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PUTNAM COUNTY, DEPARTMENT OF .HEALTH
DIVISION O F E NVIRONMENTAJ� HEALTH SERVICES
CERTIFICATE OF CONSTRUCTION COMPLIANCE TREATMENT SYSTEM
1. o n
PCHD CONSTRUCTION PERMIT # y �i - J 4
Located at � w�� raT� Town or Village UU
Owner /Applicant Name f �' Tax Map �' r�-� Block Lot I b
Formerly Subdivision Name°
Subd, Lot # 2
Mailing Address i WeST KoLLo`� �Lo n Zip 0501
Date Construction Permit Issued by PCHD
Separate Sewerage
System
built by dolt -5&1_ A0L LQ'v .
bJIV004 Address 6 ` "_r
AOLL04 Fo' W51MI'l
Consisting of
r 1,-;D
Gallon Septic Tank and 450
Lr Abe) -f ZN&B
Other Requirements: 11 rlLL
Water Supply: _ _ Public Supply From T"J" 13� 14TVkDO Address PAJJ -A2 i
or: Private Supply Drilled by Address
Building Type 415 10 NLE Has erosion'control been completed?
,;:.Dumber of Bedrooms q' Has garbage ' been installed?.
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 PCM Construction Permit and approved
plans and the standards, rules and regulations of the Putnam County, Department of Health.
Date: 0 � � � � 01` Certified by P.E. /L R.A.
,4-z � 0
(Up ProfessiRno)
Address 0 o ( y'L v� �-.
� � � i p �o I License #
Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary
to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage
treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval
of the private water supply shall become null and void when a public water supply becomes available. Such
approvals ar bject to modification or change when, in the judgment of the Public Health Director, such
revocation, od' cation change is necessary.
B �ll�ii/ Title: v Date: L
Y•
White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CC -97
e
rmnim Harry W. Nichols Jr., P.E.
Patterson Park, Suite 106
2050 Route 22
Brewster, NY 10509
Telephone (845) 2794003
Fax(845)279-4567
January 3, 2002
Robert Morris, P.E.
Putnam County Health Department
One Geneva Road
Brewster, NY 10509
RE: Individual SSTS - As -Built
Dorset Hollow, Lot #23
54 West Street
Town of Patterson
Dear Robert:
Enclosed are the following:
1. Five (5) prints of Drawing SS -23, "As Built SSTS," dated 1 -3 -02.
2. "Certificate of Construction Compliance for SSTS," dated 1 -3 -02.
3. "Guarantee of SSTS," dated 1 -3 -02.
4. Laboratory Report, dated 11- 07 -01.
5. E -911 Form.
6. Money Order for $200.00, Application Fee.
We would appreciate your review, approval and issuance of the Permit at your earliest
convenience.
Very truly yours,
r
Ha{ rry W. Nichols Jr., P.E.
HWN:his
01- 026.23
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner or Purchaser of Building Tax Map Block Lot
Building Constructed by
Location -Street
Building Type
Town/Village
001Z. 00 14oLL -OW Gsi
Subdivision Name
�2,�
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 ant of the building utilizing the
system. ,� e
Dat onth Day �� Year Signature
Owner)-:
DON55F ROLLOW DUI1, PM
Corporation Name (if corporation)
Address: Ici wcyT- goUv j APq W-6/47EP-
State N�i
Zip l ooq
Title: PP_&61P& r
POP-56T_ i+OL iOw vil.Q
Corporation Name (if corporation)
Address: i 5 vv& Ad cOw PotP 0 01EF-
State S� Zip
Form GS -97
NE
NORTHEAST LABORATORY OF DANBURY O kN ACCOgOgy
39 MILL PLAIN ROAD - DANBURY, CT 06811 CT Cert: PH -0404 �o
203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471
LABS www.NORTHEAST LABORATORIES.com a c -
LABORATORY REPORT
REPORT TO:
DORSET HOLLOW ESTATES
Attn. ALLAN J. FINN
15 WEST HOLLOW ROAD
BREWSTER, N.Y. 10509
SAMPLE SITE:
SAMPLING POINT:
SOURCE:
TREATMENT:
TEST PERFORMED
BACTERIAL:
DATE SAMPLE COLLECTED:
TIME COLLECTED:
COLLECTED BY:
DATE RECEIVED @ LAB:
TESTED BY:
LAB I.D. #:
REPORT DATE:
11/7/2001
1:30 P.M.
A. FINN
11/7/2001
LAB #11471
NOV -34
11/12/2001
DORSET HOLLOW ESTATES, LOT #23
KITCHEN TAP
WELL
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
COMMEl\ 1 OO':
- Holding Times (were) met.
RESULTS BASED ON SAMPLES SUBMITTED: 11/7/2001
SAMPLE, AS TESTED ABOVE: MOTABLE or AMNOT POTABLE
(PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER)
p.
Laboratory Director
*NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 06037• (860)828 -9787 - FAX (860)829 -1050
TOLL FREE WITHIN CT: 800 - 826 -0105 • OUTSIDE CT: 800 - 654 -1230
B§LUCE 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
Eavircumeotal Health (914) 278.6130 Fu (914) 278.7921
Nursla8 Services (914) 278.6558 WIC (914) 278.6678 Fax (914) 278.6085
Eariy'ioteeveodoa _(914) 278.6014 Preschool (914) 278-6082 Fax (914) 279% 6648
E911 ADDRESS VERIFICATION FORM
OWNERS NAME: i -Loy1 BO) LqE915 (Lo
TAX MAP NUMBER:
E911 ADDRESS:�'�
F�
TOWN: �pM
AUTHORIZED TOWN OFFICIAL:
(Signature)
DATE:
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.
CE911 VERFRM)
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PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES - -
FINAL SITE INSPECTION
Street Location _��� j- s 7-,
Town p *7r_-zsoAl
TM 9.
Date: ,2 /2;2/01
Inspected y:
Owner porzsar NOGGO�✓ %8 t/ /LD�72¢
Permit # U - f 41 -0 0
Subdivision Lot # a-3
1. Sew ale Systein Area
a. STS area located as per approved plans ...........................
b.' Fill section - date of placement
3:1 barrier Lgth. Width Avg.Dpth
c. Natural soil.not stripped ...............................................
d. Stone, brush, etc., greater than 15' from STS area..........
e. 100' from water course / wetlands ...... ...............................
II. Sewage System
a. Septic tank size - 1,000 ...: .1,25 ........other ................
b. Septic tank installed level ................ ...............................
c. 10' minimum from foundation .......... ...............................
d. Pistribution Box
1. Ail outlets at same elevation -water tested .................
2. Protected below frost .................. ...............................
1. Minimum 2 ft.Original soil between box & trenches
e. Junction Box - properly set .. ............................`Q. /
f. - renc es
. Leal required jl g,�l Length installed
2. Distance to watercourse measured + t co Ft.,.........
3. Installed according to plan ......... ...............................
4. Slope of trench acceptable 1/16 1/32 "/foot .............
5. 1-0 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 - V /�" diameter clean ....................
9. Depth of gravel in trench 12" minimum ...................
10. Pipe ends capped......... ................ ..........:....................
g. P,umn or Dosed Systems
1. Size ot pump chamber ................ ...............................
2. Overflow tank ............................. ...............................
_.._. -_3.- _Alarm, visual/audio .................... ............................... . ..
4. Pump easily accessible, manhole to grade .................
5. First box baffled ............................ ............:..........:.......
6.- Cycle witnessed by H.D.estimated flow /cyele...........
III. ouse/Buildin
a. tiouse 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 watercours
g. Footing drains discharge away from STS area ............:..
h. Surface water protection adequate... .. .........::...................
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OCT- 18_2001 04:48 PM HARRY W NICHOLS
_..., _ _ _•,_...�_,_.�._.. -- - .._... . ,....._....._ _.,_.., - _. _,_ .._.914 279 4567 P.01
PUTNAM COUNTY D&PARTit'tEn 03r ZM=
DrmioN or zxvmoN>Wi� men snm=
D L As� 3 . q•" -j
�TTZNTZtiN ADAM CE I+tE �
� enrts�r vng IW AL 1952=10 For:. Fill
All ialbriaatloa ttnaa$ be 1414Omp1eted prior to aay 7raachea g:: -
iaspa Boas being OLde,
PCHD CowuuetloA Permit ii
Loated:
OwaadAppU=t Nave: W -Block � Lot
• - - - S ..ten Name' ,....�.. .� ._.,.;......�..
Svbdivitlon Lot # fZ 3- It5
is systcw fit! caaplotav "-- Date;
b system ooaapla d -� r Date; 1611.7777
_ Is ynem consuvetad as par plans? J �...__
Is w#U drilled? ri �C °`+ }�.r..+.�r�ri VatO; _((mot Or"r%G.r......,l.__
Is wd located as por plans?
Are erosion cowsol measures in place?
I cc* that the syptem(s)i U 104 at tht above pm*mises hu boon coMucted tad 1 has Wpeeted
and Vtatd thait cotnp14011 19 accordance with the issaed PCHD Conat WOU ?Wmk and
approv,od plus and the 5taaderds, Rules and Rcgulagoas of the Putnam County Dgartmeat of
Health.
Dak: L 6 —(0 - o Certified by:
i
Address; "10 Lie.
Comoae= '
v
Form k�R -99
BRUCE R. FOLEY
Public Health Director
October 22, 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 - 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
West Street, (T) Patterson
Lot # 235 TM# 3.20 -2 -96
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.
GDR:cj
Very truly yours,
'4�e 0,
Gene D. Recd
Environmental Health Engineering Aide
1�
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
�\ l
CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM
1/ �/ o
PERWT # r r q 0 /
Locatedat 54 West Street Town or Village Patterson
Subdivision name D o r s e t Hollow E sSubd. Lot # 23
Date Subdivision Approved
1998
Owner /Applicant Name Dorset Hollow Builders
Tax Map 3. 2 0 Block 2 Lot 9 6
Renewal Revision
Date of Previous Approval
Mailing Address 15 West Hollow Road, Brewster, NY
Amount of Fee Enclosed $300.00
Building Type Res i d n e c e Lot Area . 9 2 No. of Bedrooms 4
Zip 10509
Design Flow GPD 8 0 0
Fill Section Only Depth Volume
PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED
Setarate Sewerage System to consist of
4,5 n L.LF ere ,-9- y *A,'/ l
Otlxr Requirements:
1250
gallon septic tank and
Toie constructed by Dorset Hollow Builders Address 15 West Hollow Rd., Brewster,NY
own of Patterson
W:ter Sunniv: X Public Supply From a t e r District Address
or; Private Supply Drilled by
Address
I rgresent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the
seinrate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in
acc Tdance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion
theeof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the
Deartment, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said
buffer will place in good operating condition any part of said sewage treatment system during the period of two (2) years
irnjediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original
sy:!;rn or any repairs thereto.
Silted: P.E. x
Adress 38 1 Route 6, Brewster, NY 10509
R.A. Date
License # 059346
A- VROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the
se -vge treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or
rricified w onsidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires
av pe t. , pprove or discharge of domestic sanitary sew o ly.
F3 Date:
� Title. t l
Wte copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional
Form CP -97
I
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i
G &E DEVELOPMENT, LLC
Gregg Macaluso
914- 878 -4355
March 17, 2000
Robert Morris P.E.
Putnam County Dept. of Health
4 Geneva Road
Brewster, NY 10509
Re: Dorset Hollow Estates Lot # 23
(formally Van Cleef Estates)
Edward Bloes
914- 234 -2281
This letter is to serve as a notice that I as the contractor for the Dorset Hollow
Water District, currently under construction, can provide adequate pressure to
serve the proposed lots. This water plant shall be inspected and approved by
PCDOH'for use to meet the demand requirements for the subdivision.
Very trulyXours,
dwar Bloes
G &E Development
PO BOX 352 BEDFORb, NY 10506
14.164 (2187) —Text 12
PROJECT 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. APPLICANT /SPONSOR
2 NAME
Dorset Hollow Builders
set Hollow Estates
3. PROJECT LOCATION: (formally Van C.1 e e f Estates)
Municipality Patterson. County Putnam
4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map)
Lot v�3 - Dorset Hollow Estates (formally Van Cleef Estates)
5. IS PROPOSED ACTION:
El New ❑ Expansion ❑ Modification /alteration
6. DESCRIBE PROJECT BRIEFLY:
Construction of subsurface sewage treatment system -for single- family
resid'emce and connection to public water syapply.
7. AMOUNT OF LAND AF ECTED:
ar
Initially . acres Ultimately ; acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
11 Yes ❑ No If No; describe briefly
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
® Residential ❑ Industrial ❑ Commercial ❑Agriculture ❑ Park/Forest/Open space ❑ Other
Describe:
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL,
STATE OR LOCAL)?
❑ Yes ® No If yes, list agency(s) and-permit/approvals
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
® Yes ❑ No If yes, list agency name and permit /approval
Subdivision approval from Town of Patterson Planning Board /PCDOH
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION?
❑ Yes ® No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant/sponsor name: P.W. Scott , P . E . , R.A. O O
Date:
Signature:
If the action is in the Coastal Area, and you are a state agency, complete the
Coastal Assessment Form before proceeding with this assessment
OVER
1
PART II— ENVIRONMENTAL ASSESSMENT (To be completed by F�gency)
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 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 (f1 magnitude. If necessary, add attachments or reference supporting materials. Ensure that
explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed.
❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY
occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration.
❑ Check. this box if you have determined, based on the information and analysis above and any supporting
documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts
AND provide on attachments as necessary, the reasons supporting this determination:
Name of Lead Agency
Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Of i er 1
Signature of Responsible Of icer in Lead Agency Signature o Preparer (If different fro m resp�nsible'•.oltficer)
Date
2
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 (914)278-6130 Fax (Q14) 278 - 7921
Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085
Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648
1
E911 ADDRESS VERIFICATION FORM
OWNERS NAME: Dorset Hollow Builders Lot 23
TAX MAP NUMBER: 3.20 -2 -96
E911 ADDRESS: 54 West Street
Patterson,
TOWN:
AUTHORIZED TOWN OFFICIAL:
(Signature)
DATE:
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)
BRUCE R. FOLEY
Public Health Director
t
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
LORETTA MOLINARI R.N., M.S.N.
Associate Public Health Director
Director of Patient Services
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648
September 7, 2000
Peder Scott, P.E.
PW Scott Engineering
3 871 Route 6
Brewster NY 10509
Re: Proposed SSTS: Dorset Hollow Builders
54 West Street, Lot #23
(T) Patterson, TM# 3.20 -2 -96
Dear Mr. Scott:
Review of plans and other supporting documents submitted at this time relative to the above -
regarded project has been completed. Comments are offered as follows:
The construction of this sewage disposal system may be subject to local wetlands regulations. You
should contact local wetlands officials in this regard.
If percolation tests were not witnessed by a representative of the New York City Department
Environmental Protection on this lot, percolation tests must be witnessed by a representative of this
Department.
1) The minimum of 1 foot of R.O.B. fill is to be provided for the entire primary and
expansion SSTS.
Upon receipt of a submission, revised to reflect the above comments, this application will be
considered further.
V7:904,110
urs,
Robert Morris, P.E.
RM:tn Senior Public Health Engineer
BRUCE R. FOLEY
Public Health Director
V
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
LORETTA MOLINARI R.N., M.S.N.
Associate Public Health Director
Director of Patient Services
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648
October 2, 2000.
Peder Scott, P.E.
PW Scott Engineering
3871 Route 6
Brewster NY 10509
Re: Proposed SSTS: Dorset Hollow Builders
54 West Street
(T) Patterson, TM# 3.20 -2 -96
Dear Mr. Scott:
Review of plans and other supporting documents submitted at this time relative to the above -
regarded project has been completed. Comments are offered as follows:
The construction of this sewage disposal system may be subject to local wetlands regulations. You
should contact local wetlands officials in this regard.
If percolation tests were not witnessed by a representative of the New York City Department
Environmental Protection on this lot, percolation tests must be witnessed by a representative of this
Department.
1) 1 foot of R.O.B. fill has not been provided for the primary and expansion area.
Furthermore, with 1 foot of R.O.B. the closest a trench can be to the property line is
13 feet.
Upon receipt of a submission, revised to reflect the above comments, this application will be
considered further.
RM:tn
Vepkruly yours,
;4 4/
g�
Robert Morris, P.E.
Senior Public Health Engineer
,, ... At
BRUCE R. FOLEY
Public Health Director
DEPARTMENT OF HEALTH
1 Geneva Road
t Brewster, New York 10509
LORETTA �MOLINARI R.N., M.S.N.
Associate Public Health Director
Director of Patient Services
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648
Peder Scott, P. E.
P.W. Scott Engineering
3 871 Route 6
Brewster NY 10509
RE: Dorset Hollow Builders
54 West Street, Lot #23
(T) Patterson, TM# 3.20 -2 -96
Reservoir Basin -
Dear Mr. Scott:
September 7, 2000
The Putnam County Department of Health (Department) has determined that the above referenced
application, including fee, and received by this Department on September 1, 2000 is complete. The
Department will notify you by September 27, 2000 of its determination.
® The Project has been delegated to the Putnam County Health Department for
review pursuant to the guidelines set forth in the Watershed Agreement.
❑ Joint review with the NYCDEP will commence pursuant to the guidelines set forth
in the Watershed Agreement.
If the Department fails to notify you within the above referenced time frame, you may notify. the
Department of its failure by certified mail, return receipt requested. The notice should be sent to my.
attention at the above address. This notice must include your name, the location of the project, the
office with which you filed the application originally, and a statement that a decision is sought in
accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed
Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the
notice, your application will be deemed complete, subject to standard terms and conditions as set
forth in the regulations.
Please be advised that projects within the NYC Watershed may also require Dept. of Environmental
Protection review and approval of other aspects of a project, such as stormwater plans or the creation
Letter to: Peder Scott, P.E. - September 7, 2000
-2-
of imperJious surfaces, and the project applicant should contact the Department of Environmental
Protection regarding such activities to see if Department of Environmental Protection review and
approval is required.
If you have any questions regarding this matter, please call me at (845) 278 -6130 ext. 2166.
Very ly yours,
Robert Morris, PE
RM:tn Senior Public Health Engineer.
5
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_ .. -are' obtained at eac:7 re= =lation test hole_ ' 'ALTL data to' be
for review.
2- Depth mera--urmzt; to be =de --= t^p cf hel.e_
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MST PIT DATA Rirz= TO BE SUPMITTE.D W= APP1,71 rATION
LO'T DESC=ICI ? SOILS t"N�SCNl'D:tLI) IN TEST EC 3 -
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INDICATE LEVEL AT WELYCri GRCUN C— "ER IS EN= UNTE M .
INDICATE. I= TO WHICfi WA=-. IOVM RISES A= BEING M4MUA D
DE? HOLE OBSERVATIONS MADE BY: � DATE.
DESI&N
SaL Rate Used -6--1,9 .Min /1" Drop: S.D. Usable Area Provided
No-%. of Bedroaas Septic Tank Capacity /25o gals. lope o �, c� •�c .
Ab�rption Area Provided By_ L.F. x 24" width trench
. Ct`�r •
Nam W. E_Ai�- grature
AciCess 3Rd/ /'Pour-S � SEAL . _ .
Tam ACE FOR USE BY IMUTH DE.i'Ai' = ONLY:
SC,-L Rate Approved sq -ft /gal - Ciecked by Date
P. W. SCOTT
Engineering & Architecture, P.C.
3871 Route 6
BREWSTER, NY 10509
E -Mail: pws @bestweb.net
(914) 278 -2110 FAX (914) 278 -2166
TO Putnam County Dept. of Health
4 Geneva Road
Brewster, NY 10509
WE ARE SENDING YOU CKAttached ❑ Under separate cover via _
❑ Shop drawings � Prints ❑ Plans
❑ Copy of letter ❑ Change order ❑
DATE
�� �
JOB NO.
99 -159
ATTENTION
DESCRIPTION
RE:
Dorset Hollow Estates
(formally Van Cleef Estates)
Subsurface Sewage Treatment
System (SSTS)
I
I
Construction Permit for Sewage Treatment System (CP -97)
I
the following items:
❑ Samples ❑ Specifications
COPIES
DATE
NO.
DESCRIPTION
I
Application for Approval of Plans (PC -97)
I
I
Construction Permit for Sewage Treatment System (CP -97)
I
1
Letter of Authorization (LA -97)
1
2
Design Data Sheet (DD -97)
1
House Plans (2 sets)
2
1
Letter from G & E Development,LLC, Re: Public Water
1
1
Check ��3 �� /a?3 7,41f or the amount of $ bcIo.p-D
1
I
Short Form EAF
THESE ARE TRANSMITTED as checked below:
❑ For approval
❑ For your use
❑ As requested
X] For review and comment
❑ FORBIDS DUE
❑ Approved as submitted
❑ Approved as noted
❑ Returned for corrections
❑ Resubmit copies for approval
❑ Submit copies for distribution
❑ Return corrected prints
❑ PRINTS RETURNED AFTER LOAN TO US
REMARKS
List Continued:
4 1 Septic Site Plan Drawings
1 1 E911 Address Verification Form (E911 Verfrm)
COPY TO
SIGNED:
If enclosures are not as noted, kindly notify us at once.
i� PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
APPLICATION FOR APPROVAL OF PLANS FOR
A WASTEWATER TREATMENT SYSTEM
1. Name and address of applicant: Dorset Hollow Builders
Lot # 3L3 15 West Hollow R6ad
Brewster, New York 10509
orset Hollow Estates
2. Nameofproject: formally VanCleef Est3. Location TN: Patterson
4. Design Professional: Peder W. Scott, P.E., R.5-. Address:3871 Route 6
6. Drainage Basin:
7. Type of Proiect:
East Branch Reservoir
Brewster, NY 10509
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 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
19.
erviced
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 i i— l - 9& 23. Name of Health Inspector M.
B u d z i n s k i P. E.
24.
Project design flow (gallons per day) ................
800 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
35. Are any sewage treatment areas in excess of 15% slope? . ...............................
No
36. Tax Map ID Number .......................... ... ............................. Map 3.:Zo Block
_,k Lot 4 go
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 thq Penal Law.
SIGNATURES & OFFICIAL TITLES:
Per W. Scott —Agent for Applicant
Mailing Address ........................ ............ 3871 Route 6
Brewster, New York ', 110509..; .; r {'.
r;
2
27.
Is any portion of this project located within a designated Town or State wetland?
No
28.
Wetlands ID Number ........................................................... ...............................
N/A
29.
Is Wetlands Permit required? Individual Lo.t
Has application been made to Town or Local DEC office? ...............................
N/A
30.
Does project require a DEC Stream Disturbance Permit? .. ...............................
No
31.
Is or was project site used for agricultural activity involving application of
pesticides to orchards or other crops, solid or hazardous waste disposal,
landfilling, sludge application or industrial activity? ............................ Yes/No
No
32.
Is project located within 1,000 feet of existing or abandoned landfill,
hazardous waste site, salt stockpile, landfill, sludge disposal site or any
other potentially known source of contamination? ............................... Yes/No
No
DESCRIBE:
33.
Is there a local master plan on file with the Town or Village? .........................
Yes
34.
Are community water and/or sewer facilities planned to be developed within
15 years in or adjacent to project site? ................................ ...............................
Water-'.Only
35. Are any sewage treatment areas in excess of 15% slope? . ...............................
No
36. Tax Map ID Number .......................... ... ............................. Map 3.:Zo Block
_,k Lot 4 go
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 thq Penal Law.
SIGNATURES & OFFICIAL TITLES:
Per W. Scott —Agent for Applicant
Mailing Address ........................ ............ 3871 Route 6
Brewster, New York ', 110509..; .; r {'.
r;
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
LETTER OF AUTHORIZATION
RE: Property of Dorset Hollow Builders
Located at 54 West Street
TN Patterson
Tax Map # 3.2 0 Block 2 Lot 96
Subdivisionof Dorset
Hollow Estate$ (formally
Van Cleef
Estates)
Subdivision Lot # 23
Filed Map # 2 7 71
Date Filed
12/24/88
Gentlemen:
This letter is to authorize P e d e r W. s. C o t t, P. E., R. A.
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 accordance
with the standards, rules or'regulations as promulgated by the Public Health Director of the Putnam
County Health Department, and to sign all necessary papers on my behalf in connection with this
matter and to supervise the construction of said wastewater tretment and/or water supply systems in
conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health
Law, and the Putnam County Sanitary Code.
i
V t r .
Countersigned: Signed:
P.E., R.A., # 0 5 9 3 4 6 (Owner o ope )
Mailing Address 3 8 7 1 R o u t e 6 Mailing Address: Dorset H o t l'o w Builders
Brewster 15 West Hollow Road, Brewster
State New York Zip 10509
Telephone: ( 9 1 4 ) 2 7 8 - 2 1 1 0
State New York
Zip 1 0509
Telephone: ( 9 1 4 ) 2 7 9 - 1 3 3 9
Form LA -97