Loading...
HomeMy WebLinkAbout0151DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 3.20 -2 -100 BOX 2 I IN ' I I :p IN I ■ 11L.-11 1 INN IN IL ` •� ' F� IN LA Bill ii ,� 00151 � PUTNAM COUNTY DEPARTMENT OF HEALTH � DMSION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FO ATMENT SYSTEM PCHD CONSTRUCTION PERMIT # P ' �� " DD EL p_V- Located at I. W E ZV I WE Town or Village 1 AT- MLJ5DH Owner /Applicant Name V0FJW KOW-*'J 60 iL'00 i Formerly Mailing Address Tax Map q)- �-O Block Lot 100 Subdivision Name vAN C LEEr- Subd. Lot # 6 11� wvl r 1�01'vow1 SAP B4-0A1- w Date Construction Permit Issued by PCHD --11 ', J®D Separate Sewerage System built by DOP-56f f -OLL4W NOXi Address IT IF Zip 14eaOQ 090416" /Kpi Consisting of i^i- Gallon Septic Tank and Other Requirements: J Water Supply: X Public Supply From 1AL441Q L Address orr: Private Supply Drilled by Building Type�� Number of Bedrooms Address Has erosion control been completed? `1 ,55 Has garbage grinder been installed? 1-1© 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 Dep ment of Health. Date: 411101 Certified by tL_A�L P.E. X R.A. V na? Address 9-00970 �W 6 -p NIS p God License # 5� j 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 subject to modification or change when, in the judgment of the Public Health Director, -such revocati n dificati or change is necessary. By: Title: �" Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 al 'EM r UT N AWCOUNTY H EAL .,, 76 M-4 -Genid-Roads (91 a. - 5 yt-1 0509, -gg 6L5 'v �� s- - -c:—�. 2 �"'` —.mac i. .K rtu- ,.s.�.:c �`!/Y���/ ri?_.�r W'^-t'. .r.. ,..H^:.s April 11, 2001 Robert Morris, P.E. Putnam County Health Department One Geneva Road Brewster, NY 10509 Re: Individual SSTS Compliance Van Cleef Subdivision Lot #8 53 West Street Patterson, NY T.M. #3.20.2.100 Dear Robert: Enclosed are the following: Harry W. Nichols Jr., P.E. Patterson Park; Suite 106 2050 Route 22 Brewster, NY 10509 Telephone (845) 2794003 Fax (845) 279 -4567 1. Five (5) prints of Drawing S -8, "As -Built Plan," dated 4/11/01. 2. "Certificate of Construction Compliance for Sewage Disposal System," dated 4/11/01. 3. "Guarantee of Subsurface Sewage Disposal System," dated 4/11/01. 4. Laboratory Report, dated 4/11/01. 5. Application Fee in the amount of $200.00 payable to Putnam County Health Department. If there are any questions concerning the enclosed, please call. Y�ry truly yours, i Harry W. Nich is Jr., P.E. HWN:JM:jm 01- 026.00 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM po P-4,,r,-T 1i0LL_0.W &i aa- � Owner or Purchaser of Building DOP-66r ELI W Bjibop_5 Building Constructed by 5%3 VJ t r � i PL-5 r Location - Street 96�; 10 EM (,r-, �), f�o 9L 100 Tax Map Block Lot TownNillage Subdivision Name 0 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 "Certif cate 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 occupant of the building utilizing the system. to Month A?�iL_ Day Year s Signature: Title: General Contractor (Owner) - ire 13P__� ET, 40 Li l 0 y b 0 1 a JX P-hEI-, A OLLOW w ' Corporation Name (if corporation) Corporation Name (if corporation) Address: 1' UVt%*' H-Oi,L4 w P*0 P&WAddress: State NW fop,�L_ Zip � 0 05 State 45W Y -- Zip l05 o� Form GS -0 NN NORTHEAST LABORATORY of DANBURY 39 MILL PLAIN ROAD DANBURY, CT 06811 CT Cert: PH -0404 TABS (203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 LABORATORY REPORT REPORT TO: MR ALLAN FINN 15 WEST HOLLOW ROAD BREWSTER, N.Y. 10509 SAMPLE SITE: SAMPLING POINT: SOURCE: TREATMENT: TEST PERFORMED BACTERIAL: DATE SAMPLE COLLECTED: TRAE COLLECTED: COLLECTED BY: DATE RECEIVED @ LAB: TESTED BY: LAB I.D. #: REPORT DATE: 4/3/2001 NOT STATED A. FINN 4/3/2001 LAB #11471 APR -12 4/5/2001 DORSET HOLLOW ESTATES, LOT #8, PATTERSON, N.Y. KITCHEN TAP MUNICIPAL NONE RESULT: METHOD # MAXIMIUM CONTAMINANT LEVEL (MCL) Total Coliform (Bacteria) 0 per 100 ml SM 9222B 0 per 100 ml CHEMISTRY: Chlorine Residual ND mg/L - - - - -- m1= milliliter mg/L = milligrams per Liter ND = none detected TNTC= Too Numerous To Count COMMENTS: - Holding Times (were) met. RESULTS BASED ON SAMPLES SUBMITTED: 4/3/2001 SAMPLE, AS TESTED ABOVE: DOTA13LE or ]NOT — POTABLE (PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) �4,10� ii Nn N4 Q. Laboratory Director -NORTHEAST LABORATORY, 129 MILL STREET, BERLIN, CT 060379 (860)828 -9787 - FAX (860)829 -1050 TOLL FREE WITHIN CT: 800 - 826 -0105 •OUTSIDE CT: 800 - 654 -1230 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 (914) 278.7921 Nursing Services (914) 278.6558 WIC (914) 278.6678 Fax (914) 278.6085 Es riy'Titervendon (914) 278.6014 Preschool (914) 278.6082 Fax (914) 275'- 6648 OWNERS NAME: TAX MAP NUMBER: E911 ADDRESS: TOWN: ?'3 Phi CR- oti4 AUTHORIZED TOWN 4FEICIA -L- �� /� ►,�' (Signature) DATE: /-z/ D. 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 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 (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 E911 ADDRESS VERIFICATION FORM OWNERS NAME: Dorset Hollow Builders Lot 8 TAX MAP NUMBER: 3.20 -2 -100 53 West Street E911 ADDRESS: Patterson TOWN: AUTHORIZED TOWN OFFICIAL: (Signature) DATE: 1%/2 716d 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 /}•�� ..'�'r_:ST PIT akTmA 2 '�,��•'TlO BE Sur�'-LT.�^•f��T i�v�i.Tlu r ✓/ Di:SI...Z.lr 1 TGi, J: SOILS S i:. a -,M IN .i —T aG- --Z ::0.... NO. 1 SOLE 1C. n n- M. G.r,. 4' i, ,�v —_ �a:. i ;� ate. •.� . 7' 9' io T ; 11� 12' 14' �1DIG�TD L.T'�= AT iIH -rC3 cMCUNU'Mt IS E:\l'bUN'T.T. M _ LNDICATy IZv= '-ro WHIGt: WA= =VEL RISES A= BELNG M7 u-N DEEP 1-�OLi OPSFRVATICLNS MADE BY: DATE: DESIGN Soil Rate Used -/0 Min /l" Drop: S.D. Usable Area Provided No". of B CL oams C/ Septic Tank Capacity /1,570 gals _ Tyne Absorption Area Provided By y L.F. x 24" width t:.cncn Other _ Nam P �✓ SGo7T = uGiNE��iNG� ,l�c.�,�iT�ci�igratur Address S au C: .A/,., /0,50 5 • gyp. (y , TS+ PS A= FOR USE BY fF-UTH DZ'ACMT -`?S CNLY: Soil :fate Approved sc:ft /ga? . ' C aecked by Date OF UPE, at (St-aet) ""6w, :zt neaza-ct =OSS S=eat) 77 =Tj== IICC --4-- S—u==-.Ej AP ==17S 407-� r,ar--- cf. Prn--Scak�ng Date of Percciaticn Test — A VPA I. Tes-,s '0 be repeataa at sarre de-p-ti =til kpr-r=.d=ate--Ty equal soa.1- =alms are* cbta.,:=ed .at ear-h r Ia cn tast" hole. * 'All data tz' be for review. 2. Depth =aSU--anent; to be -irz:!e —E= t--t) of hole- E:e";tn to -Water :-tcm T:*.=e Gz:cund S=2ace in Inches Soi-I'' Rate S ta= t Droa Ln mi::/Ira Dr--p Inches nches Lm=es 7,y 4 VPA I. Tes-,s '0 be repeataa at sarre de-p-ti =til kpr-r=.d=ate--Ty equal soa.1- =alms are* cbta.,:=ed .at ear-h r Ia cn tast" hole. * 'All data tz' be for review. 2. Depth =aSU--anent; to be -irz:!e —E= t--t) of hole- BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, . New York 10509 �6' 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 May 15, 2000 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 PW Scott Engineering 3871 Route 6 Brewster, New York 10509 Re: Dorset Hollow Builders, 35 West Street, Lot # 8 (T) Patterson, TM# 3.20 -2 -100 Reservoir Basin Dear Mr. Scott: . The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Department on April 19, 2000 is complete. The Department will notify you by June 5, 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 CertifiedMail, Return Receipt Requested. The notice would 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 New York City Department 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 Department of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Department of Environmental Protection regarding such activities to see if DEP review and approval is required. If you have any questions regarding this matter, please call me at (914) 278 -6130 ext. 2166. Very truly yours, Robert Morris, PE Public Health Engineer RM:cj �Vewrrl�, May 30, 2000 Department-of Environmental Robert Morris, RE _Protection Putnam Co. Health Dept. 4 Geneva Road Brewster, NY 10509 "0R CITY DEPAREMF Nr F 02 - RONMENTAL PROSE www. d.nyc.ny.us /de p (718) DEP -HELP Re: Dorset Hollow. Lot 8 West Street Patterson, Putnam East Branch Reservoir DEP Log # 10224(Joint Review) Dear Mr. Morris: Please note the following comment regarding the system design above referenced: • The percolation rate that belong to a percolation rate of 8 -10 min/inch is 0.9 gal/day/sq. ft., and not 1.0 gal/day/sq. ft. as is written on the plan. If you have any questions regarding this matter, you may contact me at (914) 773- 4416. Sincerely, 4�1-) s C j(-)e"`_` Qtt.-- Sissy De La Ossa, M.S. Environmental and Water Resources Engineer Engineering Design & Review xc: James Covey, P.E., NYSDOH 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 June 7, 2000 PW Scott Engineering 3871 Route 6 Brewster NY 10509 Re: Proposed SSTS: Dorset Hollow Builder West Street, Lot #8 (T) Patterson, TM# 3.20 -2 -100 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) Standard notes 1 -15 are to be noted on the plan. 2) Application rate is to be changed from 1.0 to 0.9 gal/day /sq. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM:tn Very truly yours Robert Morris, P.E. Senior Public Health Engineer Department of Environmental Protection 465 Columbus Avenue Valhalla, New York 10595 -1336 Joel A. Miele Sr.; P.E. Commissioner Bureau.of Water Supply William N. Stasiuk, P.E., Ph.D. Deputy Commissioner Tel (914) 742 -2001 Fax(914)742 -2027 2��y�pK CITY DEPgRTMF O N .. FN`,a�NMEMAL PB�SE�`O� www. ci. nyc. ny. us/dep-) (7 18) DEP - HELP June 27, 2000 Robert Morris, P.E. Putnam County Health 1 Geneva Road Brewster, New York 10509 Re: Dorset Hollow West Street (T) Patterson East Branch Reservoir DEP Log # 10224 Dear Mr. Morris; The New York City Department of Environmental Protection (DEP) has determined that the above referenced application is complete. The DEP 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 8, Dorset Hollow Estates," dated 3/15/00 last revised 6/22/00. The applicant must contact Jennifer Coughlan of my staff at (914) 773 - 4458 at least 2 days prior to the start of construction of the Subsurface Sewage Treatment System so that the DEP may inspect and monitor the installation. Sincerely Margaret Lloyd, P.E. Supervisor Engineering Design & Review bxc: Simroe Lloyd/Coughlan File. 14.16.4 (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 PROJECT NAME Dorset Hollow Builders F2. no Hollow Estates 3. PROJECT LOCATION: ( formally Van C.leef Estates) P f. Municipality Patterson County u n am 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) Lot'# Dorset Hollow Estates (formally Van Cleef Estates) 53 we-54 5free4. P fterooj, 5. IS PROPOSED ACTION: New ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: Construction of subsurface sewage treatment system - for single- family resid'emce and connection to public water sppply. 7. AMOUNT OF LAND AFFECTED: Initially �' S acres Ultimately ��� acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes ❑ No If No; descrlbe 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•permiVapprovals 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 MN o I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant1sponsor name-. P . W • Scott, 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) A. DOES ACTION EXCEED ANY TYPE 1 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, or 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: Ca. 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 (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: Print or Type Name of Responsible Officer in Lea Agency Signature o Responsib e O icer in Lea Agency Name of Lead Agency K Title of Responsib e Otticer Signature of Preparer (If different from responsible officer) 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 LYAttached ❑ Under separate cover via • Shop drawings ❑ Prints ❑ Plans • Copy of letter ❑ Change order ❑ GATE i .,. - 0 000 7B ` 99— 159 ATTENTION R Bert Morr ;s . RE: Dorset Hollow Estates —Lo'E48 (formally Van Cleef 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 I Letter of Authorization (LA -97) 1 2 Design Data Sheet (DD -97) I House Plans (2 sets) 2 1 Letter from G & E Development,LLC, Re: Public Water 1 I. Check #3qT V23 73,5' for the amount of $ -3pp.60 1 1 Short Form EAF THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ For your use ❑ As requested X] For review and comment ❑ FOR BIDS 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 notif us at once. 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 # 8 (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 %JW yours, Edward BPI S G &E Develbpment PO BOX 352 BEDFORD, NY 10506 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Dorset Hollow Builders Located at 53 West Street T/V Patterson Tax Map # 3.20 Block 2 Lot 100 Subdivisionof Dorset Hollow Estates (formally Van Cleef Estates) Subdivision Lot # 8 ' Gentlemen: Filed Map # 2 7 71 Date Filed 12/24/88 This letter is to authorize Pe 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 permit(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. J Very- t o Countersigned: ��" Signed: P.E., R.A., # 059346 (Owner o perry) Mailing Address 3 8 7 1 Route 6 Brewster State New York Zip 10509 Telephone: ( 9 14 ) 2 7 8— 2 1 10 Mailing Address: Dorset Hollow Builders 15 West Hollow Road, Brewster State New York Telephone Zip 10509 (914) 279 -1339 Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: Dorset Hollow Builders Lot # _8 15 West Hollow R6ad Brewster, New York 10509 Dorset Hollow Estates 2. Nameofproject: (. formally VanCleef Est�3. LocationT/V: Patterson 4. Design Professional: Peder W. Scott, P.E., R.;�. Address: 3871 Route 6 6. Drainage Basin: East Branch Reservoir Brewster, NY 10509 7. Tyne of Project: X . Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted X 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... No 10. Has DEIS been completed and found acceptable by Lead Agency? ............... N/A 11. Name of Lead Agency Town of Patterson Planning Board 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ..... ............................... ..................... Yes:-. 13. If so, have plans been submitted to such authorities? ........ ............................... Yes— Subdivision 14. Has preliminary approval been granted by such authorities? Yes Date granted: 1 ,998 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. If es name of water Supply Town of Patterson byrsystem yes, pp y Distance to water supply 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 1 > - 1q - q 6 23. Name of Health Inspector M 24. Project design flow (gallons per day) ................................. ............................... Budzinski P.E. 800 GPD 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... No 26. Has SPDES Application been submitted to local DEC office? .......................... Form PC -97 27. Is any portion of this project located within a designated Town or State wetland? No 28. Wetlands ID Number ........................................................... ............................... N/A 29. Is Wetlands Permit required? Individual 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 2 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. ao Blocky Lot 1 op 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 Sectiorp;10.45 of the Penal Law. SIGNATURES & OFFIClAL TITLES. Mailing Address: ............... ................... Scott Agent for Applicant 3871 Route 6 Brewster, New York 10509 PUTNAM COUNTY DEPARTMENT OF HEALTH DMSION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Date: l_1_6101 Inspecte y: Street Location l7- 'S T7Z F_ c ; Owner7)oR!5E7- aC —%ZS Town ='4 Permit # i`-'- - TM r 3 , �o -- — /O 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. SeNlaQe System a. - Septic tank size - 1,000 .... 1 ,25Q.:' ..... 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 & trencht e. Junction rencT —dies Box - properly set .......... ............................... engt required / Length installed V 9 2. Distance to watercourse measured 1 v v 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. PumR or Dosed Systems ize ot pump chamber ............ ............................... 2. Overflow tank ......................... ............................... 3. Alarm, visual / audio ................ ............................... 4. Pump easily accessible, manhole to grade............ 5. First box baffled ........................................ : .......... . 6. Cycle witnessed byH.D.estimated flow /cycle..... M. HouseBuildin a. House I ocated per approved plans..: ........ ... lC 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. Curt ain drain & standpipes installed according to p f. Curtain drain outfall protected & dir.to exist water g. Footing drains discharge away from STS area........ h. Surface water protection adequate ........................... nnnt­1 r.rn<4A.A APR -16 -2001 11:03 AM HARRY W NICHOLS 914 279 4567 a PUTNAM COUNTY DZPARDMNT OF WALTB DIVISION 01 ZNMONMMNTAL IEI1nALTH SERVICES ATTENTION 0 ADAM P((;F E • • R�n1F 4'�,gOA PIl�IAL 1rISPECTiON For: All Wormatiou must be My 4ompleted prior to Lay icspectioas being made. PCHD Construction Pe 't # 3 3 - d g Located: s Owner /Applicamt Nazar - ni . Formerly: Subdiviaioa Nome: Supdivigoa Lot # IS systcm.fIl completed? Date: Is system coindlete? 'u I Date: is ayatem constructed ae pet plLns? Is wen drilled? - - - -h, Is well located to per plans? Are erosion control meant= in place? Fin Treachos L� f a l�` Sv h 1q, y 2.O Block -— L Date: 1 ratify that tba oyx*sX as hated, at the above prtmisas has beta constructed and I bane laptcted and ver'if'ied their completion in accordance with the issued PCHD Consuucdon Permit and approved plus and the S=dwds, Rules and Regulations of the Putnam County Dtparuaeat of Hedt3 ZRA Date: e CwtiBd by: E Dal rofessional } ,j V., Address: �Q 1& 1 ra:��� Lit. # �' �• j'Z'`.[ Corot V= Form M-99 P.01 BRUCE R. FOLEY Public Health Director April 17, 2001 LORETTA MOLINARI RN., 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 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 Harry Nichols, PE Patterson Park, Suite 106 2050 Route 22 Brewster, New York 10509 Re: Dear Mr. Nichols: Field Inspection - Dorset ollow Builders West Street (T) Patterson TM# 3.20 -2 -100 The separate sewage treatment system can be backfilled. The following comments must be corrected in the field: • The cast iron pipe is not installed at this time. • Add silt fence below the separate sewage treatment system as shown on the approved plan. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. Very truly yours, Gene D. Reed GDR:cj Environmental Health Engineering Aide �a PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at 53 West street �;.?�f r� D Town or Village g Subdivision name D o r s e t Hollow E sSubd. Lot # 8 Date Subdivision Approved I••: Owner /Applicant Name Dorset Hollow Builders Patterson Tax Map 3.2 0 Block 2 Lot 100 Renewal Revision Date of Previous Approval Mailing Address 15 West Hollow Road, Brewster, NY Amount of Fee Enclosed $300.00 Building Type Residence Zip 10509 Lot Area • 9 2 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 1250 gallon septic tank and LI q q L. r o � Other Requirements: To be constructed by Dorset Hollow Builders Address 15 Town of Patterson Water Supply: X Public Supply From Water District ..e or: Private Supply Drilled by West Hollow Rd., Brewster, NY Address 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 treatments em 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 4— j L1- &00 Address 301 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 considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe t. pproved ischarge of domestic sanitary sewage only. By: ' Title: Date:3 / taxi White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97