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HomeMy WebLinkAbout0141DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdoos.com 631- 589 -8100 3.20 -2 -90 BOX 2 00141 ■ '7 LL rm 1�k 1. I or , I P 00141 PUTNAM COUNTY DEPARTMENT OF HEALTH Is, DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEW TMENT SYSTEM D PCHD CONSTRUCTION PERMIT # e c9 y - q°� Located at °\ J\ t_-L Cp Q R I Town or Village P a t t, r s o n Owner /Applicant Name D o r s e t Hollow B u i l d e r s Tax Map 3. oD O Block o7 Lot C C Formerly Van Cleef Estates Subdivision Name Dorset Hollow Estates Subd. Lot # 21 Mailing Address 15 West Hollow Road, Brewster, NY Date Construction Permit Issued by PCHD 1 i Zip 10509 Separate Sewerage System built by Dorset H o 1.1 o w B u i l d e r s Address 15 West Hollow R o a d Brewster, NY Consisting of 1250 Gallon Septic Tank and ,5 LCL F of 24" wide trenches and 100% reserve. Other Requirements: Town of Patterson Water Supply: x Public Supply From water District Address or: Private Supply Drilled by Building Type 'Residence Number of Bedrooms 4 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), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulati o the Putnam County Department of Health. Date: �1 ( U � y e Certified by P.E. X R.A. 3871 Route 6, Brewster, NY 10509 Address License #_05934 6 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 revocatidificat' or change is necessary. By: Title: C Date: �l 1 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 — m___ ______m____________m__________m _ ____ A_ �� ! ® • $ , � t . . . i • e $ / � } t ■, . �� ` ¢ � / ) .■ , ; a, Fill 11! . 210 III ¥ « $ ■ � , ��� � ■. , - ( § w _/- e wmm-� � x ! ■ , - ■ e ,. ; �� } a PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Dorset Hollow Builders a,0 c) C�) 171 C Owner or Purchaser of Building Tax Map Block Lot Dorset Hollow Builders Building Constructed by 1\ 7�S \LL Location - Street Residence Building Type Patterson Town/Village Dorset Hollow Estates (formally Van Cleef Estates) Subdivision Name 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 Director of the Putnam County Department of Health as tc to operate was caused by the willful or negligent act of tl system. `1 Day U_ Year Co ) - Signature 00fz,,Z C HcQ_0Lv (?501L_ DFXS Corporation Name (if corporation) Address: State the determination of the Public Health or not the failure of the system ntW the building utilizing the Title: v OO RSC 7 Hy L_L_0C.c.s Corporation Name (if corporation) Address: Zip State Zip Form GS -97 BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLMARI 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 E911 ADDRESS VERIFICATION FORM OWNERS NAME: P o 2 5 i✓rf' t-�-rD L-ce- -t e) u r L.O &12..,5 TAX MAP .NUMBER: a - 2 y E911 ADDRESS: j t �� �-�' J (2—r TOWN: AUTHORIZED TOWN OFFICIAL: /��- x4"I (Signature) DATE: J,-�, '2 com v 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 `� 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 �D Attached ❑ Under separate cover via ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ MECTIT1912 O1P DATE DATE JOB NO. ATTENTION RE: Septic As —Built Dorset Hollow Estates — Lot (formally Van Cleef Estates) Certificate of Construction Compliance 3 the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION I 1 Certificate of Construction Compliance 3 1 Guarantee of Subsurface Sewage Treatment System 3 1 As —Built Septic Plan �f Fee: $200.00`/ a r;} i C tit T-fv THESE ARE TRANSMITTED as checked below: 7 For approval XD For your use ❑ As requested ❑ For review and comment ❑ FORBIDS DUE REMARKS COPY 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: �- v Of NO, 2.8 0 e56 nelta� W 1.022 A0,11 �. 1025, a�czi 1021 Z O ® 001 l� ATA = 40,056 S,r,t Q 0? AAA - 0,920 AG,t \ VVV�-- I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: 46 Z 5 o a Inspecte y: G peE &_ Street Location 3`71_L GOUTZ L Owner -p ©xsEr Town 7r'.4srErzsd.y Permit # ;> - ;7- # - 19 TM # 3 o -- a - y o Subdivision Lot # a ewaLe vstem Area a. STS area located as per approved plans .., ......................... b_ Fill section date of placement 3:1 barrier Lgth. Width Avg.Dpth _ Natural soil not stripped ................................................. d_ Stone, brush, etc., greater than 15' from STS area.......... e_ 100' from water course / wetlands ...... ............................... II. Sewer e S stem a_ eptic to c size - 1,000 ... 1,250 .......other ................ b. Septic tank installed level ................ ............................... c_ . 10' minimum from foundation .......... ............................... d. Distribution Box 7UFoutTets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set ........... ............................... f 1 renc es engt required 5 00 Length installed !3'eqc, 2. Distance to watercourse measured 4 t ©o 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 V" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped ........................ ............................... g. Pum or Dosed S stems ize o pump c amTer ................ ............................... 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. Hruse located per approved plans ... ............................... b. Number of bedrooms ......................... 7�.. B, i................. 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 C;/02i00 17:22 PW SCOTT 19142787921 NO.023 P03 c PUT vAM COUNTY DEPARTMENT OF HEALTH DIVISI()N OF ENVIRONMENTAL HEALTH SERVICES REQUEST FOIL M& 1 NSPECTTON For: Fill Date: 6 I 112 000 Trenches L� PCHD Construction Perms it # P — Z (f7 ? j Located: ,Tr C*Wt Rocd • (T) (v) Pa-ti a rso-n Owner /Applicant Name: _ S�°G 14vt /f lew 8m;Idn; x.10 Block I Lot gQ Formerly: Subdivision Name: Uam C /e t't �• Subdivision Lot # -11 Is system fill completed? 1A Date: Is system complete? -Y-9 9 Date: 61-1 l Zoao Is system constructed as 1 ier plans? Se+e [bra Is well drilled? VA Date: Is well located as per plus? N _ Are erosion control measures in place? S. _ I certify that the system (s), as listed, at the above premises has been constructed and I have inspected and verified their comp .etion in accordance with the issued PCHD Construction Permit and approved plans and the ; 3tandards, Rules and Regulations of the Putnam County Department of Health. Date- %bfi Certified by: C .1 PE ✓ RA Design Professional Address: .3g% kwwre _ PULAIVe r- l � Y 14017 Lic. # Of -? Comments: �• tcwl<_P�rL he�DCGit�r�• _. 2- CM-rt cra - . � �C-1 FOR: ❑ ADAM LP GENE 0 (NANE) Form FIR -99 57 153.6-, Q: " 5:.' (52-52j' —4 76*5 ',06,"\V 116.$5 cd 0 06-50'4-� 325. 0o' I nn I 8-T mho N86' 10'4 -3 ! . ( 0 �18.47 II 0) f N81 p R- C-- , ka (6 RYS8 '100. R3 ;v 119 Y-P NOS To- CAPPED -P$ - IT (Typ') D3 4 BEDROOM HOUSE r i\ . :�— I SF, Q) FF-488-5 N 0 ?b MIN. BASEMENT=479.5 0 RYSIl 4'0 /Sp R .0 CIP 0 14. 4 t 0 1 /Fr 0 467 F�SEj 22 1/2, ELBO 1250 G TANK MONK goo 2.001 27=1 13 �— 188.23' :V,5? oU 22. I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWA ATMENT SYSTEM d PERMIT # Located at R�r'�- '— ^�a.. Town or Village Patter s o n Subdivision name V a n c 1 e e f Subd. Lot # 02q Tax Map 3. 2 0 Block 2 Lot ��bs Date Subdivision Approved I � le Renewal Revision Owner /Applicant Name Dorset Hollow Builders Date of Previous Approval Mailing Address 15 West Hollow Road, Brewster, New York Amount of Fee Enclosed $300.00 Building Type R e s i d aA c e Lot Area63 Ac, No. of Bedrooms 4 Zip 10509 Design Flow GPD 8 od Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of Other Requirements: To be constructed by Dorset Hollow Water Supply: Public Supply F I�SC� Builders Town rom Water ACI gallon septic tank and IO r��► -� �L. a���. W :i.. l oo % ��n! _ Address 15 West Hollow Road, Brewster, NY of Patterson 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 to sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: P.E. X R.A. Date g� Address 38h 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 wheDaqnsideredyecessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permi . A rove r discharge of domestic sanitary sewage only. A, y: Title: ( Date: f J �l 'bite 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 HEALTH 1 Geneva Road Brewster, New York 10509 R 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: Dorset Hollow Builders Jill Court, Lot #29 (T) Patterson 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 Heath Department for review 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 of impervious surfaces, and the project applicant should contact the Dept., of Environmental Protection regarding such activities to see if Dept. of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (914) 278 -6130 ext. 148. Very �y yours, Robert Morris Sr. Public Health Engineer RM/JP 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 f -c)-i "3 :�S Edward Sloes 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 approydd by PCDOH for use to meet the demand requirements for the subdivision. Edward G&E D PO Bog 352 Bedford, NY 10506 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 October 18, 1999 PW Scott Engineering 3 871 Route 6 Brewster, NY 10509 Re: Proposed SSDS: Dorset Hollow Builders Jill Court, Lot 29 (T) Patterson TM #3.20 -2 -90 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 test must be witnessed by a representative of this Department. 1. The incorrect drainage basin is noted on PC 97. 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. Design data sheet does not note date of percolation test. Upon receipt of a submission, revised to reflect the above, this application will be considered further. Very, y yours Robert Morris, P. E. Sr. Public Health Engineer I' 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 WNI; GR, AS, MB, BH Y DOCUMENTS PERMIT APPLICATION C -1 WELL PERMIT _ PWS LETTER LETTER OF AUTHORIZATION DESIGN DATA SHEET (DDS) CORPORATE RESOLUTION SHORT EAF PLANS - THREE SETS HOUSE PLANS - TWO SETS VARIANCE REQUEST FEE SUBDIVISION LEGAL SUBDIVISION SUBDIVISION APPROVAL CHECKED PERC RATE FILL REQUIRED DEPTH CURTAIN DRAIN QUIRED STANDPIPES GENERAL LOCATED IN NYC WATERSHED PLANS SUBMITTED TO DEP ?LEGATED TO PCHD EP 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 PRE 1969 NEIGHBOR NOTIFICATION LETTER BI /ZBA 100 YR. FLOOD ELEVATION OTHER REQ'D PERMITS) REQUIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) DS HYDRAULIC PROFILE GRAVITY FLOW Y NAME OF OWNER DATE EROSION CONTROL:HOUSE,WELL, SSDS VERC & 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/IN 200' OF PROPOSED SYS. PROPERTY METES & BOUNDS HOUSE SETBACK NECESSARY (TIGHT LOT) HOUSE SEWER - 1/4" FT. 4 "0; TYPE PIPE NO BENDS; MAX.BENDS 45" W /CLEANOUT FILL SYSTEMS AY BARRIER 401- FT. HORIZONTAL;SLOPE 3:1 TO GRADE FILL SPECS FILL NOTES FILL CERTIFICATION NOTE DEPTH GAUGES flLL PROFILE & DIMENSIONS FILL IN EXPANSION AREA TRENCH LF TRENCH PROVIDED 60 FT MAX. PARALLEL TO CONTOURS 100% EXPANSION PROVIDED TAX MAP # 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 CONSTRUCTION NOTES 60'MIN 5'MIN to CDS= >5 %,10'- 4 %,25'- 3 %,30'- 2 %,35' -1 %,100' - <1% DESIGN DATA: PERC & DEEP RESULTS to CD discharge /100'with 182 cons day discharge 2' CONTOURS EXISTING & PROPOSED SEPTIC TANK DRIVEWAY & SLOPES, CUT F-71 ]0' FROM FOUNDATION; 50' TO WELL FOOTING /GUTTER/CURTAIN DRAINS I WELL SOIL TYPE BOUNDARIES DIMENSIONS TO PROPERTY LINE TITLE BLOCK; OWNERS NAME,ADDRESS LOCATION OF SERVICE CONNECTION TM #,PE/RA; NAME,ADDRESS,PHONE# -DATE OF DRAWING/REVISION FTIDATUM REFERENCE LOCATION OF WATERCOURSES, PONDS LAKES AND WETLANDS WITHIN 200 FEET PROPOSED FIMSH FLOOR AND BASEMENT EL. COMMENTS: PiJIY- aCRYIT Y DE<' =AMT OF i3ZUM-T DmSICIN or :_zTvm=4a= S��Tg SaRVT= APPENDSX I DFS ': ►J L. A �Si�r." - -:—L SUr3C:: SL:1AGL DISr.rZL S1STal, F= Owrze SR!> AQtI /S /T /onI Go�2�° Accress' I'9,*^41ea e, &. Ay 3. Z O 2 %0605 T_zc:a ed at (S t eet) &J B1cck > Lot (indicate nearest czoss s-"-e--:t) i�.uniFali ty P�SoN Watershed GROT/JN MIL PERCOLATION TEST DATA P-rQU= M BE SMAa= .'17. APPLIC -TICOS 1-07-� Data of Pre-Seaking I:ate of Percolation Test HOZ�E Nts'�?EZ �CL17� TIME PC�I PCOIATICY Run Elapse Depth to .Water Frcu Water. Level. 1 � . . No _ Time Ground Surface. In Inches ' Soil Rate ,.; . Start -Stop Min. Star": Stop Drop In Min/In Drcp Inches Inches Inches - „ NO' S ; 1. Tests to be repeated at same depth until apprmdmatety equal soil rates . are • obtained .at each percolation test hole.: 'All data to' be sutmi.tte3 for reviee,a. Z. Depth xzzz =gmntsM1 to be made frcn trop of hole. rev. 9/85 1 � . 2 NO' S ; 1. Tests to be repeated at same depth until apprmdmatety equal soil rates . are • obtained .at each percolation test hole.: 'All data to' be sutmi.tte3 for reviee,a. Z. Depth xzzz =gmntsM1 to be made frcn trop of hole. rev. 9/85 G.L- TEST PIT DATA R M-U= TO BE SU&4I= WI'I'Fi UPLICATI01\1 DrSCR=IOt. r,. SOILS ENCOLJNZ'ERI:D IN TEST HO- . HOLE M. �_ HOLE M. HOLE NO. 21 Y 3' 40,4V,v saiv0 - 4' Lo Gdt/� 6' �?�K, M,V :5�.v2 7' n i 8' y' 10' • 11' . 12' 14' INDICATE LE IM AT WHICH GR=, -U = IS Ti=UN=%M . INDICATE LEVEL. TO WHICH WA= Lr Vm RISES AFTER BEING M=UNT= DEEP HOLE OBSERVATIONS MADE BY: /j. DATE: DESIGN Soil Rate Used Min /l" Drop: S.D. Usable Area Provided No-. of Bedroans Septic Tank Capacity U gals _ Type Absorption Area Provided By dad L.F. x 24" width trench Other ' Name � W SGo7T - N,-1N0, .gna Address 387/ �oUr-� . b SEAL . . co �0.05 A� THIS SPACE FOR USE BY HF-UTH DEPALMMTI ONLY: , Soil Rate Approved sq: f t /gal.. ' Checked by Date P. W. SCOTT 1 tigineering & Architecture, P.C. 3871 Route 6 BREWSTER, NY 10509 E -Mail: pws @bestweb.net (9� 278 -2110 FAX (914) 278 -2166 TO Pitnam County Dept. of Health 4 Geneva Road Brewster, New York 10509 FU 44EK� @[F 4 ° l@ W, O4cMd OA�� I JOB NO. ATTENTI N RE: i4 hl -L��� 5CFr 7 CS /_0 7- # � `— �0 Drawings WE ARE S EIIDING YOU )1 Attached ❑ Under separate cover via _ G Shop drawings )9L Prints ❑ Plans G Copy of letter ❑ Change order ❑ the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION 3 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 I��L� /� for the amount of $ 3(b0 THESE ARETRANSMITTED as checked below: ❑ For approval • For your use • As requested For review and comment ❑ FOR BIDS DUE REMARKS COPY 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: n'ily nnf 97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: Lot # Dorset Hollow Builders 15 West Hollow Road Brewster, New York 10509 2. Name of project: van Cleef Estates 3. Location TN: Patterson 4. Design Professional: Peder W. Scott, P.E. , R.5. Address: 3871 Route 6 6. Drainage Basin: _ . 8g,-yjc,* 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)? Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... No 10. 'Has DEIS been completed and found acceptable by Lead Agency? ............... N/A 11. Name of Lead Agency Town of Patterson Planning Board 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances ................. .............................. .......................................... Yes X 13. If so, have plans been submitted to such authorities? ........ ............................... Yes- Subdivision 14. Has preliminary approval been granted by such authorities? Yes Date gfanted: 1998 15. Type of Sewage Treatment System Discharge ................. surface water X groundwater 16. If surface water discharge, what is the stream class designation? .................... N/A 17. Waters index number (surface) ................................. N/A .......... ............................... 18. Is project located near a public water supply system? ....... .......................:....... Yes erviced 19. If yes, name of water supply Town of Patterson Distance to water supply by system 20. Is project site near a public sewage collection or treatment system? ................ No 21. Name of sewage system Individual Lots Distance to sewage system ._ 22. Date test holes observed 11 23. Name of Health Inspector tn, % z/,o z.,,L� 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 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? ............... Indiv........... idual ............... Lo.t ..... ............................... No Agent for Applicant Has application been made to Town or Local DEC office? ............................... N/A 30. Does project require a DEC Stream Disturbance Permit? .. ............................... No 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No No 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No No DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ................... . Yes 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ........................ ........ ............................... Water .Only 35. Are any sewage treatment areas in excess of 15% slope? .................................. No 36. Tax Map ID Number .................Pending Map Block Lot 37. Approved plans are to be returned to ..... Applicant x Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Sectioi(W0. ,A5 of the Penal Law. SIGNATURES & OFFICIAL TITLES: 0 Mailing Address: ................................... Brewster, New York 10509 i j Peder W. Scott Agent for Applicant 3871 Route 6 LS :G Brewster, New York 10509 14.164 (2187) —Text 12 PROJECT I.D. NUMBER 617.21 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) -SEAR 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 # '2 5. IS PROPOSED ACTION: O New ❑ Expansion ❑ Modificationlalteration 6. DESCRIBE PROJECT BRIEFLY: Co`ristruction single lot septic - Connection .to public watersup.ply. 7. AMOUNT OF LAND AFFECTED: G� A 0 1 Initially s0 1 acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? 13Yes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? r Lis 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 it. 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 /PCDCH 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes (3 No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE .. P W Scott, P. E. 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 OVER 1 PART 11— 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-C1-05? Explain briefly. C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly PART 111 - 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 supportrng this determination: Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Title o Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (I if Brent rom responsi e officer) Date 2 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 .TN Patterson Tax Map n 3.2 0 Block 2 Lot a Subdivision of Vancleef Subdivision.Lot #. o"Z�/ Filed Map_ #. -. 2..771 Date.Filed 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. -- t YOs' Peder W. Scott + Countersigned: Sign 3 f P.E., R.A., # 0 346 ( �.ner o rope Dorset Hollow Builders Mailing Address 3 8 7 1 Route 6 Mailing Address: G> e s Holler; Rd s— Brewster, Brewster, NY 10509 State New York Zip. 10509 State Zip Telephone: ( 914 ) 278-2110 Telephone: ( 9 14 ) 2 7 9 — 13 3 9. Form LA-97