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HomeMy WebLinkAbout0478DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13.08 -1 -99 BOX 6 r.. 00287 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) 218 - 6130 Fax (914) 278.7921 Nursing Services (914) 278.6558 WIC(914)278-6678 Fox(914)278-6085 Early 1itervendon-(914) 278'- 6014 Preschool (914) 278.6082 Fax(914)27f-6648 OWNERS NAME: JML6al, . *I-Jr01,11--t;Vq TAX MAP NUMBER: � ' ©g 1 `� (OH LLMr- LnT t7) E911 ADDRESS:Di��1 +� TOWN:`�'� AUTHORIZED TOWN OFFICIAL: (Signature) DATE: -r 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) Harry W. Nichols Jr., P.E. Patterson Park, Suite 106 2050 Route 22 Brewster, NY 10509 Telephone (845) 2794003 Fax (845) 279 -4567 June 6, 2001 Robert Morris, P.E. Putnam County Health Department One Geneva Road Brewster, NY 10509 Re: Individual SSTS Compliance Van Cleef Subdivision Lot #17 3 Bonnie Court Patterson, NY 12563 T.M. #13.08.1.99 Dear Robert: Enclosed are the following: 1. Five (5) prints of Drawing 5 -17, "As -Built Plan," dated 5/31/01. 2. "Certificate of Construction Compliance for Sewage Disposal System," dated 6/06/01. 3. Three (3) copies of "Guarantee of Subsurface Sewage Disposal System," dated 6/06/01. 4. Laboratory Report, dated 5/24/01. 5. ApplicatioA, Fee in the amount of $200.00 payable to Putnam'County fcalth Department. -'911 Address Verification Form," dated 5/08/01. If there are any questions concerning the enclosed, please call. Very truly yours, 4-1111�� Harry W. Nichols Jr., P.E. HWN: JM: jm 01- 026.00june PUTNAM COUNTY DEPARTMENT OF HEALTH > DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTION Street Location _ 3oy.✓I E ��- To «-n PArt-E r25c�i1/ TM= 1. Sewage Svstein Area Date: S c o o t Inspecte y: G, ?6ED Owner. no7z-6,67 Phi /ZQSZ!; Permit 4 p .- 3 0— o 0 Subdivision Lot 4 _E 7 a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Loth. 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 ....... ,25 ......other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ....... ........... ............... d. istribution 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. renc es 1.Length required #0 a Length installed Lfoo 2. Distance to watercourse measured _. i O 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 %s" diameter clean .................... 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped .................................... :.................... g. PumR or Dosed Systems Size of 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.estumted flow /cycle........... III. ouseBuildin a. house located per approved plans ...... .:.rr--�� ................... b. Number of bedrooms .............. ......:..1�- .............:..... . 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 plan.. f. Curtain drain outfall protected & dir.to exist watercours g. Footing-drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ............ ............................... MAY -09 -2001 10:13 AM HARRY W NICHOLS 914 279 4567 P.01 0 01-.024, 17 PUT'N M COUNTY DEPARTII n OF MALTS DrMON Of Z"MONMBNiT'AL MALTS 81RVICT6S 6,711N'TION ® ADAM ), GENE XE TJEST FOR ESAL MSP =Tm For:. piu All Wormatlon moat be Plally toffipleted prior to say Trencbes inspection~ WAS made. PCID Consuuction Permit # p 0 'Od 10 —LL Lowed: gganig- / Ovmer /Applicaat.Nama N F N Th113.d8 $IOC ,.i.�. Lot .; Formerly: SubdivWoo Name: f/a n C1 e e fit' Subdiviuoa Loi # r is system 511 completed? .4 Date:-- Is system oomDlete? Date: 1s system coutnicted u Der law? Is well drilled? ?v 1.� w-V Is well located ss per plaas? Are erosion control Mast= in place? Data: Al /A - I certify that tha system(sj as list4 at the above premises has been constntcted .s ad I have inspected sad verifed their completion is Accordance with the issued PCFID Coustmetion Permit ad approved plans and the Standards, Rules and Reguladons of the Putnam County Department of Healti Date: Certified by: PE K Digip Professio Commeaw Form M-99 IVA BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient .Services DEPARTWNT 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 May 10, 2001 Harry Nichols, PE Patterson. Park,, Suite 106 2050 Route 22 Brewster, New York 10509 - - - Re: Field Inspection - Dorset Hollow Bldrs. Bonnie Court, (T) Patterson Lot # 17, TM# 13.08 -1 -99 Dear Mr. Nichols. The separate sewage treatment system can be backfilled. The following comments must be corrected in the field: • No comments. 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 PUTNAM COUNTY DEPARTMENT OF HEALTH ��a DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # #9 ' 30 Located at 3 Bonnie Court Subdivision name D o r s e t H o 11 o w E- Stubd. Lot # 17 Date Subdivision Approved BE Owner /Applicant Name Dorset Hollow Builders Town or V illage Patterson Tax Map 13.0 8 Block 1 Lot 9 9 Renewal Revision Date of Previous Approval Mailing Address 15 West Hollow Road, Brewster, NY Amount of Fee Enclosed $300.00 Zip 10509 Building Type Re s 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 1250 gallon septic tank and 4CO L- T- "f '14,, W11 d-1 -treKGLIt_� CVJA loo z rewryV°e - Other Requirements: To be constructed by Dorset Hollow Builders Address 15 West Hollow Rd., Brewster, NY Town of Patt.erson Water Supply: X Public Supply From water District Address or: Private Supply Drilled by Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatmentsystem 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 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 treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified whe sidered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe proved ischarge of domestic sanitary sewag nlyjj By: �'✓ Title: fl)ylll / - Date: fed White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 ^i F h t s o CF HZI== APPEND= Z IM /vx 3.20 2 10605 yo at (St=Set) Bio:. 5OA/ ed GOT' 4 Wit= Cf. Date of Pe.--=Iat--cn Test / / 1-7 HOLZ N10.1--m-CR I a 7=% =1 - =-CMATTICINN Rw anse Deotrl �Y za-,, War---- Level. .:.me Grcund -`:=faca in Inches Soil Rate stzr,"�-Stco Him. S`=- SSG P Droo mr, Y-im/2:n L-zco L'Idnes In c: �- i e s " -z o -7-61 -�o 3 .:515q S 6 .7 ;07 3' 3 NC=: 1. Tests to be repee.—Z at saze depth =ti: a;;radmate'_Ty eqral il Sts so are obtained .at ea(:�"i '0='=lat:cn test hole. * 'Al? r:at-- to' 1:n- s-aj=n4-tted for review. 2. Death MEZ,=--Mnts -- tO be Trr---de of hole. 9/85 ... TEST PIT DATA R BE SUB�LtTTI� WiT1i ApDL'- `.TIO�i DLSC:=ION -,f SOILS .rNCCv�II) IN TEST HOI _, DE:.''r'H HOI.c. M. / EOLE, N0. 2 HME NO. G.L. 2' 3' v / �.� vr� y 4' l /�� .Q�y1 �Yf,GIIJti/ Svc i.✓I� Gr,� 5' 7' ' 8' 9' 11' INDICAZr• 1,10M AT WHICH GtCMV'E Z IS Fl%=U= -JM . INDICAM I.= r�L TO WHICH WATER Lc"'VF.L RISES AMR BEING =UNTERM DEEP HOLE OBSERVATIONS MADE BY: DAT': DESIGN Soil Rate Used 6 `, Min/1" Drop: S.D. Usable,Area Provided NO.. of Bearouns Septic Tank Cam - city / Z 5D gals. Type PX Absorption Area Provided By ( _ L.F. x 24" width trenca Other Name • WA P' � WV Address 397/ 6 . SEAL MIS SPACE FOR USE By HGt1LTH DEP.fEP1T CNLY: `X N,{�¢SS1 ®�.' Soil Rate Approved sr:ft /ga?.. ' Checked by T .Date G &E DEVELOPMENT, LLC Gregg Macaluso 914 - 878 -4355 March 17, 2000 Robert Morris P.E. Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Re: Dorset Hollow Estates Lot # 17 (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. t Very truly y, uf rs, ward Bloes G &E Development PO BOX 352 BEDFORD, NY 10506 14.16.4 (2/87) —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: (formall Van Cleef Estates) L Municipality Patterson County P u am 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, etc., or provide map) Lot 1 17 - Dorset Hollow Estates (formally Van Cleef Estates) Pwm e Court, i Nctf*419J�'1 . 5. IS PROPOSED ACTION: El New ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: r Construction of subsurface sewage treatment system -''for single- family resid'emce and connection to public water syapply. 7. AMOUNT OF LAND AFFECTED: p O`�— ` Initially _ acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? L• 1 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•permitlapprovais 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 . • W co t t , P.E. , R.A. Date: / Z 2—OX Applicant /sponsor name: 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 617.67 If No, a negative declaration may be superseded by another involved agency. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, of other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly. C5. Growth, subsequent development, or related activities likely to be Induced by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not identified In-Cl-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: Name of Lead Agency � 'its 4 Print or Type Name o Responsible Officer in Lea Agency Title of Respons er ,c ®Q Signature o Responsible Officer in Lead Agency Signature of Preparer (I i f'ergnt rokn'responsibl¢%'f icer) Date K 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 (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: Dorset Hollow Builders Lot 17 TAX MAP NUMBER: 13.08 -1 -99 E911 ADDRESS: 3 Bonnie Court Patterson TOWN: AUTHORIZED TOWN OFFICIAL: (Signature) DATE: 2 j ljd 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. (E91 I VERFRM) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS n REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWNER: L '16W U_AVB%u46KKET LOCATION: -_-� q30 E-- REVIEWED BY: �FiR, AS, SRDATE: _ l TAX MAP (CONFIRMED) DOCUMENTS IT APPLICATION PERMIT OR PWS LETTER t_ �J LETTER OF AUTHORIZATION DESIGN DATA SHEET (DDS) CORPORATE RESOLUTION SHORT EAF LIX PLANS -THREE SETS Lj/C_JHOUSE PLANS - TWO SETS (_,V,=WARIANCE REQUEST SUBDIVISION UULEGAL SUBDIVISION UUSUBDIVISION APPROVAL CHECKED U(—JPERC RATE (__)UFILL REQUIRED DEPTH UUCURTAI? 1 DRALN REQUIRED GENERAL LOCATED IN NYC WATERSHED PLAINS SUBINIITTED TO DEP ( LEGATED TO PCHD (� DEP APPROVAL, IF REQ'D DEEP TEST HOLES OBSERVED PPRCS TO BE WITNESSED EX- APPROVAL SSDS ADJ, LOTS 7LANDS (TOWN/DEC PERMIT REQ'D ?) TA ON DDS PLANS & PER�'NIIT SAME )PRE 1969 NEIGHBOR NOTIFICATION ETTER BI/ZBA 100 YR. FLOOD ELEVATION W/I200' USOIL TESTriG LOTS >10 YEARS OLD. V REQUIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) )SSDS HYDRAULIC PROFILE ZAVITY FLOW )NSTRUCTION NOTES 1 -15 ''SIGN DATA: PERC & DEEP RESULTS CONTOURS EXISTING & PROPOSED UVEWAY & SLOPES, CUT. )OTING /GUTTER/CURTAIN DRAINS MA SOIL TYPE BOUNDARIES TLE BLOCK; OWNERS NAME ADDRESS TMn, PE/RA; NAME, ADDRESS, PHONES DATE OF DRAWING/REVISION DATUM REFERENCE (LOCATION OF WATERCOURSES, PONDS t�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: Y N (REQUIRED DETAILS ON PLANS CONT'D) . (.__)HOUSE SEWER -'I�" FT. 4 "0'; TYPE PIPE CAST IRON C::I d BENDS; M AX BENDS 450 W /CLEANOUT RENEWALS �.�3FfE NOTE (NO CHANGE) FILL SYSTEMS 10' HORIZO�i AL; PAST TRENCH SLOPES 3:1 TO GRADE FILL SPECS / FILL NOTES 1 -5 U FILL PROFILE & DIMENSIONS ff�FILL IN 1 EXPANSION AREA FILL GREATER THAN 2 FEET CLAY BARRIER FILL CERTIFICATION NOTE DEPTH GAUGES U VOL. ON PLAN FOR R.O.B., UNCLASSIFIED & IMPERVIOUS Q (_J SEPARATION DISTANCE FROM TOE OF SLOPE TiENCIi � LF TRENCH PROVIDED LETZ7 _ 60FT MAX. PARALLEL TO CONTOUR (y V 100 %EXPANSION PROVIDED- _) FREE CRUSHED STONE OR WASHED GRAVEL ( EGEOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM SSTS 10' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL 20' TO FOUNDATION WALLS 100' TO WELL, 200' IN DLOD,150' TO PITS (y )100' TO STREAM, WATERCOURSE, LAKE (inc. ezpan) ( 50' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 10' TO WATER LINE (pits - 20') 50' INTER, 'vITTTENT DRAINAGE COURSE 200'/500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS 10' MIN TO LEDGE OUTCROP SEPTIC TANK �210'FROM FOUNDATION; 50' TO WELL WELL (J j)DIMENSIONS TO PROPERTY LINES L,JIC_JLOCATION OF SERVICE CONNECTION ((___)MIN 15' TO PROPERTY LINE SLM SLOPE IN SSTS AREA 00N U(__)REGRADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS PUMP NOTES ILJ DOSE 75% OF PIPE VOLUMEMOSE VOLUME NOTED DETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) PIT AND D -BOX SHOWN & DETAILED 1 DAY STORAGE ABOVE ALARM CURTAIN DRAIN STANDPIPES, 5' BOTH SIDES, DETAIL U 15' MIN to CDS = >5 %, 20'-4%, 25' -3 %, 35' -I %,100 % -<1% 20' MIN to CD DISCHARGE /100' with 182 cons day discharge REJ 10 ' MIN to NON - PERFORATED PIPE DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 T0: W �� Tel. (914) 278-6130 Fax (914) 278 - 7921 DATE �% Dear BRUCE R. FOLEY Public Health Director W% ptJlLDF.t1j RE: 3 '7�01jNlt__ Reservoir Basin The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received b this epartment on is complete. The Department will notify you b p of itsm ' ation. fY Y Y 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 NYCEP will commence pusuant to the guidelines set forth in the Watershed Agreement: If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which. you filed the application originally, and a statement that a decision is sought in accordance. with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed r Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice; your application will be deemed complete, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Dept. of Environmental Protection review and.approval of other aspects of a project, such as stormwater plans:or the creation Of impervious surfaces, and the project applicant should contact the Dept. 'of .Environmental Protection regarding such activities to see if Dept. of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (914) 278 -6130 ext. 166. Very truly yours, Robert Morris, PE RM:tn Public Health Engineer Ws2 PUTNAM COUNTY DEPARTMENT OF HEALTH. DIVISION OF ENVIRONMENTAL HEALTH SERVICES RE: Property of Located at LETTER OF AUTHORIZATION Dorset Hollow Builders 3 Bonnie Court T/V Patterson Tax Map # 13.08 Block 1 Lot 99 Subdivisionof Dorset Hollow Estates (formally Van Cleef Estates) Subdivision Lot # 17' Gentlemen: Filed Map # 2 7 7 1 Date Filed 12/24/88 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. Countersigned: P.E., R.A., # 059346 Mailing Address 3871 Route 6 Brewster State New York Zip Very Sign( Mailing Address Dorset Hollow Builders 15 West Hollow Road, Brewster 10509 State New York Telephone: ( 9 1 4 ) 2 7 8 - 2 1 1 0 Zip 10509 Telephone: ( 9 1 4 ) 2 7 9 - 1 3 3 9 Form LA -97 P. W. SCOTT Engineering & Architecture, P.C. 3871 Route 6 BREWSTER, NY 10509 E -Mail: pws @bestweb.net (914) 278 -2110 FAX (914) 278 -2166 TO Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 WE ARE SENDING YOU CNAttached ❑ Under separate cover via ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ LIECTITIEa o7 V o e a @WOITU L DATE ' +2 - i000 No. 99- 159 ATTENTION h Y7 N RE: Dorset Hollow Estates — LOti I (formally Van Cleef Estates) Subsurface Sewage Treatment System (SSTS) Application for Approval of Plans (PC -97) 1 the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION 1 Application for Approval of Plans (PC -97) 1 1 Construction Permit for Sewage Treatment System (CP -97) 1 1 Letter of Authorization (LA -97) 1 2 Design Data Sheet (DD -97) 1 House Plans (2 sets) 2 1 Letter from G & E Development,LLC, Re: Public Water 1 1 Check jfl1 for the amount of $3W,00 1 1 Short Form EAF THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ For your use ❑ As requested X1 For review and comment ❑ FORBIDS DUE ❑ 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 D SIGNED:. 6111t�at'.Cfk &�o . — G 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 I. Name and address of applicant: Dorset Hollow Builders Lot # 17 15 West Hollow Road Brewster, New York '10509 Dorset Hollow Estates 2. Nameofproject: (formally VanCleef EsO. LocationT/V: Patterson 4. Design Professional: Peder W. Scott, P.E., R.51. Address: 3871 Route 6 6. Drainage Basin: East Branch Reservoir Brewster, NY 10509 7. Type 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? ............... 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. I If so, have plans been submitted to such authorities? ........ ............................... Y Yes- Subdivision 14. H Has preliminary approval been granted by such authorities? Yes Date granted: 1 1998 15. T Type of Sewage Treatment System Discharge ................. surface water X groundwater 16. I If surface water discharge, what is the stream class designation? .................... N N/A 17. W Waters index number (surface) ........................................... ............................... . . N/A 18. I Is project located near a public water supply system? ....... ............................... Y Yes 19. I Serviced 20. I Is project site near a public sewage collection or treatment system? ................ N No 21. N Name of sewage system Individual Lots Distance to sewage system 22. D Date test holes observed 23. Name of Health Inspector M. B B u d z i n s k i P.E. 27. Is any portion of this project located within a designated Town or State wetland? No 28. Wetlands ID Number . ............................... 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? ................................ ............................... 35. Are any sewage treatment areas in excess of 15% slope? . ............................... 2 Water'.Only No 36. Tax Map ID Number ............................. ;........................... Map 13..08 Block 1 Lot 99 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. Fals tatements made herein are punishable as a Class A misdemeanor pursuant to Secti n Z Q.S� of the Penal Law. SIGNATURES & OFFICL4L TITLES: Peder W. Scott Agent for Applicant .. i . Mailing Address: 3871 Route 6 W Brewster, New York 10509 - i !v' -2• I V 31' -e'I I I I I I I -------------- - - - - -- -- L----------- - - - - -- 1 z fo' -2' FLOOR J06T5 10� I I r-------------------- -- rtl- ----- , --------------- - - - - -- I — —) -------------------------- - - - - -I r--------- - - - - -- ---- - - - -- - -- I - - � I 2820 - . I ---------------- - - - - -- - -r V 8'X1G' GONG. PIER W/ 2 -fS DAR5 I I 7 O - VERTICALLY FROM FOOTING TO TOP 21' -2• OF FOUNDATION WALL �) NG. sLAD W/ 6X6X10 110 W.W.n. Rffrr. IDeRrc5H OVER POLYETHYLeNE VAPOR MR 4 6' POROU5 FILL 4 WELL GOMPACTCP Dnse I UNffV1SHEP M 3'X3'X12'D. POURER GONG. FOOTDYG - I I UI'1EXG��//�TEp i I tL W/ 3 -1/2' P". PPE COLUMN W/ p 5TD. GAP 4 DA4e PLATE WELDED I I - I PROVIPE ANCHOR DOLT5 (TYP.) 30'X30'X12'P. POURep GONG. F00TINO , x W/ 3 -i/2' PVAM PPe GOLUr" W/ , 5TP. GAP 4 DASe PLATE WELPEp PROVIDE ANCHOR DOLTS (TYP.) -T N - - - I � I c I - - -� F -71 2 i- 4'X11 -7/8' A i-3 /4•Xii -7 /Vii X I- 3/4'X11 -7/8' ILV d ?- li- 3/4'X11 LV\b, 4-3/4•XN i I -7/8' 7" -7/8' IIVL\ ?/ 1- 3/4'X11 -7/ ' LVLI Q V I I// POCKET '� - - -y - - -y I I �-- —� �— —2A 7'-0' 101 7'-4' 7' -0 7'-0' I 4' GONG. SLAD W/ GX6MO110 W.W.M. Rem. I OR FCCRM5H OVeR FOLYETHYLrM VAPOR I pePRES5 TOP OF FOUNDATION , I DARRER 4 6' POROUS FILL 4 WELL GOYIPAGTEp I WALL TO ALLOW 5LAD TO I I e'uD t> ^5F I PA55 OVER 23' -2' 101 42'-4' iol 6. 1 I S• 10' GONG. DLOGK WnLL W/ HORIZONTAL REND'. 'PUR- O -WAL' EVERY 2ND. COUR5E OR 40' POURED ' _ _ CONC. 20'W. X 10ro- POURUP GONG. ® I I :..._ ^.., � .,_.". 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'....,,,.« .� , +,,. ,77, :*" � aY xi d;• ^y. -l�, t t r v ,'i 1 "BE, CAPPE Z, t ?O 't<r r also •'tc �, .. .. ..� ...:. -. .... :. .... >., ,�� ... - .,, ..... ., ,... �:: -.. ....: - .; .. ,,..: i.r _.. tee- •� . ,:. � , ,: ...... � .. ,� . F. .. .: :. r v ... , . ,, >,i RAE • -� 6N���S ,• r r .n 0 X 14 3 ;l t r ^ tr N :. _ � .. __ _, _. .. _, r. ,�,_ . - � : :: .�: ,uf • -.., �.�� �,� � aria P5 ;,,. �r J s � h 6 \ r P _ .: �.. ,. r'. ,s, i. _ t • c r.r ., t tr,.,� , .,t -, t .>;,, + r �, "' <l� t ,r• Q h WATER R?35 ,. ,:. .., .... ;. ., . - ..: � . _,..� x i v GAL ,,1250:, ,. .,. .,. ..: �'y, cA = •- a ,:, ->`. ;,. ,, s SEPTIC TANK r0, \ ti; PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEW MENT SYSTEM PCHD CONSTRUCTION PERMIT # 1` - ?j O - (D O d J a Located at J �� I �l �1 �� �i i��� Town or Village Owner /Applicant Name'bM 7V WO-M Ul�—��ax Map Block 1 Lot `lJ Formerly Subdivision Name )J K N C L-�-: E Subd. Lot # 1 Mailing Address W �--S T kAOLLOW Q6 Q h Zip Date Construction Permit Issued by PCHD 00 Separate Sewerage System built b 00WOW &) I-M -- 6Address \ 5 ST, gQE\NS IMi N 105�� Consisting of �� Gallon Septic Tank and Other Requirements: 1 Water Supply: _� Public Supply From M U PJ 1 C Address � PTTE -P�SQ N or: Private Supply Drilled by Address Building Type Ul: S \ bl;—::: N/ c - Has erosion control been completed? 1 i�-!� Number of Bedrooms 4- Has garbage grinder been installed? W I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of the Putnam County ,,Department of Health. Date: (*— b—(31 Certified by Address P.E. R.A. License # 5 (Q � 2-4- 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 app rov a subject, to modification or change when, in the judgment of the Public Health Director, such revocatio , odifica n or change is necessary. By: v` Title Date: & AV d White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 a PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM 00t,1_0w BU1LDEC.S 1- -5 ps i - q Owner or Purchaser of Building Tax Map Block Lot n02_SET G UI LDCP-S P AT T-F Ks.lJ Building Constructed by TownNillage __�) PDNN ��,-_ (_0 )�,T VAN CLE.E- Location - Street Subdivision Name NCE- 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 occupant of the building utilizing the ted: Month (D Genera Day 6 Year 1�j' 0(ZSET NOLLBv\f QU1I_WE(ZS Corporation Name (if corporation) Signature: Title: 0 W N F 1A0 LLQV P)U 1 LM�,S Corporation Name (if corporation) Address: I5 WEST �EV�IM�Address:15 tiyESj �rJLL0v1 RD,�UWSIE State IV y Zip M 50q State N Y Zip 1 r Form GS -97 ........................... y€ rrrrrmsnms;r; rr s�! 0 Die . CO NORTHEAST LABORATORY of DANBURY 39 MILL PLAIN ROAD - DANBURY, CT 06811 CT Cert: PH -0404 203) 748 -7903 - FAX (203) 748 -0652 NY Cert: 11471 LABORATORY REPORT DORSET HOLLOW ESTATES DATE SAMPLE COLLECTED: 5/23/2001 Attn:ALLAN J. FINN TIME COLLECTED: 8:00 A.M. 15 WEST HOLLOW ROAD COLLECTED BY: A. FINN BREWSTER, N.Y. 10509 DATE RECEIVED @ LAB: 5/23/2001 TESTED BY: LAB #11471 LAB I.D. #: MAY -144 REPORT DATE: 5/24/2001 SAMPLE SITE: DORSET HOLLOW ESTATES, LOT #17 SAMPLING POINT: KITCHEN TAP SOURCE: WELL TREATMENT: NONE O %N ACCOgOC, U -1 a x TEST PERFORMED RESULT: METHOD # MAXIMIUM CONTAMINANT LEVEL (MCL) . BACTERIAL: Total Coliform (Bacteria) 0 per 100 ml SM 9222B 0 per 100 ml CHEMISTRY: Chlorine Residual 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: 5/23/2001 SAMPLE, AS TESTED ABOVE: X or IMNOT POTABLE (PER STATE OF NEW YORK DEPT. OF HEALTH SERVICES STANDARDS FOR POTABLE WATER) 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