HEALTH DEPARTMENT S DIVISION OF ENVIRONMENTAL HEALTH SERVICES O � -�L POSAL FOR SEWAGE TREATMENT SYSTEM REPAIR YES NO Internal Use Only PERINIT # ❑ � Repair Permit issued in last 5 years ❑/ Not in Watershed ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. Delegated El Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION }m TOWN 1,07-,lefo.✓ TM # -3.6LO - OWNER'S NAME PHONE # d'W- f7g' —,;�97 MAILING ADDRESS 24 W,1557" 5-7- APPLICANT ;; OS -e-P11 .�%GI�G.�t► �'w�l� Name & Relationship (i.e., owner, tenant, contractor) DATE 'Y I FACILITY TYPE PCHD COMPLAINT # PROPOSED INSTALLER t Jr.rn. PHONE # gL�,s �_ 93z2 ADDRESS R�I3 /"eU` o,15 /lh�F3, Q._c..dl! ,[ILj/'REGISTRATIO,N /LICENSE # /071> jd 512. Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed system) NOTE: The Department may require submittal of proposal from licensed professional depending on the nature and extent of the repair. <47q I I ---?, e © - - ©� ('a L tom- U c� as k I, as owner,agree to the conditions stated on this form SIGNATURE f TITLE Oi4l,4Y j DATE (owner) I, the septic installer, agree to comply with the conditions of this permit for the septic system repair SIGNATURE TITLE &.JlAed� DATE !J/1i /�40- (installer) r Proposal approved with the following conditions: 1. Procurement of any Town Permit, if applicable. 2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing: a. Owner's name, Site Street Name, Town and Tax Map number b. Location of installed components tied to two fixed points c. System description (e.g., 1250 gal. Concrete septic tank, etc.) d. Installers' name and phone number 3. System repair to'be performed in accordance with the above proposal and conditions 4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the completed SSTS repair will function. -5. No completed work is to be backfilled until authorization to do so has been obtained from the Department. INTERNAL USE ONLY Proposal Approved Proposal Denied ❑ Inspector's Signature & Title at . +Ek6iratiorY Date Repair proposal is in compliance with applicable codes Yes o O COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 / PUTNAM COUNTY HEALTH DEPARTMENT A s l DIVISION OF ENVIRONMENTAL HEALTH SERVICES' - ' G ----PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR YES NO Internal Use Only PERMIT # ❑ Repair Permit issued in last 5 years rEl Not in Watershed ❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res. u Delegated ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION �P9 TOWN 11017eQSo,✓ TM # 3.aO OWNER'S NAME - 0-se-All /t/41CC4 PHONE # d?i0 =ff75 v:P_45;97 MAILING ADDRESS 26 tt/OS7 sT- 150- � -eCrv, —, -4Y,, /;LrX.? APPLICANT �% o,� r l�✓.� ,/y%/,�GG,yt� 01-cN111Z Name & Relationship (i.e., owner, tenant, contractor) DATE IY FACILITY TYPE o� PCHD COMPLAINT # PROPOSED INSTALLER GeZ)3 fIAk-41,11rn PHONE # .$y,5 �'- 9ja� ADDRESS g REGISTRATION /LICENSE # Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed system) NOTE: The Department may require submittal of proposal from licensed professional depending on the nature and ex',ent of the repair. I, as owner,acree to the conditions stated on this form SIGNATURE TITLE dl,v DATE (owrwr) I, the septic ilstaller, agree to comply with the conditions of this permit for the septic system repair SIGNATURE %�J� e�1,., TITLE DATE ) &L-4 (insUler) — RMQOal aDOrNed with the following_conditions: 1. Pocurerrnt of any Town Permit, if applicable. 2 Sibmissin of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing: a Ownes name, Site Street Name, Town and Tax Map number b Locatin of installed components tied to two fixed points c Systea description (e.g., 1250 gal. Concrete septic tank, etc.) d Installrs' name and phone number 3. system rPair to-be performed in accordance with the above proposal and conditions 4. tie propsed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the ,omplietd SSTS repair will function. 5. fo cor reeted work is to be backfilled until authorization to do so has been obtained from the Department. IM 1 r-KNAL UJt UNLT Propsal ^proved Proposal Denied ❑ Inspctor'siignature & Title D91 . Ek6iratioff Date R e . it rc7nsal is in com liance with a licable codes Yes Lg No O CO!IES_. PCHD; Owner; Installer PC-1P 9 ,9L Rev. 2/07 S� r 2 5 MY GNIM, -7 r, pOf'CH 0 00,' 77,19 0 �v H WR t l 0 S� r 2 5 MY GNIM, -7 r, pOf'CH 0 00,' 77,19 0 �v r E iwnr�wsrru�rtiawa�� PiJ'TNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE 5 REATMENT SYSTEM PCHD CONSTRUCTION PERMIT # P a a -- 9' tl _ & <)v �G Located at �� EST ��'� . Town or Village Patterson Owner /Applicant Name Dorset Hollow Bu i 1 d e r sTax Map 3.8 0 Block Q Lot g2 Formerly Van Cleef Estates Subdivision Name Dorset Hollow Estates Subd. Lot # 1:50 Mailing Address 15 West Hollow Road, Brewster, NY Zip 10509 Date Construction Permit Issued by PCHD 1 1 ' 15 Separate Sewerage System built by D o r s e t Hollow B u i lde r s Address 15 West Hollow R o a d A4 9 Brewster, NY Consisting of 12 5 0 Gallon Septic Tank and { L F of 24" wide trenches and 1007 reserve. Other Requirements: Water Supply: x Public Supply From or: Private Supply Drilled by Building Type Residence Number of Bedrooms 4 Town of Patterson Water District Address Address Has erosion control been completed? Yes Has garbage grinder been installed? No 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), accordance wi the issued PCHD Construction Permit and approved plans and the standards, rules and regul n� of the Ptjorgm County Department of Health. Date: "1 LQ G Q Certified- by Address 3871 Route 6, Bri P.E. X R.A. ((Design Professional) ter, NY 10509 License# 059346 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 approva?,'dificatiowor subject to modification or change when, in the judgment of the Public Health Director, such revocati change is necessary. > By: Pnl Title: d_ Date: A 't) White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 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 Location - Street Residence Tax Map Block Lot Patterson TownNillage Dorset Hollow Estates (formally Van Cleef Estates) Subdivision Name 30 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 _7upaoif of the building utilizing the system. Corporation Name (if corporation) Address: State Zip Signature Title: nt ,dy J Dcv,�-_Cr tilo (_L__O -D e01L0 6:S 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 (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: Q o 2 S c-T t-�-n () L) i L..0 &-rc-,5 TAX MAP NUMBER: -5 a a 0 - 2- `I E911 ADDRESS: '7 (e Vy e---,.T- TOWN: �yy���✓ " °y" z AUTHORIZED TOWN •FFICIAL: G� (Signature) DATE: C7 6W O 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 VERFRIv1) 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 K1 Attached ❑ Under separate cover via • Shop drawings ❑ Prints ❑ Plans • Copy of letter ❑ Change order ❑ LETTER OF TRANSMITTAI DATE � T, JOB NO. ATTENTION RE: Septic As —Built Dorset Hollow Estates — Lot (formally Van Cleef 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 THESE ARE TRANSMITTED as checked below: )l For approval XD 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: tX0No. No1-'�X01' No �O ry AAA =X0,117 5,F,t ��- AMA m 0,921 AC;t `O\ i S k-- 215.00' �- 166,52' its PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: 6 o Inspected y: -,P -D Street Location W_57- 5T`7t��T Owner D-R'5977" f/ ®LGOLV Ryjj.7*i€E',s Town Permit # P -- ;Z ;Z -y g TM # 3 2D — 82 Subdivision Lot # 3 0 " VsNGG r 4. Sewage System 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 ...... ............................... II. Sewage System a. Septic tank size - 1,000 ..... G250 ) ..... other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. Al1 outs at same elevation -water tested ..............:.. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set ........... ............................... f. Trenches T71egth required q zl,;l Length installed _ILV f3 2. Distance to watercourse measured 4—/ ,!�70Ft.......... 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 Size o 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. ouse. ocated per approved plans ... ............................... b. Number of bedrooms .................4/ .................... 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 06/02/00 17:22 PW SCOTT � 19142787921 NO.023 PUT] 1AM COUNTY DEPARTMENT OF HEALTH DMSI(,N OF ENVIRONMENTAL HEALTH SERVICES REQUEST FOR FINAL I USPECTION For: Fill Date: 6l /2O00 Trenches PCHD Construction Perm it # 2� Located: Wem' • i free -t (T) M P°►tytlsovt Owner /Applicant Name: _a' t, f{n kW �k�P1S TM 3' "10 Block I Lot Formerly: Subdivision Name: (/ow derf Subdivision Lot # 3Q Is system fill completed? Is system complete? Y-'. . Is system constructed as 1 let plans? Yeb . S$e &v7ne +t Is well drilled? _!�y[ A Is well located as per plai s? �1 . Are erosion control mess Tres in place? Y—e6 Date: Date: 61ileo Date: I certify that the system(s). as listed, at the above premises has been constructed and I have inspected and verified their comp tetion 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: l2 %� Certified by: pi�1•' w •� E'er • E y RA Design Professional Address: nP_ "y Lic. 0 Comments: /. Or l e,,, %t FOR: a ADAM vC, (GENE ❑ (NAME) li Form FIR -99 EM �3� i oil� PUTNAM COUNTY DEPARTMENT OF HEALTH �U) DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR S TREATMENT SYSTEM d PERMIT # vju557s ` rf&, -Oz Located at Town or Village Patterson Subdivision name y a n c l e e f Subd. Lot # t CO Tax Map 3-20 Block 2 Lot '715—� Date Subdivision Approved i T( Renewal Revision Owner /Applicant Name l3j/ija Date of Previous Approval Mailing Address / s c% r ✓b rz:014t 5 tit Zip Amount of Fee Enclosed $300.00 Building Type Res i d e n c e Lot Area No. of Bedrooms 4 Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of / 95-0 gallon septic tank and Rev,/s n 'S6 I—F x �2 y « W i dc� - <f y8L� r4�Jp 1 vo �o 1��3�'c� -✓tom' Other Requirements: To be constructed by Dorset Hollow Builders Address 15 West Hollow Rd. , Brewster, NY Town of Patterson Water Supply: 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 treatments sy tem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately 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 /rW- 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 treatinentsystem has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified whe. co idered nec sary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. roved o charge of domestic sanitary sewage only. li1 ABy: Title: � l Date: G White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 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 �-OT 72 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 approved by PCDOH for use to meet the demand requirements for the subdivision. Very s, Edward BI s G&E Development PO Bog 352 Bedford, NY 10506 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT STREET LOCATION REVIEWED BY RM, GR, AS, MB, BH Y DOCU ENr Y ERMIT APPLICATION WELL PERMIT _ PWS LETTER LETTER OF AUTHORIZATION DESIGN DATA SHEET (DDS) CORPORATE RESOLUTION SHORT EAF PLANS - THREE SETS HOUSE PLANS - TWO SETS VARIANCE REQUEST SUBDIVISION LEGAL SUBDIVISION SUBDIVISION APPROVAL CHECKED PERC RATE FILL REQUIRED DEPTH CURTAIN DRAIN REQUIRED STANDPIPES GENERAL LOCATED IN NYC WATERSHED PANS SUBMITTED TO DEP LEGATED TO PCHD DEP APPROVAL, IF REQ'D DEEP TEST HOLES OBSERVED PERCS TO BE WITNESSED / EX- APPROVAL SSDS ADJ. LOTS WETLANDS (TOWN/DEC PERMIT REQ'D ?) DATA ON DDS PLANS & PERMIT SAME 7 -PRE 1969 NEIGHBOR NOTIFICATION LETTER BI /ZBA -100 YR. FLOOD ELEVATION OTHER REQ'D PERMIT(S) REQUIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) SSDS HYDRAULIC PROFILE GRAVITY FLOW CONSTRUCTION NOTES DESIGN DATA: PERC & DEEP RESULTS 2' CONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES, CUT L FOOTING /GUTTER/CURTAIN DRAINS SOIL TYPE BOUNDARIES r TITLE BLOCK; OWNERS NAME,ADDRESS , TM #,PE/RA; NAME,ADDRESS,PHONE# DATE OF DRAWING/REVISION DATUM REFERENCE LOCATION OF WATERCOURSES, PONDS LAKES AND WETLANDS WITHIN 200 FEET PROPOSED FINISH FLOOR AND BASEMENT EL. COMMENTS NAME OF OWNER DATE EROSION CONTROL:HOUSE,WELL, SSDS PERC & DEEP HOLES LOCATED REPRESENTATIVE OF PRIMARY & EXPANSION LOCATION MAP EXP. AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE IF PUMPED, PIT & D BOX SHOWN & DETAILED HOUSE - NO.OF BEDROOMS WELLS & SSDS'S W/1N 200' OF PROPOSED SYS. PROPERTY METES& BOUNDS HOU E SETBACK NECESSARY (TIGHT LOT) HO SE SEWER - 1/4" FT. 4 "0; TYPE PIPE N ,0 BENDS; MAX.BENDS 45° W /CLEANOUT FILL SYSTEMS 6LAY BARRIER 10- FT. HORIZONTAL;SLOPE 3:1 TO GRADE FILL SPECS FILL NOTES FILL CERTIFICATION NOTE DEPTH GAUGES FILL PROFILE & DIMENSIONS VOLUME FILL IN EXPANSION AREA TRENCH LF TRENCH PROVIDED 60 FT MAX. PARALLEL TO CONTOURS 100% EXPANSION PROVIDED ON PLAN - FROM SSTS 10' TO P.L., DRIVEWAY, LARGE TREES, TOP.OF FILL 20' TO FOUNDATION WALLS _15'WELL TO PL 100' TO WELL, 200' IN DLOD, 150' PITS 100' TO STREAM WATERCOURSE LAKE (inc. expan) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATER LINE (pits -20') 50' INTERMITTENT DRAINAGE COURSE 200'/500' RESERVOIR, ETC. 150' GALLEY SYSTEMS IlllFiu_. 15'MIN to CDS= >5 %,10'- 4 0/o,25'- 3 0/o,30'- 2 0/o,35' -I %,100' - <I% 20'MIN to CD discharge /100'with 182 cons day discharge SEPTIC TANK 10' FROM FOUNDATION; 50' TO WELL A WELL DIMENSIONS TO PROPERTY LINE LOCATION OF SERVICE CONNECTION BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 .Geneva Road Brewster, New York 10509 P 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 18, 1999 PW Scott Engineering 3871 Route 6 Brewster, NY 10509 Re: VanCleef West Street, Lot #30 (T) Patterson TM #3.20 -2 -89 Dear Mr. Scott: Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. Comments are offered as follows: The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. If percolation tests were not witnessed by a representative of the New York City Department of Environmental Protection on this lot, percolation tests must be witnessed by a representative of this Department. 1. The correct street address has not been noted on the Construction Permit application. 2. Cross out all SSTS designs not relevant to this project, i.e., lot 29 and 31. 3. 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. 4. The incorrect drainage basin is noted on the form PC -97. Upon receipt of a submission, revised to reflect the above, this application will be considered further. Very t ly yours, Robert Morris, P. E. Public Health Engineer RM/jP - DIVISICN OF Zry i, - =-M H =RV= 7 _ ..... APPENDIX I = 13MN DATA ASH=_ _ -Sd SUFAC:?, Szge_l L DISPC. -AL SYS= Cwme= SRG AQc/%S/noN Go,eP Address* 1,137 PILA Al,?aN-g�l< Atlg- S ZO. • S %0605 Zo L- at (S t:.2°t )c3 // C G[9KN►.✓i4LL h° /GG iP.'� S�"-%_ /_ 3iSj B1CGC J Lot (inii.c ate nearest cross s`r.eet) .:n.ic .dli P�trr�,cso�/ Watershe G,Oeo »N ,-O=, PERCOLATT_C%I TEST DAM PBx O= M BE SU —=jA== .W� APPLIGATICLIS Gor 30 rate of Pre-Scaking 0 Date of Per=lation Test HOLE 3 NLs'�F.Z TIME JO PERCDLITICV ._..: -. - ..... _ . P _1CO=C,7 Elapse Depth to .Tate:: rYrom Water Level No, • Time Ground Surface. In Inches ' Soil- Rate Start-Stop Min. Start Stop Drop In Yn.m /In Drop Z _ 2 Inches Inches inches - 1 - 2 1IC7TES : 1. Tests to be repeated at same depth until appr=matel y equal soil rats are obtained. .at each percolation test hole. : 'All data to* be suimi.tte3 . for review. 2. Dept's measurements to be made frcn top of hole. re<r. 9185 0 . W- 3 JO .� -:A ._..: -. - ..... _ . -- -- ....... .. ........ .. .. .. ... _.__- -- e7 Z _ 2 9 ? 1 - 2 1IC7TES : 1. Tests to be repeated at same depth until appr=matel y equal soil rats are obtained. .at each percolation test hole. : 'All data to* be suimi.tte3 . for review. 2. Dept's measurements to be made frcn top of hole. re<r. 9185 IS T PIT DATA REC'u= TO BE SiJPMZTTED WITH APPLICATION DESCf=ION ' SOILS ENCOUNI'= IN TEST HOi �— DM77d HOLE NO. HOLE NO. HOLE W. G.L. e 7bJ�o% Gf,GO.n w SYenit,� 2' 1ililt r 3' Stern t ✓/ 3' ono"-,o •S4109 4' S��Ves 51 6'. 71 15LO A0 -71 r T 9' • � '1 S 121 14' INDICATE I= AT WHICH GROUNI7kr= IS ENICOU=Nzo - INDICATE L= TO Wmm WATER LEVYI<, RISES AKER BEING =13ITTERED DEEP HOLE OBSERVATIONS MADE BY: DATE: DESIGN Soil Rate Used f/� Min /l" Drop: S-D. Usable Area Provided No. of Bedroans Septic Tank Capacity /7,50 gals. Type Absorption Area Provided By.--- L.F. x 24" width t--end-1 Other _ f t 1PJ Name W gnatur a .Ehl o fL Address 3l %/. �Ocrrf 6 SEAL'S LLJ C THIS SPACE FOR USE BY IMUTH DEPAMEM ONLY: ��ESSIDN Soil Rate Approved sq. ft /gal. ' Checked by Date 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: Dorset Hollow Builders Lot # 50 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.iN.. Address: 3871 Route 6 6. Drainage Basin: Brewster, NY 10509 7. Type of Project: X . Private/Residential Food Service Apartments Institutional Office Building Realty Subdivision 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 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ......................................................... ............................... Exempt _ Unlisted x No N/A 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 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 —� 23. Name of Health Inspector 24.- Project design flow (gallons per day) 800 GPD 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... No 26. Has SPDES Application been submitted to local DEC office? ......................... N/A Form PC -97 11 2 ' 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? ............................... 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 Map .................... Ma 3, �o Block Lot8'7 36. Tax Ma ID Number ................ p 2 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 submifthose 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 210.45 of therrenal Law. SIGNATURES & OFFICiAL TITLES. d"e Mailing Adfess: ,i ............................... CP r r✓' �': Peder W. Scott Agent for Applicant 3871 Route 6 Brewster, New York 10509 14.16.4 (2187) —Text 12 PROJECT I.D. NUMBER 617.21 'SEOR Appendix C State Environmental Duality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR 2. PROJECT NAME Dorset Holl.ow 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 3111 Cornwall Hill Road For Lot # 5. IS PROPOSED ACTION: t_tNew ❑ Expansion ❑ Modificationlalteration 6. DESCRIBE PROJECT BRIEFLY: Construction single lot septic - Connection -to public water supply. 7. AMOUNT OF LAND AFFECTED: �^ Initially o oZ acres Ultimately .1 ss� 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? 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 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 C3 No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE P.W. Scott, P.7., R.A. - Applicant /sponsor name: 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 i 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 EA•F 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 ope Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible officer in Lead Agency Signature of Preparer (if different from responsible officer) Date 2 TO P. W. SCOTT 'Engineering & Architecture, P.C. 3871 Route 6 BREWSTER, NY 10509 E -Mail: pws @bestweb.net (114-278-2110 FAX (914) 278 -2166 Putnam County Dept. of Health 4 Geneva Road Brewster, New York 10509 DA 20 0 JOB NO. . ATTENTI N RE: j�. TT �a Drawings WE ARE SENDING YOU )?1 Attached ❑ Under separate cover via the following items: ❑ Shop drawings )9L Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter .❑ Change order ❑ __ COPIES DATE NO. DESCRIPTION Drawings Construction Permit for Sewage Treatment System (form CP Letter of Authorization .(form LA -97or CA -97) ' Design Data Sheet (form DO -97) Short Form EAF. House Plans (2sets) Check f(�&D;L for the amount of $ 3v0 THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ For your use ❑ As requested V (For review and comment ❑ FOR BIDS DUE REMARKS COPY 70 ❑ 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 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'/V Patterson Tax Map# 3.20 Block 2 Lot 8 Subdivision of V a n c l e e f .... Subdivision..Lot # '�o Filed Map_ #_.. ?771 Date_Filed_ CA.. 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 abcordance 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 t ly your Peder W. Scott Countersigned: Signed: P.E., R.A., # 059346 (O fro ) Mailing Address 3871. Route 6 Brewster, State New York Dor.sl�t Hollow Builders Mailing Address: :--5 ra a H Q I 9;; R_d Zip 10509 State Telephone:( 9 14) 278-21 10 Brewster, NY 10509 Zip Telephone: (9 14) 279-1339 Form LA-97