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HomeMy WebLinkAbout0150DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 3.20 =2 -99 BOX 2 00150 till r� r ir ML a;, irL 00150 ti PUTNAIVI COUNTY DEPARTMENT OF HEALTH � DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # Located at -4q Town or Village Patterson Owner /Applicant Name D o r s e t H o 11 o w B u i 1 d e r s Tax Map :3,o-LO Block 2- Lot c? cl— Formerly Van Cleef Estates Subdivision Name Dorset Hollow Estates Subd. Lot # Mailing Address 15 West Hollow Road, Brewster, NY Zip 10509 Date Construction Permit Issued by PCHD S & Lo o Separate Sewerage System built by Dorset Hollow Builders Address . 15 West Hollow Road Brewster, NY 10509 Consisting Of 12 5 0 . Gallon Septic Tank and 1,44 L F of 24" wide trenches and 1007 reserve. Other Requirements: Water Su®nly: X Town Public Supply From W ate r Address Has erosion control been completed? Y e s Has garbage grinder been installed? No or: Private Supply Drilled by Building Type Residence Number of Bedrooms 4 of Patterson District Address 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: & -;Z/. oo Certified by P.E. X R.A. (Design Professional) Address 3871 Route 6, Brewster, NY 10509 License# 059346 Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocatio m dification change is necessary. W By: � Title: �� Date: d' . WJ a 6 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 �YYS1/ N` YVl1 /1�/iiJY[Yyi��i11EYV7�jiillV L1(H7�i111Y11"YY' V Nlyytl /NLyf�/'Ytil11N/YH[1'/1741iG[W fY1ii((41NV1'�(1%C1l�IiyY/ VNI�/LSY1'll lflli V NI�IySI%VI W ZNYH1/ Vii% R' HYi�?V .!\/Hf1li/711VS1/ViNY11/V5) 1 o Ap�A 0,918 -AC 0 0 @) C1 213 -AO "\13610 Oz 12 18 19 0 14 25 P-y 17 10, < 14 moo, 62. 7'Z r7 �. -625, 62.15 - 8.4 5-13 -0710 W� t2ol -b a, 07°41 ,-0-9.1 I to6R"SET-,H-O.LLOW. WATER SUPPLIED By WATER DISTRI-ci,111V SEPTIC AREA PLAN I . I -L, LOCATION ``: - DESCRIPTION 77a-s- FROM -POINT A B C 1 D6 -1 19' -6" 54' -1o" 2 DB -2 21' -0" 49' -6" 3 DB -3 23' -6" 44' -2" 4 DB -4 20' -0" 38' -10" 5 DB -5 38' -0" 37' -6" 6 DB -6 38' -0" 37' -6" 7 TRENCH -1 69 -.9" 101' -2" 8 TRENCH -2 77' -8" 105' -9" 9 TRENCH -3 - 77' -10" 100' -8" 10 TRENCH -4 77' -2" 96' -0" 11 TRENCH -5 75' -4" 92' -0" 12 TRENCH -6 50' -8" 22' -3" 13 TRENCH -7 71' -0" 84' -4" 14 TRENCH -8 92' -6" 43' -0" 15 TRENCH -9 96' -0" 48' -0" 16 TRENCH -9 57' -3" 35' -0" 17 ST 13'-0" 25'- 7" 1 -8- _ ;. ._ ST 13: -g = 34' -0„ 19 ST 14' -1" 3.6. -3„ �tzd PUTNATM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMEN'T'AL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Dorset Hollow Builders Owner or Purchaser of Building Tax Map Block Lot Dorset Hollow Builders Building Constructed by Location - Street Patterson Town/Village p vvz Van CleeY Subdivision) Subdivision Name Residence Building Type Subdivision Lot 7 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 occupa If the building utilizing the system. ed: onth Day � Year �� Signature: Title: e Geiser ntra for ( wn - Signature Corporation Name (if corporation) Corporation Name (if corporation) Address: (S Address: 15- � i t -o L4_,&L-j R-0 State e�,w stt n. tJ H Zip --1-�Z State �(za�s C 2 , `{ Zip �c 5 t�� orn GS -97 BRUCE R. FOLEY Public Health Director LORETT A 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 (9,14) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 E911 ADDRESS VERIFICATION FORM OWNERS NAME: TAX MAP NUMBER: E911 ADDRESS: TOWN: AUTHORIZED TOWN OFFICIAL: . (Signature) DATE: Dorset Hollow Builders Lot 9 3.20 -2 -99 49 West Street Patterson 3, The Putnam County Department of Health will not issue a Certificate of Construction Compliance unless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be.submitted with the application for a Certificate of Construction Compliance. (E911 VERFW PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION ` Date: 8 7 !19 Inspected y: a 721EF6 . Street Location �,c� � -r,'T Owner �ig�.y- ,yat dw Town Permit # TM # Subdivision Lot 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 System a. e5 ptic tank size - 1,000 ... 1, 250.......other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box - properly set ........... ............................... f. Trenches T-. eh required Length installed 2. Distance to watercourse measured 0Ft.......... 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. PumR or Dosed Systems Size o pump chamber ................ ............................... 2. Overflow tank .:........................... ............................... 3. Alarm, visual/ audio .................... ............................... 4. Pump easily accessible, manhole to grade. ................ 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Building a. To—use located per approved plans ... ............................... b. Number of bedrooms ..................i'�... t1�.�................... 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. Backfll 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. Erosion control provided ................. ............................... Rev. 6/97 BRUCE R FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York. 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (914) 278 - 6130 Fax (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 Date: 8Z7 To: 7p !y_ 5 c d TT t From: Gene D. Reed Putnam County Department of Health /For your information For your review As discussed Fax #: 2-76 —2-166 No. Pages 3 (Including cover sheet) Please respond Attached as requested Please call Notes/Messages Z-©7— / "' S. `t r S , t T-O !9 111111i��pl Ws . • PA fW, _ _ : :.r - w ► R MON In the event of transmission /reception difficulties, please contact this office at (914) 278 -6130 ext. 2261. 07/31/00 16:13 PW SCOTT 4 19142787921 NO.034 003 PU7 NAM COUNTY DEPARTMENT OF REAJLTH DMSI, :)N OF ENVIRONMENTAL HEAL'T'H SERVICES ATTENTION ❑ ADAM XGENE - REtiUEST FOR FINAL INSPECTION For: Fill All information must be f illy completed prior to any Trenches L/ inspections being made. PCHD Construction Pen ait # 1 , a- } -0 0 Located: Q-q t war SOT &T, (T) (v) - Efe.�r�on•. Owner /Applicant Name, VeK-461 W U-00 SUILM-RS TM 20 Block Z Lot — Formerly: V0-0 uee f Subdivision Name: bo rl-ff o 1 v w Elti-W Subdivision Lot # Is system fill completed? Date: Is system complete?_ 2 S Date: V z o L) Is system constructed as per plans? eS Is well drilled? 61 hor Date: is well located as per pia zs? ' Are erosion control mea! ures in place? S I certify that the system(s), as listed, at the above premises has been constructed and I have inspected and verified their cowlletion 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: 1 t O d Certified by: �!_.r' ,�Z�� -!t' PE AA Design Professional Address: 3'971 000C, Ny iDYt Lie. Comments: I . 927 '(WV WOE" P& P 8, wd to a. s'(PCS yw-f �(as � W(f h (Ks tdL o � 1,0X Form FIR 99 �J A PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES r CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM D PERWT# Locatesiat 49 West Street Town or Village Patterson Subdivision name Dorset Hollow E S1tbd. Lot # 9 Tax Map 3.2 0 Block 2 Lot 99 Date Subdivision Approved Owner /Applicant Name 1998 Dorset Hollow Builders Renewal Revision Date of Previous Approval Mailing Address 15 West Hollow Road, Brewster, NY Amount of Fee Enclosed $300.00 Building Type Re s i d e n c e Zip 10509 Lot Area • 9 2 A c No. of Bedrooms 4 Design Flow GPD zbo Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Se alate Sewerage System to consist of 1.250 240 wide trenches and 100% reserve. OtherRequirements: gallon septic tank and 444 LF of To beconstructedby Dorset Hollow Builders Address 15 West Hollow Road, Brewster, NY Town of Patterson W$t� SuDDIy: X Public Supply From Water District Address or: Private Supply Drilled by Address I reprsent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the seQk sewage treatment sys_tem described above will be constructed as shown on the approved amendment thereto and in accor�mce with the standards, rules and regulations of the Putnam County Department of Health, and that on completion theree a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to. the Depalment, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said build( will place in good operating condition any part of said sewage treatment system during the period of two (2) years immdately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original systes or any repairs th reto SigrA: P.E. X R.A. Date All Addis 3871 Route 6, Brewster, NY 10509 License# 059346 APIUVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the se w$ treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or McK ed whep.Qonsidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a xxepe proved f ischarge of domestic sanitary sewage only. l 13y: Title: i /'UaJ /�� Date: ej Whicopy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -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 C Attached ❑ Under separate cover via ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ LLYTTEQ @Lr . DATE %000 JOB NO. 99-159 ATTENTION - Qo 'be rt Morr15 RE: — LC56 A g Dorset Hollow Estates (formally Van Cle.ef Estates) Subsurface Sewage Treatment System (SSTS) Application for Approval of Plans (PC -97) 1 ❑ Samples the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION 1 Application for Approval of Plans (PC -97) 1 1 Construction Permit for Sewage Treatment System (CP -97) 1 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 #'101850037 for the amount of $ '300.00 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 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 List Continued: 4 1 Septic Site Plan Drawings 1 I E911 Address Verification Form (E911 Verfrm) COPY TO SIGNED: If enclosures are not as noted, kindly notiA.tonce. 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 # 15 West Hollow Road Brewster, New York 10509 porset Hollow Estates 2. Name of project' ( f o rma l l y V anC 1 e e f E s t)3. Location TN: Patterson 4. Design Professional: Peder W. Scott, P.E., R.-i'. Addres0871 Route 6 6. Drainage Basin: East Branch Reservoir 7. Type of Project: X : Private/Residential Food Service Apartments Institutional Office Building Realty Subdivision Brewster, NY 10509 Commercial Mobile Home Park 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? 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 supplyby system 20. Is project site near a public sewage collection or treatment system? ................ No 21. Name of sewage system Indivi.dual' Lots . .Distance to sewage system 22. Date test holes observed 11 - , y -- % 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 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? ..............:............. 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 s.ao Block_ Lot q 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 state ents made herein are pun_ fishable as a Class A misdemeanor pursuant to Section 45 of the Penal Law. SIGNATURES & OFFICL4L TITLES: Mailing Address: ................................... PederlV- Scott Agent for Applicant 3871 Route 6 Brewster, New York 10509 PUTNAM COUNTY DEPARTMENT OF HEALTH ­­­DIVISION OF ENVIRONMENTAL HEALTH SERVICES,,. LETTER OF AUTHORIZATION RE: Property of Dorset Hollow Builders Located at 49 West Street T/V Patterson Tax Map # 3.20 Block 2 Lot 9.9 Subdivision of n -orset Hollow Estates (formally Van C 1 e e f Estates) Subdivision Lot # 9 Filed Map # 2 7 71 Date Filed 12/24/88 Gentlemen: This letter is to authorize P e d e r W. 3. 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. Very...ruly y r gne Signed_: P.E., R.A., # 059346 (Owner , roperty Mailing Address 3 8 7 1 Route 6 Mailing Address: . D o r s e t Hollow gu'i 1 d e r s Brewster State New York Zip 10509 Telephone: (9 14) 278-2110 15 West Hollow Road, Brewster„ State New York Zip 10509 Telephone (914) 279 -1339 Form LA -97 14.16 -4 (2187) —Text 12 PROJECT I.D. NUMBER 617.21 •SEOR Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (fo be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR 2. PROJECT NAME Dorset Hollow Builders Dorset Hollow Estates 3. PROJECT LOCATION: (formally Van C l e e f Estates) Municipality Patterson County Putnam 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) Lot # - Dorset Hollow Estates (formally Van Cleef Estates) 41 We-fi $,1're�t l�ct_�ter•s��, �� 5. IS PROPOSED ACTION: E3 New ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: Construction of subsurface sewage treatment system -for single- family resid'e.nce and connection to public water, supply. 7. AMOUNT OF LAND AFFECTED: Initially 0.5 acres Ultimately O'S, 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/Forestfopen 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; permiUapprovals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ® Yes . ❑ No I 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 C o t t, P. E R. A. 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 agency) 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 quallty 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: t 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•C5? Explain briefly. 07. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly (PART 111 — DETERMINATION OF SIGNIFICANCE IT 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 EA•F and /or prepare a positive declaration. ❑ Check. this. box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: ,i Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Title of -Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer) Date 2 D� THE CITY OF NEW YORK DEPARTMENT of ENwRONMENTAL PROTECTION JOEL A. MIME, SR., P.E. Conn issionar ��^'*nwr.►e�o� WILLIAM N. STASIUK, P.E.,Ph.D. Deputy Commissioner PHONE (914) 742 -2001 Bureau of Water Supply fAX (914) 742 -2027 April 27, 2000 Robert Morris, PY Nbmm Co. Health Dept. 4 Geneva Road Brewster, NY 10509 Re. Dorset Hollow. Lot 9 West Street Patterson, Putnam East Branch Reservoir DEP Log # 10140(7oint Review) Dear Mr. Morris: This letter is to inform you that the New 'York City Department of Environmental Protection (Department) has determined that the above- referenced application is complete. In addition, the Department has no objection to the approval of the above- referenced regulated activity. This determination is based on the review of submitted documents including the plan titled "Septic Site Plan Lot 9 prepared for Dorset Hollow Estates ", dated 03124/00. The applicant must contact Sissy De La Ossa of my'staff at (914) 773 -4416 at least 2 days prior to the start of construction of the SSTS so that a Department representative may inspect and monitor the installation: 465 Columbus Avenue, Valhalla, New York 10595 -1336 BRUCE R. FOLEY Public Health Director - May 1, 2000 DEPARTMENT OF _HEALTH 1 Geneva Road Brewster, New York 10509 111V] 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 PW Scott Engineering 3871 Route 6 Brewster, New York 10509 Re: Proposed SSTS: Dorset Hollow Estates 49 West Street, TM# 3.20 -2 -99, Lot #9 (T) Patterson 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. Current construction notes 1 -15 have not been provided. 2. The PCDOH has been having problems with the cleanliness of crushed stone. Please revise the trench detail to note either or both "dust free or washed crushed stone" with the required washed gravel as acceptable material. 3. SSTS is shown within 100 feet of the well on Lot #10. Please revise as warranted. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. e truly yqVrs, U� Robert Morris, PE Senior Public Health Engineer RM:cj BRUCE R. FOLEY Public Health Director ff � LORETTA - MOLWARI : RN., 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 (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 P.W. Scott 3871 Route 6 Brewster NY 10509 RE: Dorset Hollow Builders 49 West Street, Lot #9 (T) Patterson, TM# 3.20 -2 -99. Reservoir Basin Dear Mr. Scott: April 5, 2000 The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on March 29, 2000 is complete. The Department will notify you by April 26, 2000 of its determination. i ❑ 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: P.W. Scott - April 5, 2000 -2 of impervious 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 (914) 278 -6130 ext. 2166. RM:tn Ve ly your 1�✓� Robert Morris, PE Senior Public Health Engineer PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWNER: STREET LOCATION: REVIEWED BY: RM, GR, AS, SRDATE: TAX MAP =: (CONFIRMED) Y N DOCUMENTS Y (REQUIRED DETAILS ON PLANS CONT'D) . UUPERT-v1TT APPLICATION HOUSE SEWER -' /" FT. 4 "0 ;TYPE PIPE CAST IRON "L--)WELL PERIINI1T OR PWS LETTER (_)�)NO BENDS; DL�X BENDS 45° W /CLEANOUT (UUPC -97 )(_)LETTER OF AUTHORIZATION (_J(__)DESIGN DATA SHEET (DDS) UUCORPORATE RESOLUTION ( _J(_)SHORT EAF (_J(—)PLANS -THREE SETS ( _JC_)HOUSE PLANS - TWO SETS (_)(___)VARIANCE REQUEST SUBDIVISION (_))LEGAL SUBDIVISION UL_JSUBDIVISION APPROVAL CHECKED (_)L)PERC RATE UUFILL REQUIRED DEPTH (_)(__)CURTAIN DRAIN REQUIRED / GENERAL _)/ LOCATED IN NYC WATERSHED PLANS SUBMITTED TO DEP ( /(__)DELEGATED TO PCHD (Z(_)DEP APPROVAL, IF REQ'D (_))DEEP TEST HOLES OBSERVED �( ) PERCS TO BE WITNESSED ( _J(,)EX- APPROVAL SSDS ADJ, LOTS L_,d'(_)WETLANDS (TOWN/DEC PERMIT REQ'D ?) UUJDATA ON DDS PLANS & PERMIT SAME ((_)PRE 1969 NEIGHBOR NOTIFICATION ( _J(L_)LETTER BI/ZBA (= )(_)100 YR. FLOOD ELEVATION W/I200' _'(__)SOIL TESTING LOTS >10 YEARS OLD ( AzREQUIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) SSDS HYDRAULIC PROFILE GRAVITY FLOW '``� ( )CONSTRU NOTES 1 -15 J sSIGN DATr"DKEP RESULT: CONTOURS EXISTING &.PROPOSED (Z) DRIVEWAY & SLOPES, CUT (_J ' FOOTING /GUTTER/CURTAIN DRAINS USDA SOIL TYPE BOUNDARIES Us' UTITLE BLOCK; OWNERS NAME ADDRESS TM4, PE/RA; NAME, ADDRESS, PHONE# ( J(__)DATE OF DRAWING/REVISION U(_JDATUM REFERENCE U( JLOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. (PROPOSED FINISH FLOOR AND / BASEMENT ELEVATIONS U WELLS & SSDS'S WAIN 200' OF SSTS PROPERTY METES & BOUNDS COMMENTS: io r vc vW rqm RENEWALS E NOTE (NO CHANGE) FILL SYSTEMS 0' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE SPECS / FILL NOTES 1 -5 PROFILE & DIMENSIONS IN EXPANSION AREA FILL GREATER THAN2 FEET CLAY BARRIER FILL CERTIFICATION NOTE DEPTH GAUGES ON PLAIN FOR R. O.B., UNCLASSIFIED & IMPERVIOUS ?ARATION DISTANCE FROM TOE OF SLOPE TRENCH PROVIDED � . 60FT MAX. ARALLEL'TO CONTOURS L- J100% EXPANSION PROVIDED �DETAIIJDUST FREE CRUSHED STONE OR WASHED GRAVEL GEOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM SSTS 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL 20' TO FOUNDATION WALLS 100' TO WELL, 200' IN DLOD, 150' TO PITS 100' TO STREAM, WATERCOURSE, LAKE (inc. expan) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATER LINE (pits - 20') 50' INTERMITTENT DRAINAGE COURSE 200'/500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS 10' MIN TO LEDGE OUTCROP SEPTIC TANK FROM FOUNDATION; 50' TO WELL . WELL 4ENSIONS TO PROPERTY LINES OF SERVICE CONNECTION 15' TO PROPERTY LINE SLOPE IN SSTS AREA (S20 %) kDED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS NOTES OSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED LJ DETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) PTT AND D -BOX SHOWN & DETAILED (__)Ljl DAY STORAGE ABOVE ALARM CURTAIN DRAIN STANDPIPES, 5' BOTH SIDES, DETAIL x(—J(-JlO'MIN 15' MIN to CDS = >5 %, 20'4 %, 25' -3 %, 35' -1 %,100 % - <1% 20' MIN to CD DISCHARGE /100' with 182 cons day discharge to NON - PERFORATED PIPE =T PIT DATA RL -= TO BE SuPMITTL•'D ivy- 3lPP -Eff"z TI01? L --7 DESC=10N ? SOBS a C,'v�Tz-TtLJ IN TEST SM - P NOLr M. G.:,. PP; rxd 51 V I 6 8`` 101 '4 131 141 __. ...._.._ _ .__._____ -- - •- •- • -_ -.. INDICA y L= AT WHICH GRCU -V-- - IS r- N=U=MD - nmjr_z.TE LcVE., TO WhICti SSA= -, RISES A=— B MNG F'',=UiN''I'p.'._.D DEEP HOLE OBSERVATIONS MADE BY: DESI&N Soil Rate Used u .Min /1" Drop: S.D. Usable Are: Provides No". of Bcirocros Septic Tank Capacity 17-�V gals- mlype Rle zibsorpt, ca Area Provided By t/4/4i L.E. x 24" width -ench i Other Name W. SGoTT ENG /NE a2'IV at=e Address 39 ?1 Coar— 4 Siz1L is ++. T:iIS SPAC ± FOR USE BY ,E..EUTH DE2ArM1. NT COY: Soil Rate Approved q.,ft/gal.' Caectiei cy Date a Div�S � 1 OF -aTv;� T? TAI, ZFE-csl- S';y_ �'.�...�.:i� L,'�.i ,�•�- �ui.u� :C: ��.1Yr..3� .r�'I:� .''.tzL � 'c�'� : _.:. i�.J. (`; ^r�r �/2G ��t`f/ /� /�_O/�l lr1 �.� - -- a� ^`�J J ^ ••�f�J'H/�i'/Q✓r l�/�i�! .:l! /� l�(ffli�' .old /NS�4y 3. Z O :zcazad at S r°�) �!cj /I c �irNt�✓i4LG f °' .�.t?C_ /3. 'ZC. -� t / ( �iC�C✓te IIe? Sass c::css s `eez) GRe »N - .�'� r.� Testa of P= -ra.:...c Date of- Pe_--=—I aticn Test o RXI ZLacse No. T7Z)e $Fa- "'" -stca Y-L1. Deptz tc .Wate=r C= Ground S= -ace. St�� SLOD WaT—r Level I. i Liches ' DA-CO 1A Scil Rate I`a /_21 LLc-p '-7L/ 3 % / u/z i 2 D7C 5 c 1. Tes��s to be repeated• at sarre derst`t oats . ap^rczd=t,-,—ry equal so.L- rates . are • cbtaiaed .at eac i pe= =iat:cn test hale. • 'All data to' be . i tier for review. 2. Dept's a as=em^.t, to be made r-c.. t^c of hcl.e- rerr. 9/85 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 # 9 (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 PCROH for use to meet the demand requirements for the subdivision. VI r you Edward Bkoes � G &E Devekopment PO BOX 352 BEDFORD, NY 10506 CRY DZP,4* DrTHE CITY OF NEW YORK DEPARTMENT OF ENVIRONMENTAL PROTECTION .JOEL A. MICLE, SR_, P.E. Coe+missionor `'�°"►,ENru.RO'°r WILLIAM N. STASIUK, P.E.,Ph.D. Deputy Commissioner PHONE (914) 742.2001 FAX (914) 742 -2027 April 27, 2000 Robert Morris, P.E Putnam Co. Health Dept. 4 Geneva Road Brewster, NY 10509 Re: Dorset Hollow. Lot 14 West Street Patterson, Putnam East Branch Reservoir DEP Log # 10141(Joint Review) Dear Mr. Morris: Bureau of Water Supply This letter is to inform you that the New York City Department of Environmental Protection (Department) has determined that the above - referenced application is complete. In addition, the - Department has no objection to the approval of the above-referenced regulated activity. This determination is based on the review of submitted documents including the plan titled "Septic Site Plan Lot 14 prepared for Dorset Hollow Estates ", dated 03/23100. The applicant must contact Sissy De La Ossa of my staff at (914) 773 -4416 at least 2 days prior to the start of construction of the SSTS so that a Department representative may inspect and monitor the installation: 465 Columbus Avenue, Valhalla, New York 10595 -1336 70 ' J (1(1. TT Aft 1 7 Iriu `.�':, -, �.. _ _.- - .'-- ..•_.- . . v00 G1TY DEP,1RT,yF T ti D � P Dn fNiAI PROSE�\O? PHONE (914) 742.2001 FAX (914) 742.2027 April 27, 2000 THE CITY OF NEW YORK DEPARTMENT OF ENVIRONMENTAL PROTECTION JOEL A. MIELE, SR., P.E. Commissioner Robert Morris, RE Putnam Co. Health Dept. 4 Geneva Road Brewster, NY 10509 Re: Dorset Hollow. Lot 9 West Street Patterson, Putnam East Branch Reservoir DEP Log # 10140(Joint Review) Dear Mr. Morris: WILLIAM N. STASIUK, P.E.,Ph.D. Deputy Commissioner Bureau of Water Supply This letter is to inform you that the New York City Department of Environmental Protection (Department) has determined that the above - referenced application is complete. In addition, the Department has no objection to the approval of the above - referenced regulated activity. This determination is based on the review of submitted documents including the plan titled "Septic Site Plan Lot 9 prepared for Dorset Hollow Estates ", dated 03/24/00. The applicant must contact Sissy De La Ossa of my staff at (914) 773 -4416 at least 2 days prior to the start of construction of the SSTS so that a Department representative may inspect and monitor the installation. Sincerely, Margaret Lloyd, P.E. ( \ Supervisor v Engineering Design & Review xc: James Covey, P.E., NYSDOH 465 Columbus Avenue, Valhalla, New York 10595 -1336