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HomeMy WebLinkAbout0148DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 3.20 -2 -97 BOX 2 11 �: , . , r Ir if 0 NMI r p OIL 11 �: PUTNAM COUNTY DEPARTNIENT OF HEALTH DIVISION OF ENVIROMN E\TAL HEALTH. INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWNER: I''� W�f 7 �" TREET LOCATION: r T REVIEWED B AS, SRDATE: T.AX KAY- =: (CONFIRMED) •� Z'� �' YXN DOCUMENTS , N (REQUIRED DETAILS ON PLANS CONT'D) �PERi�ITT APPLICATION HOUSE SEWER - %," FT. 4 "0'; TYPE PIPE CAST IRON /WELL PERIMTT ORPWS LETTER UNO BENDS; DL•LX BENDS 45° W /CLEANOUT I OF AUTHORIZATION I DATA SHEET (DDS) RATE RESOLUTION EAF THREE SETS PLANS - TWO SETS L(,JVARIANCE REQUEST SUBDIVISION LEGAL SUBDIVISION k".,SUBDIVISIOIN APPROVAL CHECKED PERC RATE FILL REQUIRED DEPTH UCURTAIN DRAIN REQUIRED s GENERAL ( )LOCATED IN NYC WATERSHED CIS SUBtiIITTED TO DEP EGATED TO PCHD APPROVAL, IF REQ'D P TEST HOLES OBSERVED CS TO BE WITNESSED ►PPROVAL SSDS ADJ, LOTS 'LANDS (TOWN/DEC PE10M REQ'D ?) A ON DDS PLANS & PERMIT SAME /L--)PRE 1969 NEIGHBOR NOTIFICATION WC_JLETTERBIIZBA 0100 YR FLOOD ELEVATION W/1200' ___)(-JSOIL TESTING LOTS>10 YEARS OLD /REQUIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) U SDS HYDRAULIC PROFILE L_ *(_ .-)GRAVITY FLOW CONSTRUCTION NOTES 1 -15 DESIGN DATA: PERC & DEEP RESULTS 2' CONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES, CUT IFOOTING /GUTTER/CURTAIN DRAINS (USDA SOIL TYPE BOUNDARIES TITLE BLOCK; OWNERS NAME ADDRESS TM#, PE/RA; NAME, ADDRESS, PHONE# )DATE OF DRAWING/REVIMON .TUM REFERENCE iLOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. FINISH FLOOR AND BASEMENT ELEVATIONS WELLS & SSDS'S WAIN 200' OF SSTS PROPERTY METES & BOUNDS COMMENTS: RENEWALS (.woVe!!j3RENOTE (NO CHANGE) FILL SYSTEMS 'HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE U FILL SPECS / FILL NOTES 1 -5 FILL PROFILE & DIMENSIONS FILL IN EXPANSION AREA FILL GREA TER THU V 2 FEET CLAY BARRIER . FILL CERTIFICATION NOTE DEPTH GAUGES VOL ON PLAN FOR RO.B., UNCLASSIFIED & LNiPERVIOUS SEPARATION DISTANCE FRO`I TOE OF SLOPE . T F TRENCH PROVIDED 60FT INIAX. ARALLEL TO CONTOURS EXPANSION PROVIDED - FREE CRUSHED STONE OR WASHED GRAVEL COVER ZSEPARATION DISTANCES ON PLAN - FROM SSTS 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL 020' TO FOUiDATION WALLS 100' TO WELL, 200' IN DLOD,150' TO PITS 100' TO STREAIM, WATERCOURSE, LAKE Cmc. ezpan) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER w10' TO WATERLINE (pits -20-) - 50' IN-111 1ITTENT DRAINAGE COURSE l( 1-0 0' /500' RESERVOIR, ETC. 150' GALLEY SYSTEMS (10' TNIIN TO LEDGE OUTCROP SEPTIC TANK LA-00)10' FROM FOUNDATION; 50' TO WELL WELL DIMENSIONS TO PROPERTY LINES LOCATION OF SERVICE CONNECTION `IIN 15' TO PROPERTY LINE L$ OPE (SLOPE IN SSTS AREA 520 %) (�/ REGRADED TO 15 %, IF REQUIRED . / � DOSE/PUMP SYSTEMS ( fK )YUtiIP NOTES iE 75% OF PIPE VOLUMEMOSE VOLUME NOTED 'AIL FOR FORCE MAIN, (PIPE TYPE, ETC.) AND D -BOX SHOWN & DETAILED DAY STORAGE ABOVE ALARM CURTAIN DRAIN VANDPIPES, 5' BOTH SIDES, DETAIL 15' b1LN to CDS = >5 %, 20'4 %, 25 =3 %, 35' -1 %0,100 % -<I% 2p' NM to CD DISCHARGE /100' with 182 cons day discharge MEN to NON-PERFORATED PIPE PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: Inspecte y: Street Location Gv,657- -3T Owner pam;- c7- sio`�o... n ,111 a� Town Permit # p - 3 s --ate TM # 3 2 ©- - g Subdivision Lot # ; _q `' LoTUaT pocLori 1. Sewage System Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... II. Sewage Svstem a. Se r° ptic t size - 1,000 ...../:'1,250 ......other ................ b. Septic tank installed level ............................................... c. 10' minimum from foundation .......... ............................... d. Distributiop Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Ju cti�on Box -properly set ........... ............................... f. renl ches 1. l✓ ngth required 44o e-:) Length installed a 2: - Distance to watercourse measured +_ loa 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%" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped ................................... :.................... g. PuMp or Dosed Systems -T. 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 HD.estimated flow /cycle........... III. House/Buildin a. ouse located per approved plans... ... : ........................... b. Number of bedrooms. � IV. Well j VC-0:14 a. Well located as per approved plans . ............................... b. Distance from. STSarea 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 & dinto exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Rrminn control nravided ------------ ----•------------------------- - - - - -- 12/18/00 11:36 PW SCOTT 4 19142787921 NO.041 D03 .4 PUTNAM COUNTY DEPARTMENT OF HEALTH a` DIVIS: *ON OF ENVIRONMENTAL HEALTH SERVICES RWUT FOR FIN Ai , INSPECTION For: Fill Trenches PCHD Construction Pe mit Located (T) (V) a W,v Owner /Ap icant amr1V W &bbit TM3. Bloc Lot a�j FarYerly w � Subdivision un N unc Subdivision w Lot # Is system fill complete!? 'e d _ Date Is system complete ?_ k °t =} ate ° Is system constructed 1 s per plan ? e Is well drilled? Date Is well located as per flans? Are erosion control mt asures in place ?_ I certify that the syster i(s), as listed, at the above premises has been constructed and I have inspected and verified their completion in accordance with the issued PCHD Construction Permit and approved plans an 3 the Standards, Rules and Regulations of the Putnam County Department of Health. o Date: Certified by : PE X RA Design Professional Address Lic. # 4P J q_3 6 Comments: Dr. vrwa. FOR: 13 ADAM � GENE Form FIR -99 O Z 1 22 ApF-A - -40,000 5F 0,18 Act:�s� CLAIM; 1217 0 N 31.19' 25 2i 18 \ A x 223 \. \ k �2 2 X 10 t2cita -1- ° 17' 00" NE NORTHEAST LABORATORY OF DANBURY 39 MILL PLAIN ROAD - DANBURY, CT 06811 CT Cert: PH -0404 ILABSi (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 LABORATORY REPORT REPORT TO: DORSET HOLLOW BUILDERS DATE SAMPLE COLLECTED: 12/19/2000 cc: ALLAN FINN TIME COLLECTED: 11:00 A.M. 15 WEST HOLLOW ROAD COLLECTED BY: A. FINN BREWSTER, N.Y. 10509 DATE RECEIVED @ LAB: 12/19/2000 TESTED BY: LAB #11471 LAB I.D. #: DE -58 REPORT DATE: 12/20/2000 SAMPLE SITE: DORSET HOLLOW EST., LOT #22, PATTERSON, N.Y. SAMPLING POINT: KITCHEN SINK SOURCE: MUNICIPAL TREATMENT: NONE TEST PERFORMED RESULT: METHOD # MAXIMIUM CONTAMINANT LEVEL (MCL) BACTERIAL: Total Coliform (Bacteria) 0 per 100 ml SM 9222B 0 per 100 ml CHEMISTRY: Chlorine Residual * mg/L - - - - -- ml = milliliter mg/L = milligrams per Liter ND = none detected. TNTC= Too Numerous To Count COMMENTS: - Holding Times (were) met. - Sample collected in a sodium thiosulfate bottle. RESULTS BASED ON SAMPLES SUBMITTED: 12 /19/2000 SAMPLE, AS TESTED ABOVE: X or IMNOT POTABLE (PER STATE OF NEW YORK DEPT: OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) L 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 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM ptrrr.e -(_ M (w k I dea�. 3 (1a '2- 27 Owner or Purchaser of Building / Tax Map Block Lot NM_V � f-f6 tIrw �v i �o1�'S N tf&rS6-X-" Building Constructed by TownNillage Location - Street Subdivision Name gs-�taV44� oe Z Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occu of the building utilizing the system. Za�t: Month % Day Year '2-33 Signature: _ � %, _. Title: 0 W hAd GNCr*,1d C&Irialdtor (Owneetj - Signature Dtyset, ko tlow 9-u.,- I D' e M pmYS r_L Corporation Name (if corporation) Corporation Name (if corporation) Address: 1 V_e&- . afl yyy RoEY,(� , &Vt 5t&r Address: i-C- L�e6t KI/sw 'Rd _ A-p-Ws-ft State . /y Y Zip State N Y Zip Form GS -97 P. W. SCOTT Enj&ieering & 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 D<"Attached ❑ Under separate cover via _ • Shop drawings ❑ Prints ❑ Plans • Copy of letter ❑ Change order .❑ DA FE O roe NO. A rTENTIO RE: Septic As -Built Lan✓ 1- - Pns•e- -c Z ovyi T,,- tC,-tT, 1 Certificate of Construction Compliance 1 Samples the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION 1 1 Certificate of Construction Compliance 1 1 Report 3 1 Guarantee of Subsurface Sewage Treatment System 1 As -Built Septic Plan Fee: $200 J9.- cD9Yt— 3Y (a 4q 3 G S % 5' THESE ARE TRANSMITTED as checked below: ❑ For approval . f For your use ❑ As requested ❑ For review and comment ❑ FORBIDS DUE REMARKS ❑ Approved as submitted ❑ Approved as noted ❑ Returned for corrections ❑ Resubmit ❑ Submit _ Return _ —copies for approval _ copies for distribution corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US COP`( TO SIGNED: - BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLMARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (914)278-6130 Fax (9,14) 278-7921 Nursing Services (914) 278 - 6558 WIC (914) 218 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 E911 ADDRESS VERIFICATION FORM OWNERS NAME: TAX MAP NUMBER: E911 ADDRESS: TOWN: AUTHORIZED TOWN OFFICIAL: (Signature) DATE: Dorset Hollow Builders Lot 22 3.20 -2 -97 44 West Street Patterson Z ��G 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 VERFM PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR S ATMENT SYSTEM 0 PCHD CONSTRUCTION PERMIT # 0/ 11 Located at 4/7( Town or Village Owner /Applicant Name ifiru,&) J aS9099MIT ax Map 3. dL61 Block �2 -- Lot 7 Formerly JIhJ 7-5'—M-7-05 Subdivision Name Subd. Lot # Mailing Address 05 A-c-' La-y-�,✓ Cc::5 //f-�, 13 /cg��/ s i -2 %YL. , iL/ � Zip v '; L Date Construction Permit Issued by PCHD S'"�3 �' ciZ1 Separate Sewerage System built by 14t J Y_;o7Lovg,;Address / 5 ftoL, eio Consisting of / a- 5`0 Gallon Septic Tank and 101) L-f= � " �' �✓� 732 U�. qty Other Requirements: Water Supply: X Public Supply From Address or: Private Supply Drilled by Address Building Type, i Has erosion control been completed? L:�s Number of Bedrooms Has garbage grinder been installed? N D 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 regulations of the Putnam County Department of Health. Date: I i /y_ Certified by P, J, P.E. R.A. �7 (Design Professional) Address 3 IR" 1 i �'v >" i3i'��,r's r�?'L. , f N /� 5 U �j License # c) t `' 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 revocation, ification r change is necessary. By: Title: U Date: dl 6 % White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 P. W. SCOTT Engineering & Architecture, P.C. 3871 Route 6 BREWSTER, NY 10509 E -Mail: pws @bestweb.net (914) 278 -2110 FAX (914) 278 -2166 TO Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 WE ARE SENDING YOU ❑ Shop drawings ❑ Copy of letter DATE 2 3 eO JOB NO. 99 -159 ATTENTION RE: r Dorset Hollow Estates—Lot-1 (formally Van Cleef Estates) Subsurface Sewage Treatment System (SSTS) Application for Approval of Plans (PC -97) I C�Attached ❑ Under separate cover via the following items: ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Change order ❑ 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 Check # or the amount of $ 30U 1 1 Short Form EAF THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ For your use ❑ As requested X1 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) COPYTO SIGNED: If enclosures are not as noted, kindly notify us at once. PUTNAM COUNTY DEPARTMENT OF HEALTH 10IVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: norset Hollow Builders Ldt # G �� 15 West Hollow R6ad Brewster, New York 10509 ?formally Hollow Estates 2. Nameofproject: (formally VanCleef Est;3. LocationT/V: Patterson 4. Design Professional: Peder W. Scott, P.E., R•-i*. Address:3871 Route 6 6. Drainage Basin: East Branch Reservoir Brewster, NY 10509 7. J�pe 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. 'L�1ame of Lead Agency Town of Patterson Planning Board 2. 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 1$ Is project located near a public water supply system? Yes ....... ............................... ervi.ced I S If yes, name of water supply Town of Patterson Distance to water supplyby system ( Is project site near a public sewage collection or treatment system? ........... i Name of sewage system Individual lots Distance to sewage system Z: Date test holes observed i 1- `y - q 6 23. Name of Health Inspector M. B u d z i n s k i P. E. Z: Project design flow (gallons per day) ................................. ............................... 800 GPn Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... No Has SPDES Application been submitted to local DEC office? N/A Form PC -97 K 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? ............................ 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 5.�2o Block_) Lot 91 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 stormwaier 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 d. Class A misdemeanor pursuant to Se 'on 210.45 o the Penal Law. SIGNATURES & OFFICIAL TITLES: Pe W. Scott Agent for Applicant 3s� 1 Route 6 Mailing. Address :.... ............................... a. Brewster, New York 10509 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES RE: Property of Located at LETTER OF AUTHORIZATION Dorset Hollow Builders 44 West Street TN Patterson Tax Map# 23.20 Block 2 Lot 97 Subdivision of Dorset Hollow Estates (formally Van Cleef Estates) Subdivision Lot # 22 Gentlemen: Filed Map # 2 7 71 Date Filed 12/24/88 This letter is to authorize P e d e r W. Scott , P. E., R. A. a duly licensed Professional Engineer x or Registered Architect to apply for the required wastewater treatment and/or water supply perinit(s) 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. V Countersign d: Si P.E., R.A., # 059346 Mailing Address 3 8 7 1 R o u t e 6 Mailing Address: Dorset Hollow Builders Brewster 15 West Hollow Road, Brewster State New York Zip 10509 State New York Zip 10509 Telephone: (9 14) 278-2110 Telephone: ( 9 14 ) 2 7 9 — 13 3 9 Form LA -97 D =57LOT GF Mr=T�7� =.i, _..._........_ ... _ .... APPENDE_. �i 1.1711 �.:�-� .....L•+ .`.Ur�..UL yC.:. Li�� .. .:l-!.L ... �G �_ Cwme- 37 3. ZO 2 %4605 y0 at (S'=e°t: ZCt . GROYi1N S1;L PE2C,^I.=C,,I MM RwU =ZD M =E PDT_:.., =CyS LOT' 22 qtr of ?re= Sczki:c Date cf Per =laticr. Test /11-7 /9,- - Run 'apse Dept<z � . gates Fran SYat_- Level NO. Time Grcund Surface. In Tncies .• SOL :late Stair -j''om Mia. start Si cD Droo In Y-Ln/=n L cn in hes T*1C:1e5 Zrx:'hes - 1 12,1 3 Z :3 - 3:d7 1 ' 2 3 ' NCLS : 1_ Testz to be repeater' at sage degth =ti ap_ r=d:.=at,--,Ty eq=1 soil r`, .'s, _ . are • obtained .at each =e==lation test hole_ ' 'AL data to' be sv:-- mitt-L for review. 2_ Dept1i tma=mmmt5 to be rzde �= top of hole_ � TEST PIT DATA REOU=' TO BE S?'iM2= WITH - %PPLIC-J%TI0L\1 DES"—=ION " SOILS aNCCUNr=M IN TEST HOI"� - SOLE M. Z H=- NO _ G. 1j. T r?'o lL - Ta��iL 31 4' 6' 7' �✓ .7 ,6 , 8' �f 9' 10, 12' INDICATE 10= AT Z4EIIC-i GRCUILM = IS EA'COUNTERED - NDICATE I..T'VLZ ZU WE12G`i F�P,TE:� LcJEr RISES AFTER HENG ?: NT= DEEP HOLE OBSERVATIONS MADE BY: - DATE: DESIGN Soil Rate Used /— S Min /l" Drop: S.D. Usable Area Provided No. of Bedrocns �_ Septic Tank Capacity j?f o ga2z . Tyree Absorption Area Provided By 3_ 33 L.F. x 24" width trench Other _ Name "27- W. SGO7rr ENl /NL=�/2 /NG� Jnature Address THIS SP.AC FOR USE BY HEi M DWAMMU ONLY: . . Soil Rate Approved sq.-ft/gal. ' Checked by Date 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 # 22 (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 PCDOFI for use to meet the demand requirements for the subdivision. Very trukv/fturs, G &E Development PO BOX 352 BEDFORD, NY 10506 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 # 22 (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 PCDOFJ,for use to meet the demand requirements for the subdivision. Very truky4k rs, G &E Development PO BOX 352 BEDFORD, NY 10506 14 -16.4 (2j87)—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 Applicarit or Project sponsor) 1. APPLICANT /SPONSOR PROJECT NAME Dorset Hollow Builders 72. Dorset Hollow Estates 3. PROJECT LOCATION: (formally Van Cleef Estates) Municipality Patterson County P u t n am 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) Lot 1 a2i - Dorset Hollow Estates (formally Van Cleef Estates) 4- (� �/U� �, ti e - r Pot-(-f ff6 1 . 5. IS PROPOSED ACTION: E New ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: Construction of subsurface sewage treatment system -'for single- family resid'emce and connection to public water supply. 7. AMOUNT OF LANpp AFFECTED: Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? 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 }� S t P E R.A. - Applicant /sponsor name: P.W. c 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 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 of 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-CS? 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 ill— 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 (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ❑ Check. this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency Pfht or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer ~Signature of Responsible officer in Lea Agency Signature of Preparer (if different from responsib a officer) Date J ! t l PUTNAM COUNTY DEPARTMENT OF HEALTH , (J DIVISION OF ENVIRONMENTAL HEALTH SERVICES ' CONSTRUCTION PERMI EWAGE TREATMENT SYSTEM PERMIT # . 3 �P -o f _ s : ;,; Located at 44 West Street TownorVillage Patterson Subdivision names o r s e t Hollow E sSubd. Lot # 22 Tax Map 3.20 Block 2 Lot 9 7 Date Subdivision Approved 1998 Renewal Revision Owner /Applicant Name Dorset Hollow Builders Date of Previous Approval Mailing Address 15 West Holhow Road, Brewster, NY Zip 10509 Amount of Fee Enclosbd $300.00 Building Type Residence Lot Area .92 No. of Bedrooms 4 Design Flow GPD 8 0 0 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of I Zs gallon septic tank and 4w® LF "' yy tf Other Requirements: To be constructed by Dorset Hollow Builders Address ^15 West Hollow Rd. , Brewster, NY Town of Patterson Water Supply: x Public Supply Fromw a t e r 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 repairs thereto. Signed: P.E. X R.A. Date g VQ(,%_ Address 38\71 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 wh c sidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe rt A proved f scharge of domestic sanitary sewage only. By: Title: OPY& Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97