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HomeMy WebLinkAbout0152DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 3.20 -2 -101 BOX 2 00152 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION P V-,SEWAGE TREATMENT SYSTEM �r PERMIT # P- of ' O Locatedat 59 West Street Subdivision names o r s e t Hollow E sSubd. Lot # Date Subdivision Approved 1998 Owner /Applicant Name Dorset Hollow Builders Town or Village Patterson Tax Map 3. 2 0 Block 2 Lot 101 Renewal Revision Date of Previous Approval Mailing Address 15 West Hollow Road, Brewster, NY Amount of Fee Enclosed $ 3 0 0.0 0 Building Type Residence Lot Area - 9 2 a c -No. of Bedrooms 4 Zip '1, 0 5 0 9 Design Flow GPD 8 0 0 Fill Section Only Depth Volume PCHD NOTIFICATION IS REOUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1250 gallon septic tank and 4 06 L F of 24" wide trenches (7rows @ 58 LF) and 1007 reserve. Other Requirements: To be constructed by Dorset Hollow B u i l d e r s:; Address 15. Town of Patterson Water Supply: X Public Supply FromW a t e r District or: Private Supply Drilled by West Hollow Road, 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 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 re irs thereto. Signed: P.E. jC R.A. Date q7 3 -- )LcxD Address 3-9-7-1 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 when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it. pprov . r discharge of domestic sanitary sewage only. r / ', J By: � � �� Title: � � eu Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Street Loca ' �11 S+ Town TM # 1. Sewaee Svstem Area FINAL SITE INSPECTION Date: fZ� Inspected by: Owner Permit # Subdivision Lot # --r a. STS area located as per approved plans ........................:.. b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course/ wetlands ...... ............................... II. Sewage System a. Septic tank size - 1,000 ........1,25 .........other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribtuion Box ' -1 All out —lets at same elevation -water tested............ 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches Junction B x - properly set ................. ............................... ength required Ijp Length installed 7' 2. Distance to watercourse measured 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 v /. 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. HouseBuildin a. House I ocated per approved plans ... .....................:......... b. Number of bedrooms .................... ............................... IV. Well. a. Well located as per approved plans .............................. . b. Distance from STS area measured ft........... c. Casing 18" above grade .................. ............................... d. Surface drainage around well acceptable ....................... V. Overall Workmanship a. Boxes properly grouted. b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d. Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed,according,�to plan.l;��� • , i .a 1, f. Curtain drain outfall protected & dir::t "" Ik�watefcou'rse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 1/97 oan - PUTNAM COUNTY DEPARTMENT OF HEALTH DMSION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWNER: STREET LOCATION: REVIEWED BY: :� iR - AS, SRDATE: _ Y�N DOCUMENTS �) PERMIT APPLICATION (� /)WELL PERMIT ORPWS LETTER (PC -97 LETTER OF AUTHORIZATION DESIGN DATA SHEET (DDS) �(! )CORPORATE RESOLUTION ( �)(__)SHORT EAF (__)C__)PLANS -THREE SETS ( _)C__)HOUSE PLANS - TWO SETS (---)(--)VARIANCE REQUEST / SUBDIVISION ((� LEGAL SUBDIVISION SUBDIVISION APPROVAL CHECKED CL PE RC RATE (9 C-- I LL REQUIRED DEPTH C_)C�)CURTAIN DRAIN REQUIRED / GENERAL DLOCATED IN NYC WATERSHED C--) ANS SUBMITTED TO DEP C� DELEGATED TO PCHD (_) DEP APPROVAL, IF REQ'D L�DEEP TEST HOLES OBSERVED PERCS TO BE WTTNESSED EX- APPROVAL SSDS ADJ, LOTS WETLANDS (TOWN/DEC PERMIT REQ'D?) DATA ON DDS PLANS & PERMIT SAME EIRE 1969_ NEIGHBOR NOTIFICATION TTER BI/ZBA (_)100 YR- FLOOD ELEVATION W/I 200' (---lt ' SOIL TESTING LOTS >10 YEARS OLD AGE SYSTEM PLAN - (NORTH ARROW) FLOW NSTRUCTION NOTES 1 -15 EEP RESULTS 2' CONTOURS EXISTING & PROPOSED DRIVEWAY & SLOPES, CUT FOOTING /GUTTER/CURTAIN DRAINS USDA SOIL TYPE BOUNDARIES TITLE BLOCK; OWNERS NAME ADDRESS TM #, PE/RA; NAME, ADDRESS, PHONE# DATE OF DRAWING/REVISION DATUM REFERENCE LOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS WELLS & SSDS'S W/IN 200' OF SSTS PROPERTY METES & BOUNDS COMMENTS: (REVSHEET) TAX MAP #: (CONFIRMED) 'S .2D 2— " (a-) Y (REQUIRED DETAILS ON PLANS CONT'D) HOUSE SEWER -' /," FT. 4 "0 ;TYPE PIPE CAST IRON (_)NO BENDS; MAX BENDS 45° W /CLEANOUT RENEWALS .,;=�� NOTE (NO CHANGE) FILL SYSTEMS k—)(�)10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE SPECS/ FILL NOTES 1 -5 Cam( fFILL FILL PROFILE & DIMENSIONS L IN EXPANSION AREA FILL GREATER THAN 2 FEEAY BARRIER CERTIFICATION NOTE PTH GAUGES L. ON PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS ARATION DISTANCE FROM TOE OF SLOPE TRENCTRENCH PROVIDED 60FT MAX. RALLEL TO CONTOURS �100% EXPANSION PROVIDED DETAIL/DUST 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 (_v 0 100' TO WELL, 200' IN DLOD, 150' TO PITS CV' 100' TO STREAM, WATERCOURSE, LAKE (inc. expan) 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER (2 )L �) )10' TO WATER LINE (pits - 20') ( /�(50' INTERM TTENT DRAINAGE COURSE (;,)(-`j200' /500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS (UU10' MIN TO LEDGE OUTCROP SEPTIC TANK Ls!!1�10' FROM FOUNDATION; 50' TO WELL WELL f, SIONS TO PROPERTY LINES LOCATION OF SERVICE CONNECTION MIN 15' TO PROPERTY LINE SLOPE ZC— )SLOPE IN SSTS AREA (520 0/6) GRADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS X(—�l PUMP NOTES DOSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED DETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) PIT AND D -BOX SHOWN & DETAILED DAY STORAGE ABOVE ALARM &V20'CURTAIN DRAANDPIPES, 5' BOTH SIDES, DETAIL MIN to CDS = >5 %, 20' -4 %, 25' -3 %, 35' -1 %,.100 % - <1% MIN to CD DISCHARGE /100' with 182 cons day discharge 10' MIN to NON - PERFORATED PIPE DST= I C•"T�"�= CS`L�, 3'. M CwT.e= $�2.; aGr'C/ /S /-� oN r�,2. o ,c.::r 5.55 �.=? M,4- t•�i,?•R..� �y. -G�t ; dr/� !,f/,Uir�- o,�:�.ys Ny 3. ZO 2 %OSOS yO ...'=-a at (Street)1 Sec. Ect / .`•�:.::._'_ ''s_r Pars-- �-SOni T�at�Y�: ^.e✓. l-Rori�N• �'' '. Data Cf- Date P eX=.LZZ!CA T2.S:. /0 %3n A'- :11.: L.LP.L'S2 �pti'1 . S'Va` or"G'Z Wc' �ter Z2Ve1 HO. Ti►'" GrcummG S=acs 7_'1C:1e5 Sc-, Rate St=:. Stcdn Drcc III L/ . . 2 ...1 /; 41 3 1-,1 ;74, ;/y 4 2 3 _. 5 , . FMS: 1. Te&= to be re^ tea• at sacra? depth uat.I appr=d=at,- y eciml soil. �L�s . are obt3nea .at eac w pe=lat+cn test hole. ' 'Al i data be s-u -mitt- A for review. 2. Depth m = ewazts to be node top cf hole D G.L. T 6' 7' 7 ' r. 8' 9' 10' ,I. 12' INDIC= I.D= AT WEIICri GRO ,Z= IS E%=U== - DIM= LIE, TO Tr' UC.v Y A= ZZVM RISES = :�1G E�� LN D=. HOLE Oi'S ERVATIONS MADE BY: DATE: DESIGN Soil Rate Used 6 _ 7 Min /1" Drop: S.D. Usable F.rea Provider No". of Be roau Septic Tank Capacity 12 � ^ gals. Tyree Absorption Area Provided By L.E. x 24" width trencz Other W. rA- ,1 Tr1:,ST PIT DATA Rt' '= TO EE SMMI= W-j --r"u tun=,TIGLI DESC=GN 2 SOILS 1aC~yjN=- �LJ IiI =T HC. HC= NO EOLF. M. ? HOLE M. i nature - i a Name � (.✓. SGoT.r ,.- .uGiNE iP�NG �,JPc.�iTs• =� ���,� Address SEAL , 50 9 'MIS SPACZ FOR USE 13Y r MUTM DUAMMIM ONLY: . Soil Rate Approved sa:ft /gal. , Cnecked by , ' Date a 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 CXAttached ❑ Under separate cover via • Shop drawings ❑ Prints ❑ Plans • Copy of letter ❑ Change order ❑ U_�CTITM @IF "I ° H @LM.1OTTQL DATE 0p® JOB NO. 99 -159 ATTENTION RE: iL Dorset Hollow Estates — Lo*, (formally Van C1eef Estates) Subsurface Sewage Treatment System (SSTS) Application for Approval of Plans (PC -97) I ❑ Samples the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION 1 Application for Approval of Plans (PC -97) I I 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 #g6?_,2g50090 for the amount of $ 3oo.op 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 El • Resubmit copies for approval • Submit copies for distribution • Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS List Continued: 4 1 Septic Site Plan Drawings 1 1 E911 Address Verification Form (E911 Verfrm) COPY TO SIGNED: If enclosures are not as noted, kindly notify us at once. ti PUTNAM COUNTY DEPARTMENT OF HEALTH 7 DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM I 1. Name and address of applicant: Dorset Hollow Builders Lot # % 15 West Hollow Road Brewster, New York 10509 Dorset Hollow Estates 2. Nameofproject: (formally VanCleef Est)3. Location TN: Patterson 4. Design Professional: Peder W. Scott, P.E., R.5. Address:3871 Route 6 6. Drainage Basin: East Branch Reservoir 7. Type of Project: X . Private/Residential Apartments Office Building Food Service Institutional 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? ......................... No 10. Has DEIS been completed and found acceptable by Lead Agency? ................ N/A 11. Name of Lead Agency Town of Patterson Planning Board 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ......................................................... ............................... Yes: 13. If so, have plans been submitted to such authorities? ........ ............................... Yes— Subdivision 14. Has preliminary approval been granted by such authorities? Yes Date granted: 1998 15. Type of Sewage Treatment System Discharge ................. surface water X groundwater 16. If surface water discharge, what is the stream class designation? .................... N/A 17. Waters index number (surface) ........................................... ............................... . N/A 18. Is project located near a public water supply system? ....... ............................... Yes 19. erviced If yes, name of water supply Town of Patterson Distance to water supplyby system 20. Is project site near a public sewage collection or treatment system? ................ No 21. Name of sewage system Individual Lots Distance to sewage system 22. Date test holes observed 11-1q-9G 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 cPD 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... No 26. Has SPDES Application been submitted to local DEC offices N/A Form PC -97 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 I .,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 Sect* 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES. Mailing Address: ................................... V "-- Peder W. Scott ;Agent for Applicant 3871 Route 6 Brewster, New York 10509 2 27. Is any portion of this project located within a designated Town or State wetland? No 28. Wetlands ID Number ........................................................... ............................... N/A 29. Is Wetlands Permit required? .Individual Lo.t 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 3.;to Block_ Lot to 1 37. Approved plans are to be returned to ..... Applicant X Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item I .,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 Sect* 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES. Mailing Address: ................................... V "-- Peder W. 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 59 West Street T/V Patterson Tax Map# 3.20 Block 2 Lot 101 Subdivisionof Dorset Hollow Estates (formally Van Cleef Estates) Subdivision Lot # 7 Filed Map # 2 7 7 1 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 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. Countersi P.E.. R.A, Mailing Address. 3 8 7 1 R o u t e 6 Brewster State New York Zip 10509 Telephone: ( 9 1 4 ) 2 7 8 — 2 1 1 0 Very t y u Signed: m��� (Owner of Property) Mailing Address: Dorset Hollow Builders 15 West Hollow Road, Brewster State New York Telephone: Zip 10509 (914) 279 -1339 Form LA -97 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 # 7 (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 trukKours,: Edward Bloe G &E Develop nent PO BOX 352 BEDFORD, NY 10506 14 -16.4 (2/87) —Text 12 PROJECT I.D. NUMBER 617.21 •SEQR Appendix C State Environmental Duality Review SHORT .ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR 2. PROJECT NAME Dorset Hollow Builders Dorset Hollow Estates 3. PROJECT LOCATION: (f o r m a l l Van C 1 e e f E s t'a t e s) Municipality Patterson County Putnam 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) Lot #7 - Dorset Hollow Estates (formally Van Cleef Estates) 59 We64 5 +ree t , Pourso^j 5. IS PROPOSED ACTION: El New ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: Construction of subsurface sewage treatment system - for single- family resid'emce and connection to public water supply. 7. AMOUNT OF LAND AFFECTED: Initially 0 • S 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 11 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 /PCDCH 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 na : P.W. Scott , P . E . , R.A. Date: tl 3 1.000 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 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, 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: 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. CS. 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 im01•C5? 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 significa6t. 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 Lead Agency Signature of Responsible Officer in Lead Agency Name of Lead Agency Date I Title of Responsible Officer Signature of Preparer (if different from responsible officer) BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director t� Services Dire of Patient 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 DATE: M The . Putnam County Department of Health will not issue. a Certificate of Construction Compliance unless the: above Iorm 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 VERFRK THE CITY OF NEW YORK DEPARTMENT OF ENVIRONMENTAL PROTECTION JOEL A. MIELE, SR., P.E. Commissioner WILLIAM N. STASIUK, P.E.;Pb.D. Deputy Commissioner _ .PHONE (914) 742 -2009 Bureau of Water Supply 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 7 West Street Patterson, Putnam East Branch Reservoir DEP Log # 10156 (Joint 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 7 prepared for Dorset Hollow Estates", dated 03/27100. 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 Engineering Design & Review xc: James Covey, P.E., NYSDOH 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 �Mil LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (914) 278 - 6130 Fax (914) 218 - 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 West Street, TM# 3.20 -2 -101 Lot #7 (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. Standard notes 1 -15 are to be provided. 2. The PCDOH has been finding dirty crushed stone during final inspection requiring the, removal of the system. Please revise the absorption trench detail to clarify washed crushed stone (dust free). Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. ' Ve ly yours, Robert Morris, PE Senior Public Health Engineer RM:cj , i l` _ - -• - t 3 i / $O� 6 ' ; R _ .25.00' L '.39.27' MON' ' 480) N �RD \FD �, t #5 -_ _�` 35' MIN. 45 s5 42' / SETBACK TO` 50' MIN. i' O ROOF IAND OTING ( SETBACK TO I a DRAIN 1; ••►_ MANHOLE 4 "0 CIP vj x O O tD 1 y MH � I ; 79.49' { 2 'i t i o LIST. (D �,'(� ---•� 1250 GAL. } OZ'S I' SEPTIC TANK �`, L' m JCR- CHMENT _ /4,I SDR -� 5 I I 1" c PPER� 1 Opt DIED 1 f �/ !j %4 p 12.5% t � T _� FOR SEPTIC im 1 , �.\ L O j L' 4 "4 .SOLID O o WATER SERVICE .LINE ON$TRUCTION :N ; fir\ / 10' MIN. n I I WITHIN HE '� g % / PVC ® 1.3% 0 SETBACK CO 3 DO , Bil ER I , / / OVERFLOW , TO TANK �.1 p { I w OF NYC r�, h4 D- BOXES .(TXP.) 4 p (476) O I WETIAN t� �v, I I tL •I Df?zz �:' I i z I � o �, / ��gPGON �R�� � � . � , � �;� � � ; i � �' ; • 1 � M 1' 1 ' SETBACK MIN ! I BACK 7 TRENCHES. ' •^ 50' SETBACK` 701 ;STS V o I ii� FROM STORM ` 1) I I I I I{ I (474) U) o rn I a c )j )j .17.7 � (472) 0' TO SSTSCK 1 _ 3-- 62- 7'08 .�- '.o� 6"0 DUCTILE IRON FROM PROPERTY ., _ .,,P6 6' 267.44 WATER MAIN 4 LINE AND - F23 R2 R1 TYP. --` _ ��- I I sae 72 U 2E WATER .LINE y $ R7 R6 R,'-),.R4 7 p8 „W 9S ENDS`,OF a' E, 4' 30.05 t I S ;N52'2 220.0” bISTRIBUTION _ 3 : �� _ PIPE TO C470) NarzTOS'w �. BE, CAPPED ( 72) ba�E', # of \ — G� J_ 57 E 9 82 1�1ATER -SERVICE LIN (468) ' H RB2t