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HomeMy WebLinkAbout0142DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631 - 589 -8100 3.20 -2 -91 BOX 2 ,. 1a1. y NO MEN I IN so am I IN 00142 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPPLIANCE FOR TMENT SYSTEM PCHD CONSTRUCTION PERMIT it P' -Z�—`t ~ - �-`/- Located at 1.1-5 J \ L-1- CO ( ) R:"\ Town or Village Q 11��pN Owner /Applicant Name '00'—SFA MUM 9U 1i3O Tax Map Block ? Lot Formerly Subdivision Name Subd. Lot # Mailing Address Zip Date Construction Permit Issued by PCHD 1 r Separate Sewerage System built by Address Consisting of V293 Gallon Septic Tank and 5©O LF, ABSQ(z.P1- n/V Other Requirements: ti eJ r K Q— Water Supply: Public Supply From PA 0,(V � C,� N, Address � A l A'P CZS:QN �� 1 or: Private Supply Drilled by Address Building Type Has erosion control been completed? 1 F S Number of Bedrooms 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 regulatioAs of the Putnam CountylDepartment of Health. Date: Certified by P.E. �4, R.A. Address �� 22 S U 1 O Desi Professional) A y �0 License # �j ( 4 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 revoc tion, modifica ion or change is necessary. By: & Title: ' Date: 7 White copy - 4file7 .Y llow copy - Building Inspector; Pink copy wner; Orange copy - Design Professional Form CC -97 DIMENSION CHART (in feet) I Number t 2 3 4 5 g 10 12 13 14 15 l l� 1� I°I 20 21 22 A 32,5' 45, 60's, 56.9 (92 (99, -14' 1q.5, q 1' �4 IOV 106,5' 1 12.5' 6 1S,5' -39.5 % .4 4' 1 � ,5' 55` (91' (07' . 7z, -� 7.5' S3 5' S t' Coo' (0(0' 71' -1 S,5' '(91 S' Vo ,s % X13' 97,5' 0 TY DISPOSAL LTED ON THIS 'ECTED BY ME CORDANCE 1ATIONS OF NEW YORK =F COLLANS s� `�d 6 0 d iii L 3 - i ° j o v- 25 Rrtne Division Approved . app.l i zabl P team Col i 5ignaturt Harr" W.-Ni'ehols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 Telephone (845) 279 -4003 Fax (845) 279 -4567 July 3, 2001 Robert Morris, P.E. Putnam County Health Department One Geneva Road Brewster, NY 10509 Re: Individual SSTS Compliance Van Cleef Subdivision Lot #28 15 Jill Court . Patterson, NY 12563 T.M. #3.20 -2 -91 Dear Robert: Enclosed are the following: 1. Five (5) prints of Drawing S -28, "As -Built Plan," dated 7/2/01. 2.' "Certificate of Construction Compliance for Sewage Treatment System," dated 7 -3 -01. 3. Three (3) copies of "Guarantee of Subsurface Sewage Treatment System," dated 6/06/01. 4. Laboratory Report, dated 4/05/01. 5. Application Fee in the amount of $200.00 payable to Putnam County Health Department. 6. "E -911 Address Verification Form," dated 4/20/01. If there are any questions concerning the enclosed, please call. Very truly yours, Hairy W. Nichols Jr., P.E. HWN:JM:jm 01- 026.28 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'"Ioterveod6n-(914) 278'- 6014 Preschool (914) 278.6082 Fax (914) 278- 6648 OWNERS NAME: 10" -=T TAX MAP NUMBER: t 2, 6m Cj�tF- i.c y;) E911 ADDRESS: JILL UUR;I TOWN: AUTHORIZED TOWN OFFICIAL- : (Signature) _ DATE: 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 VERFRM) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM zco-SF -� t�o�I,o w Q u l✓QE�s "� 20 -- 2 --- �� Owner or Purchaser of Building Tax Map Block Lot Oo�SE� r��L1,ow �� rLbE�S Building Constructed by Location - Street c2,Es \OE N \ �L Building Type P K� � N _. TownNillage -VAN Cr_,J �- 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 the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the oc up t of the building utilizing the system. OO�s�T \\ou oW C3UrL-lbE�s Corporation Name (if corporation) Signature: Title: C)W N �(Z p02SI�_ \ 00 _ n Vet � U \L-16 Corporation Name (if corporation) Address: 6 W EST a0 },LO \1 ZO. Address: VS `NEST 1�o�LOW �D, d�E W�E� State Zip State N Zip�0�0°1 Form GS -97 NE NORTHEAST LABORATORY OF DANBURY 39 MILL PLAIN ROAD - DANBURY, CT 06811 CT Cert: PH -0404 LASS (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 LABORATORY REPORT REPORT TO: MR. ALLAN FINN 15 WEST HOLLOW ROAD BREWSTER, N.Y. 10509 SAMPLE SITE: SAMPLING POINT: SOURCE: TREATMENT: TEST PERFORMED BACTERIAL: DATE SAMPLE COLLECTED: TIl1vIE COLLECTED: COLLECTED BY: DATE RECEIVED @ LAB: TESTED BY: LAB I.D. #: REPORT DATE: 4/3/2001 NOT STATED A. FINN 4/3/2001 LAB #11471 APR -09 4/5/2001 DORSET HOLLOW ESTATES, LOT #28, PATTERSON, N.Y. KITCHEN TAP MUNICIPAL NONE RESULT: METHOD # MAXIMIUM CONTAMINANT LEVEL (MCL) Total Coliform (Bacteria) 0 per 100 ml SM 9222B 0 per 100 ml CHEMISTRY: Chlorine Residual ND mg/L - - - - -- ml = milliliter mg/L = milligrams per Liter ND = none detected TNTC= Too Numerous To Count COMMENTS: - Holding Times (were) met. RESULTS BASED ON SAMPLES SUBMITTED: 4/3/2001 SAMPLE, AS TESTED ABOVE: MPOTABLE or CINOT POTABLE (PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) Laboratory Director *NO BEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 PUTNA 1 COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONIMEN TAL HEALTH SERVICES a" FINAL SITE INSPECTION Date: 0 Inspecte y: !g:& Tz Street Location T& L GT Owner y gozze!)w ByiLD ,lac Town Permit # TM # 3 . a.. o -- a — `7/ Subdivision Lot # $ 1. Sewage Svstein Area a. STS area located as per approved plans ........................... b. Fill section -.date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................... ..................:............ d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course /wetlands9T­*­­­*­­­*'- b. II. Sewage System a. Septic t size - 1,000 ..... ...other ............... Septic tank installed level ............................................... c. 10' minimum from foundation ........................................... d. Distribution Box 1. All out ets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set ........... ............................... f. rt en cches r I. Length required 14 DO Length installed/,ago 2. Distance to watercourse measured%Ylo0 Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 -1/32" /foot ............. 5. 10 ft. from property line - 20 ft: foundations.......... 6. Depth of trench <30 inches from surface ........ :......... 7. Room allowed for expansion, 100% ......................... 8. Size of gravel 3/4 -1'/2" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped ........................ ............................... g. Pub or Dosed Systems 1. Size ot pump c am er ................ ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visual / audio .................... ............................... 4. Pump easily accessible, manhole to grade ................. 5. First box baffled. :.......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. HouseMuildin a. house located per approved plans ... ............................... b. Number of bedrooms ....................... ............................... . IV. Well a. Well located as per approved plans . ............................... b. Distance from STS area measured ft........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted ................... ............................... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain &standpipes installed according to plan.. f. Curtain drain outfall protected & dir.to exist watercoursf g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... .................... ....:....... i. Erosinn rnntrnl nrovided ---------------- -------------- - ----------- - - - - -- AUG -02 -2001 11:34 AM HARRY W NICHOLS 914 279 4567 P_01 c 1-0 Z(oL Ze PUTNAM COUNTY DEPARTWMNT OY UALTR DIMON oX l.NVMONMEnAL 93AT,TE URVICES - ATTENUON ❑ ADAM ENE . R A.r1t iR CT FAA F1N��SPlQrt Far:. F•ill..,. All informadon mot be My completed prior to nay Treocbm k: . inspudoas being made. PCED CoguyuW1 P it ' 1"•e i.J�r S 0r Locaed. OwaerlAppQcnt Nye: a T o $lock . Lot I $abdivision Nana: L SaW%isioa Lot # Is system U completed'? Date: `• Is syrtem GOMAete? �.._„_ ".� { Date: Is eyslem con&Wdc0d•as per p IS we11 drilled? Date- is wch located " pot plans? Are emsioa conttol measttras im p1aCe? I ca* that the syg m(s), is U4 at the above pmnises has been eom eased and I bane inspected Ltd verMed their completion In eaamtducs with the lived PCHD CouMWoa permit sad approved plans and the Standards, Ults and Regulations of thelutmm Couaty Deputment of Health Due: �1 d� CuMadby: f'B ✓.ltA Deti Professional Address's , . 8 r�.Ws`�- �y ` ue. a '� -�'9`• camvawc Form nR" d ol BRUCE R. FOLEY Public Health Director August 8, 2001 DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845)278-6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 - Fax (845) 228 - 6113 Harry Nichols, PE Patterson Park, Suite 106 2050 Route 22 Brewster, New York 10509 Re: Field Inspection - Dorset Hollow Builders 15 Jill Court, (T) Patterson Lot # 28, TM# 3.20 -2 -91 Dear Mr. Nichols: The above referenced separate sewage treatment system can be backfilled. The following comments must be corrected in the field: No comments. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. Very truly yours, Gene D. Reed GDR:cj Environmental Health Engineering Aide PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CDNSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM p '— Q �t�prove�l 1h l t l f PERMIT # L— I� Located at K J i 1_. („ — CO VE ZT Town or Village Patel ism or dav Lot �srcrr Z0 Block -)_ Subdivision name Subd. Lot # �� Tax Ma p -)— F,Zrrvwe yy ail U� 6sccffts Date Subdivision ApproQ 1 � �& Renewal Revision Owner /Applicant Name OR e: Wlml� 13;+,,,; (de Date of Previous Approval V, ( Ca(l p(e:d +' Mailing Address L-j('Sy g')lL�V Rna , ajetv-W . /Y% Zip a �� Amount of Fee Enclosed NIA Building Type Lot Area 2- JA No. of Bedrooms L' Design Flow GPD go 0 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of f/ 1-1,Jd S .too Other Requirements: D gallon septic tank and fD &VS & f0 Lf (-o To be constructed by NKe- , z 1, jn,,,j Rwj1&j-< Address W est, f I t 'PU . 4re4aPF.r .NY, WaterSunnly: T � Feet vs, Public Supply From bt/�nte Ts-rr; Ct- Address or: Private Supply Drilled by Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately followin of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repa reto. Signed: Address P.E. R.A. Date 2413 /Z)SO License # S � APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified whe co idered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. p oved f ischarge of domestic sanitary sewage only. By: Title: Date: -,� , a White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 (845) 278 -2110 FAX (845) 278 -2166 TO �roAA,1-\ ca r-r1 Cwt -4. 4c!� a� Dec& WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via ❑ Shop drawings ❑ Prints Plans ❑ Copy of letter ❑ Change order ❑ DATE t t�C ` O JOB NO. ATTENTION P. W. SCOTT ba Engineering & Architecture, P.C. 3871 Route 6 BREWSTER, NY 10509 E -Mail: pws @bestweb.net (845) 278 -2110 FAX (845) 278 -2166 TO �roAA,1-\ ca r-r1 Cwt -4. 4c!� a� Dec& WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via ❑ Shop drawings ❑ Prints Plans ❑ Copy of letter ❑ Change order ❑ DATE t t�C ` O JOB NO. ATTENTION RE: ba the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION -A M THESE ARE TRANSMITTED as checked below: For approval ❑. For your use =4` ❑ 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: �.__4�! "G If enclosures are not as noted, kindly notify us at once. a. { Shcet_of�_ . * _P.UTNAM COUNTY DEPARTMENT OF HEALTH , DIVISION Or ENVIRONMENTAL HEATLFI SERVICES. - Name and Title 4b T' VPF - F FACILITY _ Y�I L L r�;� T7 /-,o 93 I-`ackn TFT _ Signature and Title _ e receipt of this report:: S.I'GNATURE; 2 %96 Title, ,f �.- FINDINGS. , r I-`ackn TFT _ Signature and Title _ e receipt of this report:: S.I'GNATURE; 2 %96 Title, ,f PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Ib 2:gC--t tkot i oi�p Address Located at (Street) 15 Ji LJ— COyi(L I Tax Map 3.7-o Block 2 Lot 9_ (indicate nearest cross street) Municipality pAgj-p-y2._So j Drainage Basin CA---5T- !t? yzA, 3 c, _4 egznj7!� 0-4 UEYZ � rC �Fhti, `r to 4 [ ( f 4cka SOIL PERCOLATION TEST DATA Date of Pre - soaking Date of Percolation Test S�aS�o Hole No. Run No..- Time Start - Stop Elapse Time (Min.) De th to Water From Ground Surface (Inches) Start Stop Water Level Dro In Inches Percolation Rate MinlInch 1 1 for a u /O /si4 /FS' %Z. 3 3.3 3 o2t3 2z3 /D f5-%4 /01. 3 3.33 3 ass 2- 3r /n /g- /� 3 3.33 .4 23T 3o2- S% 2 1 �2"e 01,27 ) 15-" 18 " � • �� 12- 239 1%Z 15%� IaY 3/ 3.53 3 I Z "Z- 25-L 1 10 IS" 8" I 3.33 4 1 "' 10 S %Z" (� %i 3 3.33 s 13-4 3�� �� �s„ 18„ 1 3 3.33 1 I 1 4 0: 5 1 �� NOTES- 1. Tests to be repeated at same depth until approximately equal percolation at each percolation test'hole. (i.e. _< 1 min for I -30 min/inch, <_ 2 min for 31 -60 min/inc) ill data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 BRUCE R. FOLEY Public Health Director June 20, 2001 DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 Harry Nichols, PE Patterson Park, Suite 106 2050 Route 22 Brewster, New York 10509 Re: Field Inspection - Mahopac Group, LLC Hayley Hill Drive, (T) Carmel Lot # 25, TM# 66.17 -1 -55 Dear Mr. Nichols: The following comments must be corrected in the field: 1. A reinspection of the fill pad at the above mentioned lot finds the pad to be of sufficient size and depth. Trench plans need to be submitted to this office for final approval. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. GDR: cj ��I Ha li � D1 Very truly yours, Gene D. Reed Environmental Health Engineering Aide 0 Wr _. 4.1 0, of* 42-310 / 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 DATE JOB NO. v ATTENTIO RE: WE ARE SENDING YOU Attached ❑ Under separate cover via T W S the following items: • Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications • Copy of letter ❑ Change order ❑ COPIES ❑ DATE ❑ NO. ❑ DESCRIPTION ❑ For review and comment ❑ FORBIDS DUE r THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ 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: nd /v not E1 "1 �Wf#lam !Hive 11111x■ 1m1111■ 11111 MINE 111111 as 1111tf 1�1�11■ ! #111 a tlllla !1111i111�i�►f�111 � �N111111i11t 1 lilies MINES! 11111 111 go 11i11i���I111i a1�11N1iIl1N1i■ 11t111��1111111a��111111a lllliislmIl!!111 am111ion 1lillismakiliilii imlliiiim 11Ntlia��;111111�a�t1111a■ 1111 iaa��1�1��1���11lllia lliili��r1lN11���� #1111i� 1tlltl�i�l i11i��� #1ii1l� fllllaam =1 N111a7 Villas Iliiiin�ililii■i� 1!111!■ 111111�i�11111i��►�i��ll #■ 41i11i���1i1N1i�r�1,� 1111■ Ii111i���1111ti��S�1111ii= �. �..,.... �....� �- ter...- .��.. 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SCOTT email pws@bestweb.net ENGINEERING & ARCHITECTURE, P.C. 3871 ROUTE 8 1845! 278-2110 BREWSTER, NY 10509 FAX 18451278.2165 F" TRANSMITTAL. PROJECT: TO: �- t TO: FAX: a-`7 FAX: TO: TO: FAX: FAX: NO OF PAGES INCL. TRAMWITTAR: o -- DATE. SJ I Q 0 FROM. P S' �- S /h Al V I f kwi Please call 845 -278 -2110 if this transmission is illegible or unclear 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 .Set-vices Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 April 20, 2001 Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 Peder Scott, PE PW Scott Engineering 3871 Route 6 Brewster, New York 10509 Re: Field Inspection - Dorset Hollow Builders 15 Jill Court, (T) Patterson Lot # 28, TM# 3.2 -2 -91 Dear Mr. Scott: Inspection of the fill pad is complete. The following comments must be corrected in the field: • Four (4) trees are within the fill pad. All trees within 10 feet of the toe of fill on fill pads greater than 2 feet in depth shall be removed. It appears it may be beneficial to redesign the system to save trees. Be advised that trees within the 100% expansion area can be welled. Furthermore a letter from the owner may be submitted to this Department explaining that the owner accepts all responsibility for any damage to the separate sewage treatment system caused by the trees. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. Very truly yours, Gene D. Reed GDR:cj Environmental Health Engineering Aide -Sheet of ' * * _ PUTNAM COUNTY DEPARTMENT OF HEALTH y .� .. DIVISION.OF -ENVIRONMENTAL- HEATLH SERVICES FIELD ACTIVITY REPORT r. s -N A MF.: 120 40- fib 0[ 6,04./. SW4 TPI; : A4 FS�e Street Town ,State Zip PERSON IN CHARGE ` -._ nR° TNTAR VTFWFt) �_/ 9Ti0( P Name and Title = TYPE' -OF FACII,ITY F %G� P14- F:l NDINGS.. ' , f I 7 r Cle 3 Jae IZ-Ay s w r - n Signatare'and Title °RFPCi.R.T l2 °F'C'F.TVFT) RY2 x T acknowledge receipt 4f this report SIGNAT.URE,• 02 / 9 6 Title _ R av Cb BRUCE R. FOLEY Public Health Director A DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 April 20, 2001 Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 Peder Scott, PE PW Scott Engineering 3871 Route 6 Brewster, New York 10509• Re: Field Inspection - Dorset Hollow Builders 15 Jill Court, (T) Patterson Lot # 28, TM# 3.2 -2 -91 Dear Mr. Scott: Inspection.of the fill pad is complete. The following comments must be corrected in the field: • Four (4) trees are within the fill pad. All trees within 10 feet of the toe of fill on fill pads greater than 2 feet 'in depth shall be removed. It appears it may be beneficial to redesign the system to save trees. Be advised that trees within the 100% expansion area can be welled. Furthermore a letter from the owner maybe submitted to this Department explaining that the owner accepts all responsibility for any damage to the separate sewage treatment system caused by the trees. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. Very truly yours, A., Gene D. Reed GDR :cj Environmental Health Engineering Aide 04/18/01 15,54 PW SCOTT � 19142787921 NO.110 002 Pi 7NANI COUNTY DEPARTivIENT OF HEALTH DIVISION OF ENVIRONi•IENTAL HEALTH SERVICES REQUEST FOR FIN A L INSPECTION For: Fill Trenches PCHD Construction Pixmit # �s Located ` . J- t i_ e.. 2 _ O(V) MM90—A) Q Owner /Applicant ivan.e TMq, 2.• Block Z Lot [ FormerlyVAQ C 2,f ek` .J _Subdivision Name—D2f.Z4L k ) M .1' Subdivision Lot # 8 Is system fill complet!:d? Date Is system complete ?_ Date Is system constructed as per plans? _ Is well drilled? _ Date Is well located as per Glans? Are erosion control rr easures in place? I certify that the syste m(s), as listed, at the above premises has been constructed and I have inspected and verifiec l their completion in accordance with the issued PCHD Construction Permit and approved plans a A the Standards, Rules and Regulations of the Putnam County Department of Health. Date: 'd Ce PE XA e q Design Professional Address 6VWS4e L Pt tC� 1 Lie. # "s 3 (� Comments: U, oiLq FOR: 0 ADAM XGIENE Form FIR -99 04/18/01 15:54 PW SCOTT 4 19142787921 NO. 110 001 INP.w_ SCOTT email pwsQbesbNeb.net ENGINEERING & ARCHITECTURE, P.C. 3871 ROUTE 6 (845) 278.2110 BREWSTER, NY 10509 FAX (845) 278 -2166 FAX TRANSMITTAL PROJECT: TO: r� TO: FAX: 2 �'" �] Z I FAX: TO: TO: FAX: FAX: NO OF PAGES INCL. TRAN 3MITTAL: DATE. q X j FROM PA16- o Commonts: 1 ! Please (all 845 -278 -2110 if this transmission is illegible or unclear t � , Z' ,, '/ YO, ';L is Ol j Q •.. I . .4. BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 April 30,200 1 Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 Peder Scott, PE PW Scott Engineering 3871 Route 6 Brewster, New York 10509 Re: Field Inspection - Dorset Hollow Builders 15 Jill Court, (T) Patterson Lot # 28, TM# 3.2 -2 -91 Dear Mr. Scott: The following comments must be corrected in the field: • This is a follow up letter to inform you that a secondary sieve test has been performed on the above referenced project. As stated in my previous letter dated April 24, 2001 no more than 10% by weight of fill material should pass a. #100 sieve. 44.9% passed a #100 sieve from the first sample collected at this site. The secondary sieve test results are 19.4% passing a #100 sieve. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261 GDR:cj Very truly yours, /4 e'h-Q- Gene D. Reed Environmental Health Engineering Aide 1 i- 5 J _ F 4 r BRUCE R. FOLEY Public Health Director April 24, 2001 LORETTA MOLINARI R.N.; M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing services (845) 278 - 6.558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 Peder Scott, PE PW Scott Engineering 3871 Route 6 Brewster, New York 10509 Dear Mr. Scott: r' Re: Field Inspection - Dorset Hollow Builders 15 Jill Court (T) Patterson Lot # 28, TM# 3.2 -2 -91 The following comments must be corrected in the field: • The R.O.B. fill material has failed a sieve test. No more than 10 percent by weight of the fill material should pass a # 100 sieve. 44.9% passed a # 100 sieve from the sample collected at this site. A secondary sample will be collected and tested to confirm this test and the results will be sent to you. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. Very truly yours, .,TN Gene D. Reed GDR:cj Environmental Health Engineering Aide i 0 r PUTNAM COUNTY DEPARTMENT OF HEALTH -� DIVISION OF ENVIRONMENTAL HEALTH SERVICES lr CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at Subdivision name v a n c l e e f Town or Village Patterson Subd. Lot # 96 Tax Map 3 .2 0 Block 2 Lot W q r Date Subdivision Approved I I q A Renewal Revision Owner /Applicant Name pcie_5 e- t4eti_,o,LJ 6 ci/c.buyzs Date of Previous Approval Mailing Address aAA-7 J Tzy �v �ip 05-0 Amount of Fee Enclosed $ 3 0 0.0 0 Building Type R e s i d e n c e Lot Area I Ac-No. of Bedrooms 4 Design Flow GPD BOCK Fill Section Only Depth P Volume liQf PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of /c �QQ gallon septic tank and lod&iJ5 d�1 Z off" t,rC�G� �c» J–F A0-10070 R SOWI& wlm A piLL Df� Other Requirements: Tobeconstructedbynorset Hollow Builders Address 15 West Hollow Rd., Brewster, NY Town of Patterson Water. Sunnly: Public Supply From Water District Address or: Private Supply Drilled by Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said 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 repair ereto. Signed: P.E. X R.A. Date Address 871 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 ?nconsider# necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe It pprov for discharge of domestic sanitary sewage only. By: Title : Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional __ 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 3871 Route 6 Brewster, NY 10509 Re: Dorset Hollow Builders Jill Court, Lot 28 (T) Patterson TM #3.20 -2 -91 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 incorrect address is noted on the permit application. 2. The design data sheet has not been signed or sealed by the design professional. (Enclosed) 3. Form PC -97 notes the incorrect drainage basin. 4. Trench lengths are noted as 55 feet each in the plan view, however, the trenches scale and are noted as 50 feet in length in the SSDS design data. 5. Fill is to extend 20 feet horizontally past the edge of the trench and then slope 3:1 to grade. Please check expansion trenches 1, 2, 3 and 4. Revise accordingly. 6. Please submit the minimum of two additional fill plans. Upon receipt of a submission, revised to reflect the above, this application will be considered further. RM/jp V truly yo , 'W' �" " Robert Morris, P. E. Public Health Engineer G� - 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) 27 ct6 8 8ober 18, 1999 PW Scott Engineering 3871 Route 6 Brewster, NY 10509 Re: Dorset Hollow Builders Jill Court, Lot 28 (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 13, 1999 is complete. The Department will notify you by December 1, 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 truly yours, Robert Morris Sr. Public Health Engineer SR/jp 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, New York 10509 WE ARE SENDING YOU V Attached ❑ Under separate cover via ❑ Shop drawings 19- Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ OA�40 JOB NO. ATTENTI N RE: f4�j T #� cPS Drawings ❑ Samples the following items: ❑ 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 for the amount of $ 3v0 THESE ARE.TRANSMITTED as checked below: • For approval • For your use • As requested fA For review and comment ❑ FOR BIDS DUE REMARKS '9PY TO ❑ Approved as submitted ❑ Approved as noted ❑ Returned for corrections ❑ Resubmit ❑ Submit- 0 Return _ _.copies for approval -copies for distribution corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US If enclosures are not as noted. kind/v notity us at once_ 97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RI: Property of Dorset Hollow Builders Located at Vancleef Estates, Route 311 & Cornwall Hill Road '1N Patterson Tax Map # 3.2 0 Block 2 Lot Subdivision of V an c 1 e e f Subdivision Lot #. '�Is Filed Map - #- X771 Date.Filed_..l 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 permits) to serve the above -noted property in kcordance 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 PublicHealth Law, and the Putnam County Sanitary Code. Very t ly yo rs, Peder W. Scott Countersigned: Signed: P.E., R.A., # 0 5 9 3 4 6 (Owner of Prope Dorset H llow Builders Mailing Address 3 s 7 1 Route 6 Mailing Address: Brewster, Brewster, NY 10509 State New York Zip 10509 State Zip Telephone: ( 9 14 ) 278-2 1 10 Telephone: (9 14) 279-1339 Form LA -97 14 -16.4 (2ff)—Text 12 PROJEI- I.D. NUMBER 617.21 -SEAR Appendix C. State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART i- PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPJCANT /SPONSOR PROECT NAME T)o_set Hollow Builders FVaJncleef Estates 3. PRO ECT LOCATION: kunicipality Patterson County Putnam 4. PREISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) Vzncleef Subdivision - Access from Route 3111 Cornwall Hill Road Fer Lot # 5. IS P--3J0dPOSED ACTION: �� +_New ❑ Expansion ❑ Modification /alteration 6. DES;RIBE PROJECT BRIEFLY: Co>:istructionsingle lot septic - Connection .to public water supply. 7. AMOUNT OF LAND AFFECTED: e� Initially �a� acres Ultimately acres 8. WIL! PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ayes ❑ 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? C@ 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 13No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE P.W. Scott, P.E., R.A. - D Applicant/sponsor name: Date: Signature: M If the action is in the Coastal Area, and you .are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 PART II— ENVIRONMENTAL ASSESSMENT (To be completed by agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? if No, a negative declaration may be superseded by another involved agency. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, of other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly. C5. Growth, subsequent development, or related activities likely to be Induced by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not identified in-Cl-05? Explain briefly. C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (aj setting (i.e. urban or rural); (b) probability of occurring, (c) duration; (d) Irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ❑ - Check. this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supportl.ng this determination: Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency 1 Name of Lead Agency 2 Title of Responsi e O icer Signature of Preparer (If different from responsible officer) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT STREET LOCATION - NAME OF OWNER REVIEWED BY RM, GR, AS, MB, BH DATE TAX MAP # Y DOCUMENTS a� A� APPLICATION cif PERMIT PWS LETTER R- OF-A UT IIZATION N DATA SHEET (DDS) EAF - THREE SETS PLANS - TWO SETS VCE REQUEST FEE SUBDIVISION LEGAL SUBDIVISION SUBDIVISION APPROVAL CHECKED PERC RATE //—?/ FILL REQUIRED ' F DEPTH CURTAIN DRAIN REQUIRED 3; TANDPIPES t f ROSION CONTROL:HOUSE,WELL, SSDS . PERC & DEEP HOLES LOCATED REPRESENTATIVE OF PRIMARY & EXPANSION LOCATION MAP AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE IF PUMPED, PIT & D BOX SHOWN & DETAILED / AHOUSE - NO.OF BEDROOMS WELLS & SSDS'S W/1N 200' OF PROPOSED SYS. PROPERTY METES & BOUNDS OUSE SETBACK NECESSARY (TIGHT LOT) HOUSE SEWER - 1/4" FT. 4 "0; TYPE PIPE NO BENDS; MAX.BENDS 45° W /CLEANOUT FILL SYSTEMS CLAY BARRIER 10- FT. HORIZONTAL;SLOPE 3:1 TO GRADE FILL SPECS FILL NOTES FILL CERTIFICATION NOTE DEPTH GAUGES GENERAL FILL PROFILE & DIMENSIONS LOCATED IN NYC WATERSHED EWAGE SYSTEM PLAN - (NORTH ARROW) VOLUME PLANS SUBMITTED TO DEP 50' INTERMITTENT DRAINAGE COURSE FILL IN EXPANSION AREA J>ELEGATED TO PCHD TRENCH DEP APPROVAL, IF REQ'D LF TRENCH PROVIDED 60 FT MAX. J3EEP TEST HOLES OBSERVED PARALLEL TO CONTOURS PERCS TO BE WITNESSED 100% EXPANSION PROVIDED EX- APPROVAL SSDS ADJ. LOTS SEPARATION DISTANCES SPECIFIED ,WETLANDS (TOWN/DEC PERMIT REQ'D ?) ON PLAN - FROM SSTS DATA ON DDS PLANS & PERMIT SAME IYMIN to CDS= >5 %,10'- 4 %,25'- 3%,30' - 2%,35' - 1%,100' - <I% ,LO' TO P.L., DRIVEWAY, LARGE TREES, TOP OF FILL kE 1969 NEIGHBOR.NOTIFICATION O' TO FOUNDATION WALLS 15'WELL TO PL TE I/ZBA R$5001' 0' TO WELL, 200' IN DLOD, 150' PITS YR. FLO LL-.E.V� 0' TO STREAM WATERCOURSE LAKE (inc. expan) MI l;RMI (S) TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER REQUIRED DETAILS ON PLANS 10' TO WATER LINE (pits -20') EWAGE SYSTEM PLAN - (NORTH ARROW) 50' INTERMITTENT DRAINAGE COURSE SSDS HYDRAULIC PROFILE 200'/500' RESERVOIR, ETC. GALLEY SYSTEMS VITY FLOW _150' NSTRUCTIONNOTES IYMIN to CDS= >5 %,10'- 4 %,25'- 3%,30' - 2%,35' - 1%,100' - <I% DESIGN DATA: PERC & DEEP RESULTS 20'MIN to CD discharge /100'with 182 cons day discharge - CONTOURS EXISTING & PROPOSED _ SEPTIC TANK DRIVEWAY & SLOPES, CUT ®10' FROM FOUNDATION; 50' TO WELL OOTING /GUTTER/CURTAIN DRAINS WELL IL TYPE BOUNDARIES IMENSIONS TO PROPERTY LINE TITLE BLOCK; OWNERS NAME,ADDRESS 1311LOCATION OF SERVICE CONNECTION M #,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. CONINIENTS: PfCT-1 -r-u1M =0=,- DE: ar� 'I' OF Sr —=H - DIVISION -Or' s.' _..._........_ ... - -. APPENDIX T .S..'=t__ 1- =B5Jr'. � c DL xL __:, 'SYS = F =Z Dr _ owne A , +Z Cir eo{ rc r as ? n4wo tak ke - �, t t �.p6n5 ! ' P . at. (St_aet� 3� SeV_ 3, act — -C T a� 1aG�SS 13, 5l Bloc. i ..act '[ (irdi�re aeazes ` ccss s = eet) / 1 �..�. =: �! i �_r �Cc11 C'.�' S a 4!\ wzt°Ysh e� ��c� •�o �1 - sow P. i�a.T-rcy T r-Am RSA � To BE Su _W_T= .w APP=o_r"1c1Lqs �C ate cs P_'e°- Scax:ng Date of P` =Iatic . Test - 60H EOLi • :. .ELa_)se Depth to.Kater r? G,I WatO- levpl. Ti.-;� Ground Surface. Ln I.-aches ' Sc, - Rate Std -SLoo i_.Ln. Stzzt Stop Inches Inches Inches �y X019 3v a-�15- j - 2= /i0 //0' 30 _.... .��..;o- 2�t. I s ./ol 0 3 i. 0 , 1 1 2 3 gS : 1. Tests to be repeated at saute depth until apprm:imatel y equal soil rats r axe' obtained at each percolation test hole. All data to' be submi —,_ - for review. 2. Depth maa_Saremnts to be made fran top of hole. w:; cO a TEST PIT DATA REOUIl?`°:.. TO BE SUPMITTID WITH APPLICAT .7 DESCR=ION OF SOILS IIVCCiL -MMED IN TEST HOLES DEr� BOLE No. 1 Bom M. HOLE NO.. G.L. T,7 s o, L ] � S u vt� �0i Ir OC�o-1.. ="v� / 2 /Ol/+l 3' C'mc�rsc� sc.��c� "j"�3``'`'k4✓c% R 5' 6' 7' r ' 9' 10' . 11' • 12' 13' 14' INDICATE LL•'M AT TEACH GROUNa%TPTER IS EtMUNTERM - _ ............ _._............ _ .. _ INDICATE I= TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP BOLE OBSERVATIONS MADE BY: a- l M- DATE: _ DESI� vOGN Soil Rate Used 16 Min /1" Drop: S.D. Usable Area Provided No. of &edrocros Septic Tank Capacity 12 SO gals. Type ('O Absorption Area Provided By S-OP Z.F. x 24" width trench N Other Name Signature _ Address SEAL. _ THIS SPACE FOR USE BY HEALTH DEPAFMT117r ONLY: Soil Rate Approved - sq:ft /gal.' Checked by Date CF - - Div 1Sictii of .;tiiL`i 7T�. =i, 'yam,' S -7- -rte, ...._........_ ... - -. ?E�iI) — IM res s yr eo{ rc =zss -? fir" 'm;� l TK �.kAki ��u4'1 S P i2 3 �L14 a� loG �fS at. (S t eet) I' Se=•. Plcc: T e a�-�t �css s`a t) ?-,Colo inq L'Am PSCTJ D To BE r�u' -w—r'�' 3 .T=•? AP°r�LC =CATS D f P �. we Cb1 Utz cf Data of cm Test 6//3/57 - 30 h� Eorz NNUEE R C ZrLu�• P�TiC�L �`�'?C,I = C"'LtiT'rCY rlacse Depth to .Fiat~- F 'cm i.,eve1 LL. T: .� �Grcund Juriac -6. � cc,� -7 In Riches St.= Droo 1-1 inches Iris :es Inches - 3 OL ~ : :Ivor ILI -30 3 / I33 30 3 5 2 - 3 + 5 _ =: ? 2�TFS : 1. Tests to be repeated at sage depth antis appr= ja tel g soil rates _ are obtained at each p&x=lation test, hole_ ALL data to' to far review. _ 2. Depth mazurernents to be ,Wade frm tap of hole. _ =: D TEST PIT DATA REQUip TO BE SUE - .NUTTED =i'I7i APPLICAT7' T .a DrSCR=10N OF SOILS El,!= Z` -MLZLD IN TEST HOLES DII'TH HOLE NO. EOLE. W . HOLE NO. G.L. j n T ah S �...: � O\L 21 Sc_vrc1!4 LDat✓ri So -V\A! � I0,6,Vy I& -Y _<e, C4, z Oct /� - 3' C 5a��c� DPa cac:�,vl� hoc t: 41 _egr�ci\v,�. zoC De C0 tc 05117 �rYSta» 51 \ 6' r 81 10' lit INDICATE LE.'VET, AT WHICH GROUNLS Tu�T. �t IS EN=UN7 -,M _ Y INDICATE I,EVLZ M WHICH WATER LEVEL RISES AFTER BEING =UNTERM a o li' I pod S. r 5- . DES HOLE OBSERVATIONS MADE BY: � �vki7 %1/I ��/�o„� 1�F 1�I [ eit,�r3 DATE: _ DESIGN -Soil Rate Used (J Min /l" Drop: S-D. Usable Area Provided No. of Bedroans Z4 Septic Tank Capacity %Z SO gals. Type )P�- CO Absorption Area Provided By 5-00, L.F. x 24" width trench Other i Name 's LJ- Scaxu­ eiOr, ' f K, P C • signature Address I-o Jam.= CQ SEAL ��aP !1_Py'� lk 4A THIS SPACE FOR USE BY HEALTH DEPART = ONLY: - - Soil Rate Approved - sq. ft/gal .' Checked by , PUTNAIA COUNTY DEPARTMENT OF HEALTH o e 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 46_ 15 West Hollow R6ad Brewster, New York 10509 2. Name of project: Van Cleef Estates 3. LocationT/V: Patterson 4. Design Professional: Peder W. Scott, P.E. , R-5,- Address: 3871 Route 6 Ea ranc 6. Drainage Basin: Croton River Brewster, NY 10509 7. Type of Project: x . Private/Residential Apartments Office Building Food Service Institutional 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 Exempt _ Unlisted X No N/A 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? .......................................................... ........ ........................ Yes:, 13. If so, have plans been submitted to such authorities? ........ ............................... Yes— Subdivision 14. Has preliminary approval been granted by such authorities? Yes Date granted: 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 �b;3 7 23. Name of Health Inspector n, r--X oZt AJS/,/ i._i 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 offices N/A Form PC -97 27. Is any portion of this project located within a designated Town or State wetland? No 28. Wetlands ID Number ........................................................... ............................... N/A 29. Is Wetlands Permit required? Individual Lo.t 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 Na 32, Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? Yes/No No DESCRIBE: 33. Is there a local master plan on file with the Town or Village? Yes 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ....................... Water'.Only 35. Are any sewage treatment areas in excess of 15% slope? . ............................... No 36. Tax Map ID Number ................" ....................... Map 3.;-o Block o2 Lot 1 / 37. Approved plans are to be returned to ..... Applicant x Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as" a Class A misdemeanor pursuant to Section 210.45 of the P?nal Law. SIGNATURES & OFFICIAL TITLES: Mailing Address: ................................... Peder �—scott Agent for Applicant 3871 Route 6 Brewster, New York 10509 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES .J APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: Dorset Hollow Builders Lot # 9 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: JR-A % VRAk -4 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 X 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... No 10. Has DEIS been completed and found acceptable by Lead Agency? ............... N/A 11. Name of Lead Agency Town of Patterson Planning Board 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ........................................................ ................ ................ Yes: 13. If so, have plans been submitted to such authorities? ........ ............................... Yes- Subdivision 14. Has preliminary approval been granted by such authorities? Yes Date granted: 1998 15. Type of Sewage Treatment System Discharge ................. surface water X groundwater 16. If surface water discharge, what is the stream class designation? .................... N/A 17. Waters index number (surface) ........................................... ............................... N/A 18. Is project located near a public water supply system? Yes ....... ............................... serviced 19. If yes, name of water supply Town of Patterson Distance to water supply by system 20. Is project site near a public sewage collection or treatment system? ................ No 21. Name of sewage system Individual Lots Distance to sewage system 22. Date test holes observed 61 13 -7 7— 23. Name of Health Inspector M, /5V.0 i al511– 800 GPD 24. Project design flow (gallons per day) ................................. ............................... 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? Individual Lot No Has application been made to Town or Local DEC office? ............................... N/A 30. Does project require a DEC Stream Disturbance Permit? .. ........................ ........ No 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ......................I...... 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 sites ................................................ water;.only 35. Are any sewage treatment areas in excess of 15% slope? . ............................... No 36. Tax Map ID Number ..... ....................... Map 3. Block oZ 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 Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: Mailing Address: ................................... Peder W�Scott Agent for Applicant 3871 Route 6 i . �.333vrz -- Brewster, New York 10509 l'',f� 3 i r 4