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HomeMy WebLinkAbout0155DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 3.20 -2 -105 BOX 2 , : ; IN iy AA 16 1 4,lrm � ■ 4 T ol L klLL 00155 Sent By: LLL; 234587 ; Sep -13 -04 9:1.9AM; PUTNAM COUNTY MALTH DEPARTMENT 1rVI5ION OF ENViRONNWT'AL HEALTH SERVICES €j SI'CE LOCA'l'ION W C--5T X12-1 6 T - j OWNEWS NAMe c-y-A" lZ" E MAII,,ING ADDRESS 5 We--S ' A tM# -�.�o PERSON IlM RVIE D PCHD Can 04 tw .ems owner,'t�wea, ace. DATE � O -04 i"KPE FAG'iLl PROPOSED INSTALLER tJ L-- v - - PHONE Z ADDRESS 6�* 1+0-e- *4 RAMN# of t�pNLY tint# Page 2/5 p,tomw (Include sketeb locating all adjacent webs): NOTE: Repair mW be in sale location and of isema type as original sewage disposal .Diffavat location may require submittal of proposal Rona 11cmed professional tea 4c im&, rend toot. o i l i fI I, as owner, or Mort9d ag of owner the condidow stated on this form. sicrr� Tm, .BMW so"V Hdth dW.fhllaMdu& Wa9,Qa= I. Prvcnrcment of any Town permit, if applkmbla 2. Submission of as built rcpalr sketch in duplicate showiq: IL owners name b. Site Sheet Flame, Town and Tax Map number. o. Location of h*Wed components W to two facd points (e.g.,hau d Syatcm description (e.&'1250 gal. C.onente sgdc tame:, three pre c. taakta' s c and number. 3. Syatush repair to be perfomud in accordance the above pmposd and Proposal approv inspector's Sig� do Title COPIES: Ww1c (PCHM Yellow (Town 84; Pink (applicant) PCAP "NIL t '1 r7cra1rs,lcr ^_ nu vxa ut7►�au ��ra rr� � l7_17_7fa�i1 'Mf1F.� 'r amen). 0 diem. - X V deep 1115-10--, /s /o y DATE KV A7,C lant ;n_7 _qnr CG) Sent By: LLL; 234567 SEEP -03 -2004 04:17 P.U. SCOTT LOT Not 4 -a 0.958 AC AMA Irl 16 1-7 Sep-13-04 9:19AM; Page 3/5 '1 8452702166 P.03/04 v ME= f I1;��'1�� I 08Q . MA fan =55,(9 Good 9'29-1 501 V�o L01" 1% Sent B`y: LLL; SEP-03 -2004 'x14:17 234567 ; P. W. SCOTT Sep -13 -04 9:20AM; Page 5/5 ji 8452782166 P.04/04 LOCATION DESCRIPTION FROM POINT A B 1 ST' _ 2 ST 14,_6„ 4$'- „ 6 3 ST - - 4 ST 23' -6" 5 OB 40' -6" 6a. -0" 6 DB 42'_0" Of-9t,. 7 DB 43' -0" 8 __._.. DB 45' -6" . _ 50#_01, _g ...DB 48' -2" 46'..1 p" 10 DB 51' -6" 45' 3" 11 D8 55' -0" 44' -0" 12 TRENCH -P1 103' -8" 109' -10" 13 TRENCH -P2 103' -0" 108' -5" 14 TRENCH -P3 104 -0" 1001 - 0" 15 TRENCH -P4 105, --0" 16 17 TRENCH -P5 TRENCH -P8 106' -0" 109' -0" 111' -9" 18 TRENCH -P7 112' -0" 113'_3" cco_� �_crnna 'nin�i rn�• a� TGi • aa�- a7l� -7Q�1 • f NAME: PI ITNAM C71I IN1 I i Tf17AI P. PIZ I I Y DEPARTMENT OF P. 5 Sent 8'y: LLL; 234567 ; Sep -13 -04 9:19AM; Page 4/5 I , SEP -2- 2004 , j3:54 FROM: PUTNAM COUNTY ,DEPART 845-278-7921 M96087085 P:1-11 a UTNAIVI CO J'N "S� DEPARTMEN"I` O►F EE T D SION OF ENVIRONMENTAL HEALTH S RVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE THE ,TMENT SYSTEM PCHD CONSTRUCTION PERKIT # P (E Locawd at � Town or Village ,^ Owner /Applicant Name 5e-y -Hollow . �� i �15TAx Map RIM)c Foraaczly�. ,,�,1�rlti� � 7e!� ES`f G1 rtE S - _ -- Subdlvision Nam - I SWA. Lot '- Mailing Address IV Bate Construction Xet6t issued by pCliD '7 /11 %p &mratz. 5SVe0g!t 515tew built by m L Consisting of . ' .f Gallon SepticTank and „ other Requin meats: _ ... Water Suonly; TowN 6r t�es?� Public Supply From ettr ra }•srrrGt _ AddrCSSr o. rc Private: Supply Drilled by _ A&=ss Building Type C t Has erosion control bean completed? Number of Bedmoms Has garbage grinder Won imsmlled? _ 1 certify that the system(s), as listed, serving the above premises weir, cob ovuetcd built plans (copies of which arc attached), in accordance with the issued PCHD Cc plans and the standards, rules and regulations a team Coup cm Date: �9 ° "� Certified by _ ofestfonal} of Address 3, 01 Rm ra f, , If yVA.Ktov ! - /V Y , 4i-0 ; License # Any person occupying pre nises served by the above system(s) draft promptly take, such to segue the d6rftfion of any unsanitary oonditions resulting from such usage,. Appr( tmatrnent system shall become null and void as soon as a public sanitary sever become! of the private water supply shall become null And. void when a public water supply approvals ubject to modification or ebange whew in the judgment of the Fu revocation cation flrphange is necessary. By: Title: U _ White copy - HI) pile; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy Lot zip /04'a 9 ky A � ! NQ, ally as shown on the as- on PanWt and approved P.B. R.A. Action as n4ay be nccessnry Val of the separate sewage available ud the approval becomes available. Such die Heaht Director, such )ate• pcsign Professiopal Farm CC -97 i U'T1i1AM COUNTY DEPARTMENT OF HEALTH D ISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # P 00 Located at � i r1,�9r✓S �� tY� Town or Village r Cot ffemYs g Owner /Applicant Name NY&et- HnAokl &tJC1,eie>-Tax Map 3,10 Block I Lot IBS Formerly [ /Gnu C I�et• �.S f'Gt fop S Subdivision Name .1/'rV.S,C> -tl 75-rcc Subd. Lot # If— Mailing Address C. CV <-C� HC' t I'm l R' Cut ul P re'ws er Zip Date Construction Permit Issued by PCHD % ��Jj y Separate Sewerage System built by 1k�E r' 0)[10W kt+4G�fAddress it fib( m' ff ilow RA 'A '5(cl' Consisting of ( "�1'0 Gallon Septic Tank and LF- } �� r La,'. �'d"e ty*�I C ltes Other Requirements: Water Sunnly: Public Supply From �I jm t-;t�,r 1>4S t y ct . Address or: Private Supply Drilled by Address Building Type A-p— _<,� ; d—e %fit C E Has erosion control been completed? Ntunber of Bedrooms Has garbage grinder been installed? NO 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 . e Putnam Count - epartment of Health. n Date: Certified by P.E. X R.A. W rofessional) Address �ff ?) 2-.2 �' ,, �, - 1:3�t trY': N r 1 a f� �� License # 3 4� 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 ubject to modification or change when, in the judgment of the Public Health Director, such revocation, o ification or change is necessary. By: AMA0 Title: U� Date: 11hioi White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 0 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' (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Peder Scott, P. E. Scott Engineering. 3871 Route 6 Brewster, NY 10509 Re: Proposed Compliance: Dorset Hollow Builders 85 West Street, Lot 4 (T) Patterson TM 3.20 -2 -105 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: 1. Footing and gutter draw discharge was not found during final inspection on October 19, 2000. 2. Curtain drain discharge was not found during final inspection on October 19, 2000. 3. Current codes requ9ires that the satisfactory results of a coliform bacteriological analysis of a water same taken from the service connection, performed by a NYS Health Dept. approved lab. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Vci�y ly yours A'�AWOO Robert Morris, P. E. Senior Public Health Engineer RM /jp P. W. SCOTT - Engineering & Architecture, R.O. 3871 Route 6 BREWSTER, NY 10509 E- !Nail: pws @bestweb.net (914) 278 -2110 FAX (914) 278 -2166 TO Putnam County Dept. of Health' 4 Geneva Road Brewster, NY 10509 k [LIEUVIEn @1P DATE L 0 / 7 .) JOB NO. ATTENTION 1C� RE: Septic As -Built Dorset Hollow Estates - Lot # (formally Van Cleef Estates) 1 Certificate of Construction Compliance 3 WE ARE SENDING YOU Attached ❑ Under separate cover via the following items: ❑ Shop drawings ❑ Prints '❑ Plans ❑ Samples ❑ Specifications ❑ Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION 1 Certificate of Construction Compliance 3 1 Guarantee of Subsurface Sewage Treatment System 3 1 As =Built Septic Plan 2Fj q� Fee: $200.00 THESE ARE TRANSMITTED as checked below: :93 For approval X7 For your use ❑ As requested ❑ For review and comment ❑ FOR BIDS DUE REMARKS COPY TO ❑ 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 SIGNED: V L/ V � e� If oncInsures are not as noted, kindly notify u , ?t once, _VLA, PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner or Purchaser of Building Tax Map Block Lot boys e �ti i Building Constructed by Town/Village Location - Street Subdivision Name u( ,1 ct Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the oc ant of the building utilizing the system. Month �o Day Year Z'''' Signatur - Signature Corporation Name (if corporation) Title: 0 W Corporation Name (if corporation) Address: L, tp—cE. Ftoli,n ,/ Prev5 -f t 4- Address: ��s t, � ill ,; �c State # j Zip t S —o `1 State l� Zip (z P05 Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Street Location i,,l —osr 5 -rng-gr Town P4 rrrrr5c1,v TM # g: ;1. d -- ;L — /cg 5- 1. Sewaize Svstem Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Lgth. Width Avg.Dpth c. Natural soil not stripped ................... ............................... d. Stone, brush, etc., greater than 15' from STS area.......... e. 100' from water course / wetlands ...... ............................... II. Sewage System a. Septic tank size - 1,000 .......: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 TZen� required zlo,a Length installed boo 2. Distance to watercourse measured -�- is o 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 %2" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped ........................ ............................... g. Pumn or Dosed Systems 1. 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. HouselBuildin a. House located per approved plans . b. Number of bedrooms...... 3 `1.` IV. Well LA'S- Stiawp. ©H . 7-1 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 c tones <4" diameter .............. e. Curtain drain staridpi a nstalled according to plan.. f. Curtain drain ou a protected & dinto exist watercour; g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rav F /Q7 Date: 9 &,o Inspecte Owner w Rr�rL a�R s Permit # 'P— 3 - y y Subdivision Lot # Y "71,wgaT ,foie ��;; BRUCE R. FOLEY Public Health Director t 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 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 FAX COVER SHEET 19 Date: 1?9T �-o A.'�>a To: ?E Gel, Cev T;�' Fax #: 8 2-16 6 From: Gene D. Reed Putnam County Department of Health �ZFo r your information _ For your review No. Pages Please respond Attached as requested As discussed Please call _... __ Notes/Messages `✓ S;� d�0� -� 13 -1�L�— -- -- — - - - -- - - -- - In the event of transmission /reception difficulties, please contact this office at (914) 278 -6130 ext. 2261. CE R. FOLEY dic 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 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 FAX COVER SHEET Date: /D /�d�oa To: zo -rr Fag #: ;7-7 S ' 2-16 6 1Ze; LaT !Y Moscow i, W-05 i 5.i C�i�rrE7?SoN From: Gene D. Reed Putnam County Department of Health ZFor your information For your review As discussed No. Pages (Including cover sheet)- _ - --- - - - - - -- -- ............... - -- - -- j _ Please respond Attached as requested Please call Notes/Messages ♦ r ♦ t In the event of transmission /reception difficulties, please contact this office at (914) 278 -6130 ext. 2261. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM n PERMIT # 5 - Located at 85 West Street Town or Village Patterson Subdivision names o r s e t Hollow r s SUbd. Lot # 4 Date Subdivision Approved 1998 Tax Map 3. 2 0 Block 2 Lot 105 Renewal Revision Owner /Applicant Name Dorset Hollow Builders Date of Previous Approval Mailing Address 15 West Hollow Road, Brewster, NY Zip 10509 Amount of Fee Enclosed $ 3 0 0.0 0 Building Type Res i d e n c e 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 125.0 gallon septic tank and 40n L r= crr— ���� � t tJ i✓ Tl�-�� C:ct"�� Other Requirements: To be constructed by Dorset Hollow Builders Address 15 West Hollow Rd., Brewster, NY Town of Patterson Water Supply: x Public Supply From Water District Address or: Private Supply Drilled by K 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 s,, stem 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 6o C Address 3871 Route 6, Brewster, NY 10509 License# 059346 APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage trea system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified w en c sidered n cessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pen i proved ischarge of domestic sanitary sewage onl . By: Title: h C � -^ Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 � | | ) | MI 10/18/00 10:27 PW SCOTT -> 19142787921 NO.006 902 cp° P[ ITNAM COUNTY DEPARTMENT OF HEALTH DIVI!'-ION OF ENVIRONMENTAL HEALTH SERVICES QUEST FOR FIN A L INSPECTIQN For: Fill Trenches X PCHD Construction Pe rmit # !_'3V ='0 a Located 0 � 't% s-t1"e C {'1� ('V'} C -ATre f ';l Owner /Applicant Nam : 3rM 3t W Block �L Lot Po t' Formerly OW el'( Subdivision Name P!!neZ. f 4 /mill iS�q' 7t,$ Subdivision Lot # Is system fill completed? � A - Date Is system complete? _ YEA _sb COP" CAV.S Date� VV y Is system constructed t s per plans ?_ �_ Is well drilled? Date Is well located as per plans? Are erosion control measures in place? I certify that the systen ►(s), as listed, at the above premises has been constructed and I have inspected and verified :heir completion in accordance with the issued PCHD Construction Permit and approved plans am I the Standards, Rules and Regulations of the Putnam County Department of Health. Date: f° ter 00 Certified by: Pe d e s W.' S c o t tpE X RA x Design Professional 3871 Route 6 Address Brewster. New York 10509 Lic. # 059346 Comments: �• r i , rt %C T a.144 C&W are �. 61) ,d mar, ce r _ ��Vf Chid beC t i,�� _ CIP __. FOR: 0 ADAM C1 GENE Form FIR -89 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 1?11 Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ 112UTEQ W DATE v l - 6 V ` Z 3 JOB NO. 9 9 — 1 5 9 ATTENTION DESCRIPTION RE: Dorset Hollow Estates t -.r,T:ttL (formally Van Cleef Estates) Subsurface Sewage Treatment System (SSTS) 1 1 Construction Permit for Sewage Treatment System (CP -97) 1 ❑ Samples the following items: ❑ Specifications COPIES DATE NO. DESCRIPTION I 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 #5q5- /1�3 7_24for the amount of $ 3oca, c 1 1 Short Form EAF THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ For your use ❑ As requested X:1 For review and comment ❑ FORBIDS DUE REMARKS List Continued: ❑ 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 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. 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 # q 15 West Hollow Road Brewster, New York 10509 Dorset Hollow Estates 2. Name of project: (formally VanC16ef Es0. Location TN: Patterson 4. Design Professional: Peder W. Scott, P.E., R.Sk. 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? ............... 11. Name of Lead Agency Town of Patterson Planning Board N/A 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: 1198 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) ..................................... I..................................... . N/A 18. Is project located near a public water supply system? ...................................... Yes erviced 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 Individual Lots Distance to sewage system 22. Date test holes observed __q-%5 - q 6 23. Name of Health Inspector M 24. Project design flow (gallons per day) ................................. ............................... 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... 26. Has SPDES Application been submitted to local DEC office? ............. :........... Budzinski P.E. 800 GPD No 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 Lo.t Has application been made to Town or Local DEC office? ............................... N/A 30. Does project require a DEC Stream Disturbance Permit? .. ............................... No 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ............................ Yes/No No 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No No DESCRIBE: 33. Is there a local master plan on file with the Town or Village? ......................... Yes 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? Water-'.only 35. Are any sewage treatment areas in excess of 15% slope? . ............................... No 36. Tax Map ID Number ............................. :........................... Map -3.Ao Block '), Lot 1015 37. Approved plans are to be returned to ..... Applicant X Design Professional NOTE: All applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Letter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of t1K Penal Law. SIGNATURES & OFFICIAL TITLES: Mailing Address: ................................... 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 85 West Street T/V Patterson Tax Map# 3.20 Block 2 Lot 105 Subdivisionof Dorset Hollow Estates (for.mally Van Cleef Estates) Subdivision Lot # Gentlemen: 4 Filed Map # 2 7 7 1 Date Filed 12/24/88 This letter is to authorize P e d e r W. s. c o t t, P. E., R. A. a duly licensed Professional Engineer X or Registered Architect to apply for the required wastewater treatment and/or water supply 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. Very t ou , Countersigned: P.E., R.A., # 059346 Mailing Address 3 8 7 1 Route 6 Brewster State New York Telephone: Zip 10509 (914) 278 -2110 Mailing Address: Dorset Hollow Builders 15 West Hollow Road, Brewster State New York Telephone: Zip 10509 (914) 279 -1339 Form LA -97 TEST PIT MT-''A R, -'= TO BE Su7Ml= NMI'H App1 r:ATyONi >L 4 DZS= -TIC. F SOILS r — Mjk1IT;RLD IN TEST E� S H= NO_ 1 EOL:: M. -7 � HCLE N0_ G. r. - j 2' .y IN 31 i Jr 71 a 10` 11, 12' 14' - MDIC=T,- 10TEL AT WMICH GRCUNUC -C—M IS EL \=UL\ITTINE7 - I�WIG�TE LEVY TO WHICH SIa= 10= RISES A= BEING I''=UNT.EE-tID - DEEP HOLE OBSE.ERVATIONS MADE BY: DAM: DESI&N Soil Rate Used 4- - Min /1" Drop: S.D. Usable Ares Provided No". of Be rocs Septic Tanis Capacity gals. ^_+ape I-Ile, c ,-/v6 . Absorption Area Provided By VOd L.F. x 24" width trench Other Nam � W. SCoT' E, _ I,,VPZNIW ZA c yi��c.�r��f igratt: e Address 3)671 SF-kL . THIS SPACE FOR USE 13Y l i1LT:i DE. IU 'O 0=: Soil Rate Approved sq :ft /gal. ' Ciecke3 by Date in d DE - AmAmiT CF 'dEUM-T DrJISIC,1 OFiVL�L'�r, Fib yL"'I? Sc.tViC:S . 3PPENDIX I DD�yG.d � S - �JESu'r�_.C= Sr:^Tr�Gc. DLP r'iL SLS F= M. owmer SRG 237 3. ZO 2 %0605 y0 l cat d at ( S tre--t) -cJ d-A-4- �a C •• _ /:%.I- B1CCk j rot (incu.cate nearest cross street) 1�..:nic:.r,.,a! i � r PrF�,�sonl_ WatrYs::e� GRoT�n� SOS, PE2COL'T'IC3-q T_.ST r-An- RE'.ED T � T �? Zata of P`-e- Scak -,Ln Date of Percclaticn Test EOLc, ' N ---IP- cZ SCr ?'7tiiE PERC OZAZETON P_�".cCOL��'ICLI Run Elapse Depth to .Water r?°ca Water Level No. Ti.Me Ground Su.�ace. In inches ' Soil Rate Start -Stoo ML-1. S` Stop Drop In M..in /la Drop — Thdies Inches Inche -s .. l - .2 -30 � • 2.;��, � pct Z/ , rl L y .. 3 • . 3 •- -- • J - ...__ ... _ _.. _... _. .._.. .. .... ......— ..ten -.- ..._ ,rr� 3 3,.37 _3,59 —r 2 tCOLS : 1_ Tests to he repeated• at same depth until agprc dmately equal soil =ts are obtained .at each per=laticn test hole. A-1 data to' he su�nitt� for reviera. 2_ Depth mas= -2nts to be ride f -"= too of hole- 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 # 4 (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. G &E Development PO BOX 352 BEDFORD, NY 10506 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 (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 1 1 Van C.1 e e f Estates) Municipality Patterson County Putnam 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) Lot I - Dorset Hollow Estates (formally Van Cleef Estates) 5. IS PROPOSED ACTION: 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 syapply. 7. AMOUNT OF LAND AFFECTED: Initially . 3 acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? U Yes ❑ No If No; describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ® Residential ❑ Industrial ❑ Commercial ❑Agriculture ❑ Park/Forest/Open space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? ❑ Yes ® No If yes, list agency(s) and-permit/approvals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ® Yes ❑ No If yes, list agency name and permit /approval Subdivision approval from Town of Patterson Planning Board /PCDOH 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? ❑ Yes ® No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant /sponsor name: P.W. S c. t t , P . E . , R.A. Date: gF, /0--6 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 11— 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) Ct. Existing air quality, surface or groundwater . quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, of other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation of fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly. C5. Growth, subsequent development, or related activities likely to be Induced by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not identified In-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 Lead Agency Signature of Responsible Officer in Lead Agency Name of Lead Agency Date ORA Title of Responsible Officer Signature of Preparer (if different from responsible officer) BRUCE R FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLrNAR1 RN., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (914) 278 - 6130 Fax (9,14) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 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: Dorset Hollow Builders Lot 4 3.20 -2 -105 E911 ADDRESS: 85 West Street Patterson TOWN: AUTHORIZED TOWN .OFFICIAL: (Signature) DATE: Z? Go 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 VER Uvf) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS NANIE OF OWNER: REVIEWED BY: Y N DOCUME C-)(-UPERNIrr APPLICATION JUUWELL PERMIT OR PWS LETTER REVIEW SHEET FOR CONSTRUCTION PERMIT STREET LOCATION: _ ail L r . AS, SRDATE: �J rs TAX MAP =: (CO NTS. Y N ( REOUIRED DETAIL C_)LUPC -97 UULETTER OF AUTHORIZATION C_JC__)DESIGN DATA SHEET (DDS) UUCORPORATE RESOLUTION C__)C_JSHORT EAF (-)(JPLANS -THREE SETS C--)C-)HOUSE PLANS - TWO SETS UUVARIANCE REQUEST SUBDIVISION (_JC„JLEGAL SUBDIVISION UUSUBDIVISION APPROVAL CHECKED UUPERC RATE UUFILL REQUIRED DEPTH C-)(--)CURTAIN DRAIN REQUIRED GENERAL C-JC JLOCATED IN NYC WATERSHED CJUPLA -NS SUBNffITED TO DEP (__)(_)DELEGATED TO PCHD C JC_JDEP APPROVAL, IF REQ'D )(_)DEEP TEST HOLES OBSERVED C-JC-)PERCS TO BE WITNESSED UUEX- APPROVAL SSDS ADJ, LOTS (—JL—)WETLANDS (TOWN/DEC PERMIT REQ'D ?) UUDATA ON DDS PLANS & PERMIT SAME C_ (_)PRE 1969 NEIGHBOR NOTIFICATION C-JC_JLETTER BI/ZBA (___)0100 YR. FLOOD ELEVATION W/1200' (-JC_)SOIL TESTING LOTS >10 YEARS OLD REQUIRED DETAILS ON PLANS C-) _}SEWAGE SYSTEM PLAN - (NORTH ARROW) C-JC--)SSDS HYDRAULIC PROFILE U(_JGRAVITY FLOW C-J(_)CONSTRUCITON NOTES 1 -15 C_J(_JDESIGN DATA: PERC & DEEP RESULTS U(_)2' CONTOURS EXISTING & PROPOSED (-)(DRIVEWAY & SLOPES, CUT U( JFOOTING /GUTTER/CURTAIN DRAINS C__)( -JUSDA SOIL TYPE BOUNDARIES ( JC )TrrLE BLOCK; OWNERS NAME ADDRESS TNt",, PE/RA; NAME, ADDRESS, PHONE# (-JC_)DATE OF DRAWING/REVISION (-)( _JDATUM REFERENCE )C_)LOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. C__)(_JPROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS Cj( JWELLS & SSDS'S W/IN 200' OF SSTS ( J( )PROPERTY METES & BOUNDS COMMENTS: NFIRMED) -�) . ?-j Z -L a S ON PLANS CONT'D UUHOUSE SEWER -' /," FT. 4 "0'; TYPE PIPE CAS UUNO BENDS; MAX BENDS 450 W /CLEANOUT RENEWALS UUSrrE NOTE (NO CHANGE) FILL SYSTEMS C_J(-,_)l0' HORIZONTAL; PAST TRENCH SLOPES 3:1 U(UFILL SPECS/ FILL NOTES 1 -5 UC__)FILL PROFILE & DIMENSIONS C___)(�FML IN EXPANSION AREA T IRON TO GRADE .FILL GREATER THAN2 FEET UU CLAY BARRIER U(_)FILL CERTIFICATION NOTE UUDEPTH GAUGES UUVOL. ON PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS UUSEPARATION DISTANCE FROM TOE OF SLOPE THE C�C_JLF TRENCH PROVIDED 60FT MAX. C�C-JPARALLEL TO CONTOURS (�CJ100% EXPANSION PROVIDED C__)C_JDETAIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL U(___)GEOTEXTII.E COVER SEPARATION DISTANCES ON PLAN - FROM SSTS UU10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL UU20' TO FOUNDATION WALLS 0(__)100' TO WELL, 200' IN DLOD,150' TO PITS U(_J100' TO STREAM, WATERCOURSE, LAKE (inc. eapan) (�C�50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER C_JC_)10' TO WATER LINE (pits - 20') (_)C_--)50' INTERiMITTENT DRAINAGE COURSE ( _JCJ200'/500' RESERVOIR, ETC. ,150' GALLEY SYSTEMS C_J(J10' MIN TO LEDGE OUTCROP SEPTIC TANK (__)(�10' FROM FOUNDATION; 50' TO WELL WELL UUDIMENSIONS TO PROPERTY LINES C_JCJLOCATION OF SERVICE CONNECTION C_jC_)MIN 15' TO PROPERTY LINE. SLOPE ( J(� jSLOPE IN SSTS AREA - (520 %) C�UREGRADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS UUPUMP NOTES CUUD OSE 75% OF PIPE VOLUME/DOSE VOLUME NOTED UC�DETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) UUPrr AND D -BOX SHOWN & DETAILED' C-JC -i1 DAY STORAGE ABOVE ALARM CURTAIN DRAIN UUSTANDPIPES, 5' BOTH SIDES, DETAIL (�C_j15' MIN to CDS = >5 %, 20'-4 %, 25' -3 %, 35' -1 %,100 % -<1% (_)C__)20' MIN to CD DISCHARGE /100' with 182 cons day discharge (_)(-__)10' MIN to NON - PERFORATED PIPE n ' m h. o - :o ac T- %N / F z . MINAGE /T —� ON GREEN _ SHIT 741.31 ' 204.59- 229.36• 238.82 95' ql X r+i C.�83.5 \ ~ / r/ / r 96.26 I� n1 / A Wv 592.46' . x..21. a : 3�s's4g` 6 So I \ U r a a o20 t ° io.os 193.00' R=275.00, 77.19' \ W I FF-4n.o % G+ O G =473.0 I ' I I / \ \ ti N I w tip/ / 7r % r. v O ON GREEN _ SHIT 741.31 ' 204.59- 229.36• 238.82 95' ql X r+i C.�83.5 \ ~ / r/ / r 96.26 I� n1 / A Wv 592.46' . x..21. a : 3�s's4g` 6 So I \ U r a a o20 t ° io.os 193.00' R=275.00, 77.19' \ W I FF-4n.o % G+ O G =473.0 I ' I I / \ \ ti N I w tip/ / 7r % r.