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HomeMy WebLinkAbout0480DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13.08 -1 -101 BOX 6 .� .i „ Bill so I tji+- I' I ' r T � i. L t r , If prill If I fill I r If in I. ' BRUCE R. FOLEY Public Health Director"-' DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI - R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 P.W. Scott 3871 Route 6 Brewster NY 10509 RE: Dorest Hollow Builders 14 Bonnie Court, Lot #15 (T) Patterson, TM# 13.08 -1 -101 Reservoir Basin Dear Mr. Scott: May 3, 2000 The Putnam County Department of Health (Department) has determined that ,the above referenced application, including fee, and received by this Department on March 29, 2000 is complete. The Department will notify you by May 23, 2000 of its determination. ❑ The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. ® Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed complete, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Dept. of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation . _- Letter to: P.W. Scott - May 3, 2000 -2- of impervious surfaces, and the project applicant should contact the Department of Environmental Protection regarding such activities to see if Department of Environmental Protection review and approval is required. If you have any questions regarding this matter, please call me at (914) 278 -6130 ext. 2166. Vefy ` ly yours 4::7 �i Robert Morris, PE RM:tn Senior Public Health Engineer DD. D rib :. :� •` "— = -�u ui� C:.: ��. ri- D= Pcr,�sI.� S='S.i�".'� 2 I 1_ Tes-,z to be repeated at same depth uat-:S ap?r=dmtely equal Soil =,-2s are' obtained .at each p&=- laticn test hole. ALIT data ta' be .' ty- for review. 2_ Dept:: tmas==rMn s tC be ma. ^.e f-= trp of T=e. rev. 91 %44 �iyHi41Q1lNITT= '_�� /Nc��/ ;. ao 2 10605 Z� :,;w- at (St�e_r.) �I /c czzw ��//�LG,f'6G.P� se--- 13. BI.CC: ^� a ,== � _� T /S . P_�CVS - Date o:: Late O% w1'.c n Test // /-I /,7 — LOLL LM L.Z'�pSZ repti, to - wate'' Ylate= Levu No. Ground Su=-face. in Inches ' Sow Rate S tz-_- -S t co Min. Star t S L,-:.p Drop Tr, Drcp inches in=' es InLuies 3� .5 2 I 1_ Tes-,z to be repeated at same depth uat-:S ap?r=dmtely equal Soil =,-2s are' obtained .at each p&=- laticn test hole. ALIT data ta' be .' ty- for review. 2_ Dept:: tmas==rMn s tC be ma. ^.e f-= trp of T=e. rev. 91 TZST PIT IlATA RF - "= TO BE Sua..MI = g= APPLT ^ATIC'I DESC= -I0\ �F SOILS IN Tr�:,ST fir. D� "3 HC E No. em. IN Zlyl G c iT�-v2t Urature G.:.,. Address -�--- I SF-%L q ei 5 G' ( i 7' $1 �C'OGGt�i 7� Ix % 9' 10' r_Ca M. 11' . 12' Ni DIC. IO JL.r AT S,'i IM GRCiJNL,C= IS F.. LN=UNT - - INDICATE J VII, M WHICH MTV IZ'M RISES AFTIM EELIG : \C3U` 'I-RM DE'...° HOLS OBSEERVATIONS MADE BY: DATA: DESI&N Soil Rate Used Min /1° Drop: S.D. Usable Area- Provided No- of 3rouns Z/ Septic Tank Cacaci'y l�•. = o gam? Tyre �/ :- ,.•,G. Absorpticn Area Provided By L.F. ,. 24" width; "ranch Other Name em. IN Zlyl G c iT�-v2t Urature Address SF-%L q ei THIS SPA= FOR USE BY I.ALTH DMUMZ7-11 T CXLY: ,'r0�� � Soil- Rate Apprcved sq:ft /gal. C'zecked r 0, Date e , Department of Environmental Protection 465'Colur6us Avenue Valhalla, New York 10595 -1336 -Joel-A. -Miele Sr., P.E. Commissioner Bureau of Water Supply, William N. Stasiuk, P.E., Ph.D. Deputy Commissioner Tel (914) 742 -2001 Fax (914) 742 - 2027 - rOaR CITY DEPAR,MF Hf 7ROA'MENTAL PROSE` —de-p-) (718) DEP-HELP June 27, 2000 Robert Morris; P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 Re: Dorset Hollow Bonnie Court Lot 15 (T) Patterson East Branch Reservoir DEP Log # 10198 Dear Mr. Morris: The New York City Department of Environmental Protection (DEP) has determined that the above referenced application is complete. The DEP has no objection to the approval of the above referenced regulated activity. This determination is based on the review of submitted documents including the plan titled "Septic Site Plan, Lot 15- Dorset Hollow Estates," prepared by P.W. Scott, Engineering & Architecture, P.C., dated 3/17/00 last revised 6/22/00. The applicant must contact Jennifer Coughlan of my staff at (914) 773- 4458 at least 2 days prior to the start of construction of the Subsurface Sewage Treatment System so that the DEP may inspect and monitor the installation. Sincerely, Margaret Lloyd, Supervisor Engineering Design & Review bxc: Simroe Lloyd/Coughlan file. BRUCE R.. FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 . Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 June 6, 2000 P.W. Scott Engineering 3 871 Route 6 Brewster NY 10509 Re: Proposed SSTS: Dorset Hollow Builders West Street, Lot #15 (T) Patterson, TM# 13.08 -1 -101 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) The application rate for a percolation rate of 8 -10 min/inch is 0.9 gal/day /sq.ft. Please revise accordingly. 2) The minimum of 444 linear feet of fields are required for each of the primary and reserve area. Please check plan to insure the proper lengths are shown. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM:tn Ve Lly ours , Robert Morris, P.E. Senior Public Health Engineer 'ADRKGITY DEP.IRT,yf .yl ® � A P �e ENTAL PROZE�`O PHONE (914) 742.2001 FAX (914) 742 -2027 May 23, 2000 THE CITY OF NEW YORK DEPARTMENT OF ENVIRONMENTAL PROTECTION JOEL A. MIELE, SR., P.E. Commissioner Robert Morris, RE Putnam Co. Health Dept. 4 Geneva Road Brewster, NY 10509 Re: Dorset Hollow. Lot 15 Bonnie Court Patterson, Putnam East Branch Reservoir DEP Log # 10198(Joint Review) Dear Mr. Morris: WILLIAM N. STASIUK, P.E.,Ph.D. Deputy Commissioner Bureau of Water Supply Please note the following comment regarding the system design above referenced: • The application rate for a percolation rate of 8 -10 min/inch is 0.9 gal/day/sq. ft., and not 1.0 gal/day/sq. ft. as is written on the plan. Even though the proposed length of trenches for the primary area is sufficient, it is not for the reserve area. If you have any questions regarding this matter, you may contact me at (914) 773 -4416. Sincerely, Sissy De La Ossa, M.S. Environmental and Water Resources Engineer Engineering Design & Review xc: James Covey, P.E., NYSDOH 465 Columbus Avenue, Valhalla, New York 10595 -1336 14- 16.4 (2/87) —Text 12 PROJECT I.D. NUMBER 617.21 'SEAR Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT /SPONSOR 2. PROJECT NAME Dorset Hollow Builders Dorset Hollow Estates 3. PROJECT LOCATION: (formall Van Cleef Estates) Municipality Patterson County P u 1n am 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) Lot # 15 - Dorset Hollow Estates (formally Van Cleef Estates) 5. IS PROPOSED ACTION: E New ❑ Expansion ❑ Modification /alteration 6. DESCRIBE PROJECT BRIEFLY: Construction of subsurface sewage treatment system - for single- family resid'e.nce and connection to public water supply. 7. AMOUNT OF LAND AFFECTED: Initially 0.15 acres Ultimately s acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes ❑ No If No; describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ® Residential ❑ Industrial ❑ Commercial ❑Agriculture ❑ Park /ForestlOpen 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 permitlapproval 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 P.W. Scott, P . E.. , R.A. Date: Signature: 0 y�L r 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 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 S. 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, 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 Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsi e o icer) 2 \ON,� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWA T SYSTEM PERMIT # P `-� c "�� j-- w Located at 14 Bonnie Court Subdivision name Date Subdivision Approved 1998 Town or Village Patterson Subd. Lot # 15 Tax Map 13.0 8 Block 1 Lot 101 Renewal Revision Owner /Applicant Name Dorset Hollow Builders Date of Previous Approval Mailing Address 15 West Hollow Road, Brewster, NY Amount of Fee Enclosed $300.00 Building Type R'e s i d e n c e Zip 10509 Lot Area • 9 2 A c No. of Bedrooms 4 Design Flow GPD Z)o Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL JS COMPLETED Separate Sewerage System to consist of 1250 gallon septic tank and 4 5 0 L F o f 24" wide trenches (10 rows @ 45) and 1007 reserve. Other Requirements: To be constructed by Dorset Hollow Builders Address 15 West Hollow Road, Brewster, NY Town of Patterson 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 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 repairs thereto. Signed: Ll;;2 P.E. R.A. Date 3 Address 38 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 perm' . A roved fo charge of domestic sanitary sewage only. By: Title: SY fi/ Date: D�1 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -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 # 15 (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 truVyours, Edward Bloes G &E Development PO BOX 352 BEDFORD, NY 10506 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 CfAttached ❑ Under separate cover via • Shop drawings ❑ Prints ❑ Plans • Copy of letter ❑ Change order ❑ Iff—U71-0 @I CT ° H11�_K J0CTV11 DATE 3- °t L/ -A000 JOB NO. 99— 159 ATTENTION o e f Morr is RE: Dorset Hollow Estates —L04' 15, (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 ❑ Approved as submitted 0 Resubmit copies for approval Application for Approval of Plans (PC -97) 1 ❑ Approved as noted 1 Construction Permit for Sewage Treatment System (CP -97) 1 ❑ Returned for corrections 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 I 1 Check #q6q- ;L85'oo-35 for the amount of $ 300.00 1 1 Short Form EAF THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ Approved as submitted 0 Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints X1 For review and comment ❑ ❑ FOR BIDS DUE ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS List Continued: 4 1 Septic Site Plan Drawings 1 I E911 Address Verification Form (E911 Verfrm) COPY TO SIGNED: If enclosures are not as noted, kindly notify us at PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Dorset Hollow Builders Located at 14 Bonnie Court TN Patterson Tax Map # 13.08 Block 1 Lot 102 Subdivisionof Dorset Hollow Estates (formally Van Cleef Estates) Subdivision Lot # 15 Filed Map # 2 7.71 Date Filed 12/24/88 Gentlemen: 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. P.E., R.A.,I# 059346 Mailing Address 3 8 7 1 R o u t e 6 Brewster State New York Zip 10509 Telephone: ( 9 14 ) 2 7 8— 2 1 10 wwuci ui r1UPcny) Mailing Address: Dorset Hollow Builders 15 West Hollow Road, Brewster State New York Zip 10509 Telephone: (914) 279 -1339 Form LA -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION 'OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: Lot # 15 Dorset Hollow Builders 15 West Hollow Road Brewster, New York 10509 porset Hollow Estates 2. Nameofproject: (formally VanCleef Estf3. LocationT/V: Patterson 4. Design Professional: Peder W. Scott, P.E., R.'�. Address:3871 Route 6 6. Drainage Basin: East Branch Reservoir Brewster, NY 10509 7. 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? ............... 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: 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 erviced 19. If yes, name of water supply Town of Patterson Distance to water supply by 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 23. Name of Health Inspector M. B u d Z i n s k i P.E. 24. Project design flow (gallons per day) ................................. ............................... 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit'required ?... 800 GPn No 26. Has SPDES Application been submitted to local DEC office? N/A ......................... Form PC -97 36. Tax Map ID Number ............................. :........................... Map_i3.oa Block i Lot ioi 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 Sectio771 q.45 of the Penal Law. SIGNATURES & OFFICL4L TITLES: Peddr W. Scott. Agent for Applicant Mailing Address 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 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_i3.oa Block i Lot ioi 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 Sectio771 q.45 of the Penal Law. SIGNATURES & OFFICL4L TITLES: Peddr W. Scott. Agent for Applicant Mailing Address 3871 Route 6 ..... ............................... Brewster, New York 10509 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 OWNERS NAME: E911 ADDRESS VERIFICATION FORM Dorset Hollow Builders Lot 15 TAX MAP NUMBER: 13.08 -1 -101 E911 ADDRESS: 14 Bonnie Court Patterson TOWN: AUTHORIZED TOWN OFFICIAL: (Signature) DATE: 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) 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 Q WE ARE SENDING YOU Attached ❑ Under separate cover via ❑ Shop drawings ❑ Prints b Plans ❑ Copy of letter ❑ Change order ❑ FUEVVIER @[F 4 ° a @W044ad DATE �y / / /ZS 'D � J08 NO. ATTENTION RE: Septic As —Built Dorset Hollow Estates — Lot # (formally Van Cleef Estates) 1 Certificate of Construction Compliance 3 the following items: ❑ Samples ❑ Specifications COPIES DATE NO. DESCRIPTION 1 1 Certificate of Construction Compliance 3 1 Guarantee of Subsurface Sewage Treatment System 3 1 As —Built Septic Plan 4 Fee: $200.00 C D& O3 THESE ARE TRANSMITTED as checked below: :J For approval 11 For your use ❑ As requested ❑ For review and comment ❑ FORBIDS DUE REMARKS • Approved as submitted • Approved as noted ❑ Returned for corrections • Resubmit copies for approval • Submit copies for distribution • Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US COPY TO SIGNED: v`,— '.' enclosures are rot as noted, kindly notify ur. at once. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Dorset Hollow Builders Owner or Purchaser of Building Dorset Hollow Builders Building Constructed by Location -Street Residence Building Type Tax Map Block Lot Patterson TownNillage Van Cleef Subdivision Subdivision Name l_f Subdivision Lot r 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 fore a peri od 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 o t the building utilizing the system. Dated", _ Day (t Year Signature. Title:- �,J�,vc1 - S i o-nature Corporation Name (if corporation) Corporation Name (if corporation) Address: T WC -t A-e4 9f ?r Address: It tt,� qhi /x,� State I Zip (ova State ,/y qr l - Zip Form GS -97 09/07/00 14:06 PW SCOTT 4 19142787921 PUTVAM COUNTY DEPARTMENT OF HEALTH DIVISII )N OF ENVIRONMENTAL HEALTH SERVICES ATTENTION ADAM GENE REOLIFSI FUR FINAL (NSPECTION For: Fill All information must be Billy completed prior to any Trenches �I inspections being made. PCl D Construction Pert it # .1 - 31 -00 NO. 291 1903 Located: _ � tt it Cep. _ (T) (V) .-M .ft P.Y3t119 Owner /Appl' t e: o 1 TM 110 BlocLot COL Formerly: taytg Subdivision Name: Polm _ow 4rams Subdivision Lot # Is system fill completed? Date: Is system complete? _ Ste 011 Date: Dpi Is system constructed as .)er 1 s? )!LOA See !t° . Is well drilled? Date: Is wall located as per pla is? Are erosion control measures in place? I certify that the system(s) as listed, at the above premises has been constructed send. I have inspected and verified their comllotion 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: f!D Certified by: PE RA -44 Design Professional Address: t 6 #rceysrP�- Lic. Comments: Cori -Brae -ter der , rto t c rg j/ Beam "I a� Ae Awe fo 44-C Form FIR-99 BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New .York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 Date: 7/j/ /,027 To: P. U, 5eor-r Fax #: a78 -2164 l' ' R Wv, Glec� ��-}: � No. Pages (Including cover sheet) From: Gene D. Reed Putnam County Department of Health ZFor your information For your review As discussed 13 Please respond Attached as requested Please call Notes/Messages CO/ 1.1 ENT t L Tf/E G2v5 ifED S` -ONE 05c'A '/N 7ii6 5.5„1 S, 7—i2F,Vchl0 5 11A5 A XA 66 &JovAt/-T of S icyV,6' b`i U S % A.VA D025-S IV07— /yl�F_T GU777ZF�/T GODS. ., In the event of transmission /reception difficulties, please contact this.office at (914) 278 -6130 ext. 2261. PUTNAM COUNTY DEPARTMENT OF HEALTH :Q DIVISION OF ENVIRONMENTAL HEALTH SERVICES . FINAL SITE INSPECTION Date: 9 oe� Inspecte y:.�; �EE,Z Street Location ��,N„/� you ?tT Owner 7)o'nsbT UazLow f3u1L.'DcF_s Town Permit # p 3a -00 TM # J 3, o e -- I - /o ! Subdivision Lot # 1:5 1. Sewage 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 ...... ............................... I1. Sewage System a. eptic c size - 1,000 .......:1; 50 ........other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1. All outlets at same elevation -water tested ................. 2. Protected below frost .................. ............................... 3. Minimum 2 ft.Original soil between box & trenches e. Junction Box. - properly set ........... ............................... f. 'trenches T-.Te—n—gth required ,�4 50 Length installed SO 2. Distance to watercourse measured Ft.......... 3. Installed according to plan ......... .............. .I................ 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 ...................... ............:................v0 g. Pump or Dosed Systems Size ot pump chamber ................ ............................... 2. Overflow tank ............................. ............................... 3. Alarm, visual/ audio .................... ............................... 4. Pump easily accessible, manhole to grade. .. ............... 5. First box baffled ........................................ .. ....... 6. Cycle witnessed by H.D.estimated flow /cycle........... III. House/Buildin a. House ocated per approved plans... ............... b Number of bedrooms ........................�..l3. ................ 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.. f. Curtain drain outfall protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ... ............................... i. Erosion control provided ................. ............................... Rev. 6/97 YES I NO I COMMENTS /?Jct cl zAtlov -F%s eYery So %o r4 BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R.M, M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 September 11, 2000 I PW Scott Engineering 3871 Route 6 Brewster, New York 10509 Re: Field Inspection -Lot 15, "VanCleef Bonnie Court, TM# 13.08 -1 -101 (T) Patterson, Permit # P -32 -00 Dear Mr. Scott: W The following comments must be corrected in the field: • The crushed stone used in the SSTS trenches has a large amount of stone dust and does not meet current codes. Only washed gravel or crushed stone "(dust free) may be used in absorption trenches. • Add cleanouts every 50 ft. (septic tank to SSTS). • Expose all end caps. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. Very truly yours, 0 4ew Gene D. Reed GDR:cj . Environmental Health Engineering Aide. BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 DATE: 9, %11/ e) o Re: Field Inspection - L® - I " V"vl C lee -/' two SON A!I C Loa x-r., T M, 41- 1-3, (T) y'er►�I rt >t- tom' A Dear: The following comments must be corrected in the field: The crushed stone used in the SSTS trenches has a large amount of stone dust and does o not meet current codes. Only washed gravel or crushed stone "(dust free)" may be used in absorption trenches. ® ADZ> �L7/t104'T5 !%N�Zj� �5c'PT /c Te 0 cx'Q054-:7 AL.L EA/D G,1-5 If you have any further questions, please contact me at (914) 278 -6130 ext. 2261. Very truly yours, GDR:tn fieldins Gene D. Reed Environmental Health Engineering Aide ALLEN BEALS, M.D., J. D. MARYELLEN ODELLY Commissioner of Health Couro Executive ROBERT MORRIS, P.E. MPH Director of Environmental Health �. DEPARTMENT OF HEALTH Z Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 • Owner's Name: �'-ti VL �` < < w�ec tti Owner's Phone Site Address: y 1 �p v\-- --e Z-� . Town: '` r3�✓l Tax Map # Z 44 Owner's Mailing Address: (1-1 ���-� ��• -� C4. , N -1 t Z S�o'3 Owner's Signature: — Description of Proposed Addition: *Number of existing bedrooms: Total number of bedrooms (existing + proposed): . * (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) * *Any addition which is considered a bedroom requires formal approval of plans (Construction permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Department of Health, 1 Geneva Rd, Brewster, NY 10509, Phone: (845) 808 -1390. 1. Certified check or money order for $100.00. 2. Two sets of sketches of existing floor plan (drawn to scale, all living area Including basement, to be shown and dimensioned and use of each room specified). (See section 3.c of Bulletin HA -1) 3. Two'sets of proposed floor plans (drawn to scale - with name, street and tax map #) * Non - professional sketches are acceptable and preferred. (See Section 3.d of Bulletin HA -1) 4. Copy of survey showing all well and septic locations on the subject property to the best of your knowledge. Contact this office with any questions. 5. Copy of Certificate of Occupancy from the Town or Certification from the Building Department with legal bedroom count of dwelling. OFFICE USE COMNMNTS Rev. July 2013 5. DORSET HOLLOW ESTATES: `Arlington" DECK 16'• 0 112'•0" BRKFST. FAMILY 14'•0 "X13' 2" ROOM 12'•1 "X13'•2" CL LIVING ROOM cL 15'.1 I "x 13'•2" FOYER COVERED PORCH — a o K 1 11' 4 "X13' 2" o® LAUNDRY 0 8.6 "x5'•10" P.R. l 0. DINING ROOM 13'•8 "X 13'•2" FIRST FLOOR W.I.C. Lil s. CL BEDRM. N0.3 8'•0 "X9.10" M. BATH 14'•8 "X9'•10" LC. LC CL MASTER BEDRM. BEDRM. NO.2 BEDRM. NO.4 13'•8 "X13'•2" 14'•10 "X16'•6" 10'•6 "x10'•10" C SECOND FLOOR GARAGE 23'•0 "X23'•0" G ocrS ATTIC I ' Ji mes Gagliardo Excavating Cont. LTD. 37 Game Farm Road Pawling New York 12564 TO: Phone /fax 845.855.3573 •%Sct/Are- GoLrr og) DATE ORDER N0. 0 y7A-2 t ✓ SHIP TO L� P ccO��C1 � �����9ufF'��D w�'- 'SHI��p 6 �' - "��►'``��O B� OI T� � � Ia�RMS' v n �" �� ALLEN BEALS, M.D., J.D. Commissioner of Health ROBERT MORRIS, P.E., MPH Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 July 25, 2014 Phone ## (845) 808 -1390 Fax # (845) 278 -7921 Alvin Dillman 14 Bonnie Court Patterson, NY 12563 Re: Addition — Approval — Dillman MARYELLEN ODELL County &ecutive No Increase in Number of Bedrooms 14 Bonnie Court (T) Patterson, T.M. 13.8 -1 -101 Dear Mr. Dillman: This Department has received and reviewed the plans for the proposed addition to the above mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp from this Department dated July 25, 2014. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at five without prior approval by this Department. 2. The SSTS has been upgraded to a five bedroom system by adding an additional 750 precast concrete septic tank in series with and after the existing 1,250 gallon septic tank (Repair Permit R- 022 -14). The existing fields are now large enough to support a five bedroom house based on the reduced design flow of 150 gallons per day per bedroom. 3. The area of the existing sewage disposal system and its expansion area must be maintained. 4. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc ... 5. The approval is for the modifications only and does not validate any construction shown as existing that has not obtained proper approvals from other agencies having jurisdiction. 6. This approval is valid for two (2) years and expires on July 25, 2016. Any permits or variances required under the jurisdiction of the Town of Patterson are the responsibility of the applicant. If you have any questions, please contact me at (845) 808 -1390 ext. 43157. Tsephctfully, S. Paravati, Jr., P.E. ant Public Health Engineer JSP:cml cc: BI (T) Patterson Rr I / 6Z-Acr4. -- -T-ovi 9llim of- Pe, 71T e-,, Afire ��O 94e II JU R4w �3 Ow-73V All-I 31�S�' ^- Putnam County Department of Health Division of Environmental Health Services /�/�tt�� SSTS Repair - Final Site In tion Date: �'--T� Inspected.by: f 'L'�`°` Installer: Street Location: 15P_,nn,`e_ Gf, Owner: -D4f� —� Town: Po_�,rs on Repair Permit #: (2 - D 2-9- - /j/ TM # / 3, 1. Type of System:. ConventionalM Alternate 17 Comments: 2. Sentle Tank Yes No N/A Comments _ a. Septic tank size - 1,000... 1,250 ... other ..... 76 ,'H S b. Septic tank installed level ...................... 9 4c e°X4- iv,e� odw� c. 10' minimum from foundation .................. d. Distribution Box i. All outlets at same elevation (water tested),.. ii. Protected below frost ............................. Minimum 2 ft. Original soil between box & trenches C. Jukdon Box - 0 ro erl set .,. E e , L Systetd tompletely opened for inspection ii. Length required Length installed iii. P!E slope checked ... ............................... iv. Installed according to plan ..................... v. 10 & from property line - 20 ft - foundations ... vi. Size of gravel % - I '' /:" diameter-clean ......... vii. Depth of gravel in trench 12" minimum ......... viii. Ends capped .... ............................... Pump or Dosed Systems 3. a. SSTS Area located as per approved plans b. Fill section - c. Distance from water course/wetlands 4. Overall Workmanship a. Boxes properly grouted and installed correctly ........... b. All pipes flush with inside of box .... ........... c. Backfill material contains stones <4" diameter ......... " d. Curtain drain & standpipes installed according to plan e. Curtain drain outfall protected & dir to exist watercourse E Footing drains discharge away from SSTS area ......... g. Erosion control provided ............................ Additional Comments: RFSI Rev - 011312 PUTNAM COUNTY HEALTH DEPARTMENT �� ✓ _ 6 IVISION OF ENVIRONMENTAL HEALTH SERVICES D *�, FV. PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR Y N Internal Use Only PERNIrT # ❑ F pair Permit issued in last 5 years El of in Watershed pair within Boyd's Comers, W. Branch or Croton Falls Res. Delegated pair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION [ phnre4 Cr T TOWN TM # OWNER'S NAME Act- PHONE # MAILING ADDRESS (ce g cZv'(.% APPLICANT 8,.�►-�+-+� _ % 3 j Name & R lationship (i.e., owner, tenant, contractor) DATE 'Z Z't < FACILITY TYPE me. PCHD COMPLAINT # PROPOSED INSTALLER Is" Z4z:4�iey PHONE # 9 /`l- yat may/ ADDRESS Ac /G 6?1�- V%jfA.)Oe RE GISTRATION /LICENSE # PZ 83 � A6 Pro sal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed system) NOTE: The Department may require submittal of proposal from licensed professional depending on the nature and extent of the repair. I, as owner,agree to the conditions stated on this form T SIGNATURE TITLE. DATE (owner) I, the septic installer, agree to comply with the conditions of this permit for the septic system repair SIGNATURE IL TITLE % ®'' DATE (Installer) ProRgoW aRp0Z with t0ellovying conditions: 1. Procurement of any Town Permit, if applicable. 2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing: a. Owner's name, Site Street Name, Town and Tax Map number b. Location of installed components tied to two fixed points c. System description (e.g., 1250 gal. Concrete septic tank, etc.) d. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and conditions 4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the completed SSTS repair will function. 5. No completed work is to be backfilled until authorization to do so has been obtained from the Department. Proposal Approved re is in INTERNAL USE ONLY Proposal Denied with applicable codes Date E Yes 5 rip1ratlon vat No ❑ COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 MEMORY TRANSMISSION REPORT TIME APR -01 -2014 08:47AM TEL NUMBER 8452787921 NAME ENVIRONMENTAL HEALTH FILE NUMBER 578 DATE APR -01 08:46AM TO 88553573 DOCUMENT PAGES 001 START TIME APR -01 08:46AM END TIME APR -01 08:47AM SENT PAGES 001 STATUS OK FILE NUMBER 578 * * * SUCCESSFUL TX NOT ICE PU-rNAM COUNTY HEALTH CEPARTMENT V �/ G 1\/ISION OF EN\/1RONMENTAL HEALTH SERVICES P OPOSAL 1=0R SEWAG TREATMENT SYSTEM REPAIR ' f'• i�. . YES tL41 Intsrnal Use Only PERYfr r ��-n1'Z- L �epair Pemsit pis.�s��ued In feet S years L Ot In Waterahad C] Repair wrthln Boya'a Corn-ra. W. erYrlan er t:rotnn Falia Rea. Oelegatea C3 Rep01r Within 200 ft, of a — nonmume or DEC - mapped woUan0 t] Joint Review ' SITE LOCATION Jy /Tv�1.. nr: t�T- TOWN TM # t OWNER'S NAME MAILING AOORESS c2..75'v2 "7 APPLICANT Q...- ..+ -./^ �71►%.�/I ��3 lJaTe 8 R l6KlOnawp p.a_, Owner, terlarR, mttran:eA /!A.� S ,S� 3• GATE �.� Z.�'t �• `� FACILITY TYPE - {.Js/a.t� �r PCHC COMP�/LAINT p PROPOSED INSTALLER sari AOOFIESS neI3isTRATION /LICENSE # F-r000sal (Include a aeparata alcetch locating the houaa, property lines, all adJaoent Weise wlti In 200 Teat or repair and the locatlots of exlatlrtg and propoaad system) NOTE: Tha Oapartment may require submittal of proposal from licansetl professional depanding on the nature and axtent of the repair. Z? .�t.z7'� ✓/ :)a.� -_ —'_� G'/ ,r cu�'�k /Jr..�. -l`— 7�' - - -- G. / 1. as ownar.agrae to the conditions atsted cn this form / SIGNATURE �oWnsr) 1. the septic instalniew. agrae to comply with the conditions of this p_)arrnit for the septic system repair Sl43NATURE /Ls� / ^� _ TITLE J.4++ Ilw- DATE (Installer) ^' poet arts ie..nwin- 1 . Proauramant of any Town Ponnit. if applicable. 2. Submission of as built repair sketch by tha saptlo systam installer within 30 days of the repair, in duplica a showing: a- QwnoWa nartte. Sibs straat Mnmo. Town and Tax Map number b. Location of Installed componants tled to two fixed pointy a. 8yastem description (a.g.. 1250 gal. Conoreta septic tank, etc.) d. Installers' name and phona number S. Systern repair to be paAOrmad In ecoortyanca with the above proposal and o0ndlilons 4. The proposed SS TS repair Is considered a best tit design mncl there Is no guarantee to the duration at which the -complatea SST9 repair will function_ S. Ho Completed work Is to be baoKltllga until MUthbrtmal1On to ao so has bean obtalned from Ina oopartrnenc / INTERNAL USB ANLY Proposal Approved �� Proposal Denied [� n pector's Ignature M -rITJa a E1W.Wrealon Date Re air proposal to In com lienbe with applicable codas Yes .21 No 0 COPIES: PGHO; Owner, Installer PC -RP 00ML per• 2007 14 Bonnie -A in ' Mon Apr 14 2014 01:51:20 PM. GoM" Alual . ......... ... � 7GI ux � � •7 Acl-c>, HERE, Inte id 4,X AC, CA'- T L — Ti S. �� {� .. ƒ §.O Nv/ �O D A r a , ? \ 1® \2( /OV\# » �� : \2vg ( 04R; of 5§ Ti . y i� } -t ]�f ` 1'31�/ \� /L E " NS Tb Ia£sf e �i0 HE c §O\ FOR APPRO . j ! BON • C' J N M LOON TY! DE; P Aft Ud"] E N'I OP 11LA-12i I I 's 2a _.�%I.S1,4_PPROVE0 FOR B)DTiOOAI COUNT ONLI, 7P TO 'rHE.Sr ; Tjk i E PCDOII FOR APPRa V SUBMITTED40 iA D p UTN AM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF;CONSTRUCTION COMPLIANC F01, 'V GE TREATMENT SYSTEM PCA .CONSTRUCTION PERMIT # P - l Located at t � - -�� r� Town or Village P Tot, xi Tax Map I3.C}� Block I Lot o1 Owner /Applicant NamdpoPIk fi i 4�+-► ' '`' '` Formerly �fA;.1 �t �s -i-%� "S Subdivision Name Ww5trr t . g Lzkl t>✓`3 P Subd. Lot # 5� Mailing Address 15-: s (yT y-t� Zip Date'Construchon Permit Issued by PCHD _ Separate Sewerage System built by Address Consisting of 1 JL S Gallon Septic Tank and 45� LF � `� `' r y o -iY1.�1.►G =�S f � :; Other Requirements Water Suoaly � Public Supply From w xT', _ Qis�2� t Address —_ PP Y or Private Supply Drilled by Address Building Type (� 1,D Has erosion control been completed? �� G Number of Bedrooms Has garbage grinder been installed? I'ertify that the system(s), as.listed, serving the above premises were constructed essentially as shown on the as- . -,,,,,,,,built plans {copies o f 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. rirt Date: I `� pt� Certified by P.E. R.A. v (Design Professional) c);,3 0 ) License # 4 Any person occupying prenuses served by the above system(s) shall promptly take such action as may be necessary to secure the correction; of any; unsanitary conditions resulting from such usage. Approval of the separate sewage .' treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to `modification or change when, in the judgment of the Public Health Director, such J, ,revocatio ficati ' or change is necessary. ' : Title: LJ Date Dpi t' Y VVbite oo ' File; yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional } -97 Form CC i �.. _ ..._..._�_��.....- ..___._r..r .,r_�. , �,... -.��__ - ---- ._._.._. S O_ I� _L 1 l� / S�4 3 p f 23 0 3p 25 28,00 ��w 8,20, LOT No. 15 AMA - 1.727 AC. t WE 2 511'. F M� < U.0 J 11/ 2 5TY. Ft?. C U.C.> O Z LOCATION DESCRIPTION FROM POINT A B 1 CIP 41' -5" 26' -11" 2 ST 83' -10" 22' -5" 3 ST 84' -10" 26' -6" 4 ST 93, -7„ 29' -7" 5 ST 95' -0" 32' -10" 6 DB 141' -8" 1Q1' -8" 7 _ DB 148' -0" 107' -5" 8 DB 154' -7" 11.4' -2" 9 DB 160' -4" 120' -2" 10 DB 168' -0" 127' -4" 11 TRENCH -P1 157' -7" 136' -11" 12 TRENCH -P3 165' -4" 143' -0" 13 TRENCH -P5 172' -5" 149' -3" 14 TRENCH -P7 180' -4" 156' -6" 15 TRENCH -P9 186' -0" 162' -2" 16 TRENCH -P2 167' -0" 115' -9" 17 TRENCH -P4 175' -5" 125' -0" 18 TRENCH -P6 187' -5" 136 -3" 19 TRENCH -P8 195' -0" 145' -5" 20 TRENCH -P10 202' -0 1 154' -0"