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HomeMy WebLinkAbout0481DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13.08 -1 -102 BOX 6 00290 my r 16 T ..6 IL r or - .� ram 00290 .X" PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE F R SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # t'� �CUCO G_; Located at ;�, (bo P 0 < <- c o j gX- Town or Village Owner /Applicant Name -`- lb o'sk,0 =its Tax Map i *3 , 08 Block (_ Lot j c) Z- Formerly V% rd CLA-_'L'_P e 5 Subdivision Name 0c4z6AA- WjL' O �,3 OST1jT' - Subd. Lot # 1 if Mailing Address IS udl-r3 i 1#z2-i L_Gt_,j 9.,O � 1--� S3 Zip _1C) 9 Date Construction Permit Issued by PCHD /QL) Separate Sewerage System built by yaz-s i r s eB 0i t yA ddress 1 we5-t- 4o LLbw (2 oo� Consisting of I �-� t� Gallon Septic Tank and -4o (p LC= ter— �{ °' i lr��� -r2�- �c -b+ca- O{�� I U U v 1t? —t�� e- YLpj L7-5 Other Requirements: Water Sup"I : — —' Public Supply From W !N» y i s-c-t cfT' Address or: Private Supply Drilled by Address Building Type d i y L-* c:-45 Has erosion control been completed? & S Number of Bedrooms "-1 Has garbage grinder been installed? 00 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: 14 loo Certified by �— P.E. ->-<, R.A. (Design Professional) Address vIK7 i (2e),J CQ , i3 � � �2, Nei (USA Q) License # G 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 subject to modification or change when, in the judgment of the Public Health Director, such revocatio , dification or change is necessary. B d �4 Title: Date: lZi L� White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM r �. Dorset Hollow Builders �.5 t'`� y `� 7 Owner or Purchaser of Building Tax Map Block Lot Dorset Hollow Builders Building Constructed by Location - Street Residence Building Type Patterson TownNillage Van Cleef Subdivision Subdivision Name 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 system. Ir ".onth _ Dav (t Year Z 'Dov Signatur Title: Gene`ri ra or wner) - S igna re Corporation Name (if corporation) Corporation Name (if corporation) Address: T �ti�`�S� �� � �c ITrt -&.w ?'r Address: Cf- wes, few /�v I 'd State' %SAY Zip ( °Sa State s ,� /YY Zip Form GS -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 0 WE ARE SENDING YOU Attached ❑ Under separate cover via ❑ Shop drawings ❑ Prints '❑ Plans ❑ Copy of letter ❑ Change order ❑ DATE JOB 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 I 1 Certificate of Construction Compliance 3 1 Guarantee of Subsurface Sewage Treatment System 3 1 As -Built Septic Plan 461 �7J g� G Fee: $200.00 okeo6- t( 0 THESE ARE TRANSMITTED as checked below: 41 For approval 17 For your use ❑ As requested ❑ 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 COPY TO SIGNED: If enclosures ?re not as noted, kindly notify us at once. 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: TAX MAP NUMBER: E911 ADDRESS: TOWN: Dorset Hollow Builders Lot 14 13.08 -1 -102 12 Bonnie Court Patterson AUTHORIZED TOWN OFFICIAL: (Signature) DATE: 3/2 3 /ea 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) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ��1� FINAL SITE INSPECTION / Date: I' 6 ory Inspecte y: G, F ga, Street Location B,AtAll y- Gmuzr Owner Dolts Aoccyw &az D,rrs Town Permit # ;> —a 9 --o e> TM # Subdivision Lot # / 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 ...... ............................... II. Sewage System a. Septic tank size - 1,000 ..... 1,250 .......other ................ b. Septic tank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Box 1A outlets 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.-Le�l required O6 Length installed- O 2. Distance to watercourse measured -f- /-00 Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 - 1/32 17foot ............. 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' /Z" diameter clean .................... --� 9. Depth of gravel in trench 12" minimum ................... 10. Pipe ends capped .................................. :................ 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/Building a. House located per approved plans ........................:...... b. Number of bedrooms........... . IV. Well �..` op�i��� W��,',+ a: Well located as per approve p ........... ................ 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 ................. ............................... RPv F, /97 �Y� 5 ICS Imo' IMAM I== I== I== ICS ICJ ICS ICS ICS ICS ICS mm �Y� 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 Yorke 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: �// XOP To: P L✓, 56o `fT ' Vet-vi Glee-- From: Gene D. Reed Putnam County Department of Health v For y our information For your review As discussed Fax #: x-78-0-16( No. Pages (Including cover sheet) Please respond Attached as requested Please call In the event of transmission/reception difficulties, please contact this office at (914) 278 -6130 ext. 2261. 09/07/00 14:06 PW SCOTT 4 19142787921 NO.291 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION D ADAM A GENE - &QUEST EMEWAL INSPECTION For: Fill All information must be f illy completed prior to any Trenches inspections being made. PCHD Construction Pen it # �Le DD Located: 11 v ni.yt, - (T) M Ph" o'h Owner/Applicant Name: , 046(t_6 TM Q, 09 Block. Lot /o 1 Formerly: Staff Subdivision Name: i 'ds rer ftT Subdivision Lot # Is system fill completed? Date: Is system complete? �)%tE Date: 7 7Too Is system constructed as per plans? 2_1&_* Cqt . Is well drilled'? #11A - Date: Is well located as per pla is? Are erosion control meawres in place? I certify that the system(s) , as listed, at the above premises has been constructed and I have inspected and verified their coq letion 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: fz o Certified by: PE ✓ R.A esign Professional Address, Reki,,e 6,,� 1�(.`l t °f ° c1 Lie. # Comments: --- IU1r7 Farm FIR -99 NO 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 (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 PW Scott Engineering 3871 Route 6 Brewster, New York 10509 Re: Field Inspection -Lot 14, "VanCleef" Bonnie Court, TM# 13.08 -1 -102 (T) Patterson, Permit # P -28 -00 Dear Mr. Scott: U 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. • Expose all end caps. • Need bedroom count (house was locked). • Need to locate the footing drain outlet. 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 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 /)/ % 06 TO: P, w, SGoTi Re: Field Inspection Le, T -Rc,NNfF- (T) p i?5 V N Dear: The following comments must be corrected in the field: ® CZ66 'Vl<v s-roev E , , , `!'r'C • FXPa s� ��� E/(� GAPS • N e;El7 � Ev'Roc�M cov,u T �NovS � �i,�� �6c pC�v� / NFE:P .7o Zoe -*7-C T•�� Fa�>7^/4 -Ph -AIN ©vTLET, If you have any further questions, please contact me at (914) 278 -6130 ext. 2261. Very truly yours, Gene D. Reed GDR:tn Environmental Health Engineering Aide fieldins 1 lov 0o'O S c-� Ica �I ' °N 10"I 0 0 Ckv ti 's O .9 °o 9 O O _ 0 O yo 7:r-'Ddg160 -d�dd �rl N -,L0l oo' LOCATION DESCRIPTION FROM POINT A B 1 CIP 25' -8" 42' -8" 2 ST 30' -0" 44' -2" 3 ST 34, -2" 39' -8" 4 ST 36' -4" 47' -6" 5 ST 40' -0" 63' -0" 6 TRENCH -P1 63' -9" 35' -4" 7 TRENCH -P2 67' -5" 31' -2" 8 TRENCH -P3 71' -9" 28' -0" 9 TRENCH -P4 76' -0" 26' -0" 10 TRENCH -P5 80' -9" 24' -7" 11 TRENCH -P6 85' -3" 25-6" 12 TRENCH -P7 91' -2" 29' -3" 13 TRENCH -P1 117' -3" 88' -6" 14 TRENCH -P2 119' -4" 87' -0" 15 TRENCH -P3 121' -8" 86' -0" 16 TRENCH -P4 124' -3" 85' -3" 17 TRENCH -P5 127' -1" 85' -0" 18 TRENCH -P6 130' -2" 85' -1" 19 TRENCH -P7 132' -3" 85' -8" r, PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEW TREATMENT SYSTEM 0 PERMIT # Located at 12 Bonnie Court TownorVillage Patterson Subdivision name n o r set Hollow E sSubd. Lot # Date Subdivision Approved 1998 14 Tax Map] 3 -0 8 Block i Lot 102 Renewal Revision Owner /ApplicaritName Dorset Hollow Builders Date of Previous Approval Mailing Address 15 West Hollow Road, Brewster, NY Amount of Fee Enclosed $300.00 Building Type Res i d e n c e Lot Area • 9 2 A cNo. of Bedrooms 4 Zip 10509 Design Flow GPD &.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 4 06 L F of 24" wide trenches (7 rows @ 58 LF) and 100% reserve. Other Requirements: To be constructed byn o r s e t H o l l aw Builders Address 15 Town of Patterson Water Supply: X Public Supply From w a t e r District or: Private Supply Drilled by West Hollow Road, Brewster, NY Address Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto Signed: P.E. X R.A. Date Cam" 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 considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new p it. Approv or discharge of domestic sanitary sewage only//. By: Title: ✓ ,G� Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design rofessional Form CP -97 R � . . ^_> 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 (_2N C) b r Pk c�S C) WE ARE SENDING YOU Attached ❑ Under separate cover via _ • Shop drawings Prints ❑ Plans • Copy of letter ❑ Change order ❑ RE: VA AN CD, venec) -mil 1 ❑ Samples JOB NO. the following items: ❑ Specifications ' THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ For your use ❑ As requested Por review and comment ❑ FORBIDS 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 P (z) a SIGNED: if enclosures enclosures are not as noted, kindly notify us at once. DESCRIPTION THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ For your use ❑ As requested Por review and comment ❑ FORBIDS 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 P (z) a SIGNED: if enclosures enclosures are not as noted, kindly notify us at once. Engineering & Architecture, P.C. 3871 Route 6 (914) 278 -2110 Brewster, NY 10509 FAX (914) 278 -2166 May 15, 2000 Robert Morris P.E. Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Re: Proposed SSTS - Dorset Hollow Estates 12 Bonnie Court, TM# 13.08 -1 -102, Lot #14 (T) Patterson Dear Mr. Morris: Our office has received your comment letter dated May 11, 2000. 1. We have revised the drawing per your comments #1, #2 and #3. Please find the revised drawing enclosed with this letter. 2. The percolation rate is verified to be 3 min /inch. Please refer to perc. test data attached in the application package submitted to you. The range of percolation rate on the drawing is revised accordingly. Please do not hesitate to call if you have any questions. Best regards, Peder W. Scott, P.E., R.A. President ARCH I T E C T U R E *ENGINEERING *SITE PLAN NI N G P_i',•..;:Ll!a_i BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster,. New York 10509 LORETTA MOLINARI RN., 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 Peder Scott PW Scott Engineering 3 871 Route 6 Brewster NY 10509 Dear Mr. Scott: May 11, 2000 Re: Proposed SSTS: Dorset Hollow Builders 12 Bonnie Court, Lot #14 (T) Patterson, TM# 13.08 -1 -102 a 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) Construction notes 1 -15 have not been provided. 2) Please revise the design data percolation rate on the plan to reflect a 3 -7 minutes /inch range. A percolation rate below 3 minute /inch is unacceptable. 3) Please revise the trench detail to note either or both "dust free or washed crushed stone ", with the require note washed gravel as acceptable material. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very truly yours, ey-�� Iq Robert Morris, P.E. RM:tn Senior Public Health Engineer �� VDaK CITY DEPgaTME J ti 2 Doftw �e ENTAL PROSE�`O� PHONE (914) 742.2001 FAX (914) 742.2027 April 27, 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 14 West Street Patterson, Putnam East Branch Reservoir DEP Log # 10141(Joint Review) Dear Mr. Morris: WILLIAM N. STASIUK, P.E.,Ph.D. Deputy Commissioner Bureau of Water Supply This letter is to inform you that the New York City Department of Environmental Protection (Department) has determined that the above - referenced application is complete. In addition, the Department has no objection to the approval of the above - referenced regulated activity. This determination is based on the review of submitted documents including the plan titled "Septic Site Plan Lot 14 prepared for Dorset Hollow Estates ", dated 03/23/00. The applicant must contact Sissy De La Ossa of my staff at (914) 773 -4416 at least 2 days prior to the start of construction of the SSTS so that a Department representative may inspect and monitor the installation. Sincerely, Margaret Lloy Supervisor Engineering Design & Review xc: James Covey, P.E., NYSDOH 465 Columbus Avenue, Valhalla, New York 10595 -1336 BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORETTA MOLINARI - RN., 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: Dorset Hollow Builders 49 West Street, Lot #14 (T) Patterson, TM# 13.08 -1 -102 Reservoir Basin Dear Mr. Scott: April 5, 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 April 26, 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 - April 5, 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. Ve t ly yours, �.✓" Robert Morns, PE RM:tn Senior Public Health Engineer PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Dorset Hollow Builders Located at 12 Bonnie Court TN Patterson Tax Map # 13.08 Block 1 Lot 102 Subdivision of Dorset Hollow Estates (formally Van C lee f Estates) Subdivision Lot # 14 Gentlemen: Filed Map # 2 7 71 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 ttnam County Sanitary Code. P.E., R'A., # 059346 Mailing Address 3871 Route 6 Brewster State New York Zip 10509 Telephone: (9 14) 278-2110 V S Mailing Address: Dorset Hollow Builders 15 West Hollow Road, Brewster State New York Telephone: Zip 10509 (914) 279 -1339 Form LA -97 CF �Jl� M -ir] r .. JJ���./i_�� ../✓� i..i..d ✓ r..rr+�i�..� �... ..� ►�ril.n 1 /V. CHrer S�cG :7Cyisi�o,v G�.•2;� :.�c::�s _ 7 � � �,a- rH,4•,eo.v.�� ,�y� �,r/N,r�- �, 3.20 � J06o5 yo L=--r7 at (S� t} .x%3/1 c G�.r,y�,✓,�w, %G P� Ste_ /3. �1cC:: a:t / L`"...:.r._...r.L' �; r'�,7`' -•.�•� o�/ � Ytat°..'"s er G.2i: »n/• i>-t-- of P-- --SCc'1C:_ :C ;,y-IM APP =C rC LOT Date of Test HOLD, ,L% .zc CatA- 'rTCLq nlln Elapse Dept: to .water -ca Water Leve? No. TL:;� Gr-Unc Sty =ace. L^ —czes ' Soil Rate Sta 'n -stca Min. Stop Drop :r, Y .a .1, 1 Br Cp inc.11es Lnches LnChes 3 11'2 1' &) 7 % 14 Z�' _ . .,S Ile i 2 3 1. Test= to be repeater at same depth unt? ap...rccaztely equal sail rate ms r . are obtainei .at erch Der r ..1at =on test hole. ' A2,1 data t..;* be for revie -a. 2. Depth mwzurernn'6---Q tc be made ... =, trp of hole. Nampa G✓ oTl �NGiNE�� /A mf;Aiqjgnatu e ' c Address 3�7/ /Poi 6 SEAI, 59 THIS SPACD FOR USE BY H UTH DEP.UMERT ONLY: :....:. Soil Rate Approved Sc:ft /gal. Checked by Date b TEST PIT DAiA RC ?'• � TO BE SU&yi = 1 u .- APPL '' Tr CNL1 4T Di:,S ?. =-TT_ON yr SC =S E;^^ I� IN TEST S01�.3 i Dr"'.�. T.1. Hozz-_. NO / =2 M. HOLZ X70. G.:.. 3' 4' 6 t 8' 9' 10, . 11 • INDI= I07M AT MC = , -Z-1= IS EL \=UPI ,:-L= . L'gDjaM L=- TO wMCH YAM, :Z'vM RISES AFwR SING DES HOLE OBSERVATIONS MADE BY: DAME: DESIGN Soil Rate Used //- 5 Min /l" Drop: S. D. Usable Area Provided No- of Bedroans Septic Tank Caracity /25o ga? s . r, AbSOrptwCn Area Provided By L.E. :: 24" Width tre:7C7 Other Nampa G✓ oTl �NGiNE�� /A mf;Aiqjgnatu e ' c Address 3�7/ /Poi 6 SEAI, 59 THIS SPACD FOR USE BY H UTH DEP.UMERT ONLY: :....:. Soil Rate Approved Sc:ft /gal. Checked by Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONINLENTAL HEALTH INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE TREATMENT SYSTEMS REVIEW SHEET FOR CONSTRUCTION PERMIT NAME OF OWNER: STREET LOCATION: REVIEWED BY: RK GR, AS, SRDATE: YZ DOCUMENTS PERMIT APPLICATION _j2 )WELL PERtiiTT OR PWS LETTER . OF AUTHORIZATION DATA SHEET (DDS) LATE RESOLUTION TAX MAP =: (CONFIRMED) (REQUIRED DETAILS ON PLANS CONT'D) . U) )HOUSE SEWER - %" FT. 4 "0'; TYPE PIPE CAST IRON U``UNO BENDS; NLAX BENDS 450 W /CLEANOUT RENEWALS LPL _)SrrE NOTE (NO CHANGE) FILL SYSTEMS 10' HORIZONTAL; PAST TRENCH SLOPES 3:1 TO GRADE (_ �J- (�SHORT EAF FILL SPECS / FILL NOTES 1 -5 (_) /)PLANS -THREE SETS ( ) FILL PROFILE & DIMENSIONS ((__)HOUSE PLANS - TWO SETS `�— FILL IN EXPANSION AREA UUVARIANCE REQUEST,* FILL GREATER THAN FEET SUBDIVISION i� VA LPL )LEGAL SUBDIVISION L_)L_)SUBDIVISION APPROVAL CHECKED UUPERC RATE UUFILL REQUIRED DEPTH U(_JCURTAIN DRAIN REQUIRED GENERAL (_)(_)LOCATED IN NYC WATERSHED UUPLANS Si��.flTFED -T P ( LEGATED TO PCHD U DEP ROYAL IF RE ' U ST HOLES OBSERVED UUPERCS TO BE WITNESSED ( _JL)EX- APPROVAL SSDS ADJ, LOTS (,__)(_)WETLANDS (TOWN/DEC PERMIT REQ'D ?) ( _J(__)DATA ON DDS PLANS & PERMIT SAME (_)L,PRE 1969 NEIGHBOR NOTIFICATION U(_JLETTER BI/ZBA (__)0100 YR. FLOOD ELEVATION W/I 200' (___) OIL TESTING LOTS >10 YEARS OLD REQUIRED DETAILS ON PLANS SEWAGE SYSTEM PLAN - (NORTH ARROW) SSDS HYDRAULIC PROFILE (A(77 )GRAVITY FLOW UCTION NOTES 1 -15 iESIGN DATA: PERC & DEEP RESULTS 'CONTOURS EXISTING &.PROPOSED WAY & SLOPES, CUT ING /GUTTER/CURTAIN DRAINS SOIL TYPE BOUNDARIES ITTTLE BLOCK; OWNERS NAME ADDRESS TM", PE/RA; NAME, ADDRESS, PHONE# (DATE OF DRAWING/REVISION TUM REFERENCE ( l_) LOCATION OF WATERCOURSES, PONDS LAKES,WETLANDS WITHIN 200' OF P.L. U( PROPOSED FINISH FLOOR AND BASEMENT ELEVATIONS W (--D(__)PROPERTY METES & BOUNDS COMMENTS: U CLAY BARRIER F]-LL CERTIFICATION NOTE a(TJDEPTH GAUGES VOL. ON PLAN FOR RO.B., UNCLASSIFIED & IMPERVIOUS W, I . SEPARATION DISTANCE FROM TOE OF SLOPE RT ENCH ,F TRENCH PROVIDED ARALLEL TO CONTOURS 00% EXPANSION PROVIDED 60FT MAX. AIL/DUST FREE CRUSHED STONE OR WASHED GRAVEL EOTEXTILE COVER SEPARATION DISTANCES ON PLAN - FROM SSTS 0' TO P.L. DRIVEWAY, LARGE TREES, TOP OF FILL 0' TO FOUNDATION WALLS 00' TO WELL, 200' IN DLOD, 150' TO PITS 00' TO STREAM, WATERCOURSE, LAKE (inc. expan) 0' TO CATCH BASIN, 35' STORMDRAIN, PIPED WATER 0' TO WATER LINE (pits - 20') 0' INTERMITTENT DRAINAGE COURSE 00' /500' RESERVOIR, ETC. _ 150' GALLEY SYSTEMS 0' MIN TO LEDGE OUTCROP SEPTIC TANK . FROM FOUNDATION; 50' TO WELL WELL DIMENSIONS TO PROPERTY LINES LOCATION OF SERVICE CONNECTION (� MIN 15' TO PROPERTY LINE SLOPE (SLOPE IN SSTS AREA 520 %) LJLJREGRADED TO 15 %, IF REQUIRED DOSE/PUMP SYSTEMS L_) P NOTES L� OSE 75% OF PIPE VOLUMEIDOSE VOLUME NOTED Li DETAIL FOR FORCE MAIN, (PIPE TYPE, ETC.) PIT AND D -BOX SHOWN & DETAILED 1 DAY STORAGE ABOVE ALARM CURTAIN DRAIN U STANDPIPES, 5' BOTH SIDES, DETAIL 15' MIN to CDS = >5 %, 20'4 %, 25' -3 %, 35' -1 %,100 % - <1% 20' MIN to CD DISCHARGE /100' with 182 cons day discharge 10' MIN to NON - PERFORATED PIPE P. W. SCOTT Engineering & Architecture, P.C. 3871 Route 6 BREWSTER, N.Y 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 GATE 3-� -, 1000 JOB NO. 99— 159 ATTENTION Robert (hor -rj' 5 RE: Dorset Hollow Estates - j.0t 9!q (formally Van Cleef Estates) Subsurface Sewage Treatment System (SSTS) Application for Approval of Plans (PC -97) I WE ARE SENDING YOU CI(Attached ❑ Under separate cover via the following items: • Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications • Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION 1 Application for Approval of Plans (PC -97) I 1 Construction Permit for Sewage Treatment System (CP -97) I 1 Letter of Authorization (LA -97) 1 2 Design Data Sheet (DD -97) I House Plans (2 sets) 2 1 Letter from G & E Development,LLC, Re: Public Water I I Check #469- 295'oo3y for the amount of $ `30o.00 1 I Short Form EAF THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ For your use ❑ As requested X] 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 SIGNED: If enclosures are not as noted, kindly notify at once. G &E DEVELOPMENT, LLC Gregg Macaluso 914 - 878 -4355 March 17, 2000 Robert Morris P.E. Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Re: Dorset Hollow Estates Lot # 14 (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. *Deve PO BOX 352 BEDFORD, NY 10506 14 -16-4 (2187) —Text 12 PROJECT I.D. NUMBER 617.21 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) SEDR 1. APPLICANT /SPONSOR 2. PROJECT NAME Dorset Hollow Builders Dorset Hollow Estates 3. PROJECT LOCATION: (f o r m a l l Van C l e e f Estates) �n Municipality Patterson . County P u am 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) Lot # ly - Dorset Hollow Estates (formally Van Cleef Estates) 1. 1 0A.J U ie Coo;A , gcJ_Leryo j , ),J'y 5. IS PROPOSED ACTION: El New ❑ Expansion ❑ Modificationlalteration 6. DESCRIBE PROJECT BRIEFLY: Construction of subsurface sewage treatment system - for single- family resid'e.nce and connection to public water sypply. 7. AMOUNT OF LAND AFFECTED: _ Initially �•J� acres Ultimately 0.6 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/FoiesUOpen 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: • W S Co t t, P. E., R. A. - Date: Signature: If the ac on is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 PART II— ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. ❑ Yes ❑ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another involved agency. ❑ Yes ❑ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, 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 (a) 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: :t Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency V, Title of.Resp—=ible Officer Signature of Preparer (If different from responsible officer) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISIONFOF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: Dorset .Hollow Builders Lot # iq_ 15 West Hollow Road Brewster, New York 10509 Dorset Hollow Estates 2. Nameofproject: (formally VanCleef Est)3. LocationT/V: Patterson 4. Design Professional: Peder W. Scott, P.E., R.Jik. Address:3871 Route 6 6. Drainage Basin: East Branch Reservoir 7. Type of Project: X . Private/Residential Food Service Apartments Institutional Office Building Realty Subdivision Brewster, NY 10509 Commercial Mobile Home Park Other (specify) . 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ....................... ............................... Type I Exempt Type II Unlisted X 9. Is a Draft Environmental Impact Statement (DEIS) required ?. ......................... No 10. Has DEIS been completed and found acceptable by Lead Agency? ............... N/A 11. Name of Lead Agency Town of Patterson Planning Board 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ......................................................... ............................... Yes:l 13. If so, have plans been submitted to such authorities? ........ ............................... Yes— Subdivision 14. Has preliminary approval been granted by such authorities? Yes Date granted: 1.998 15. Type of Sewage Treatment System Discharge ................. surface water X groundwater 16. If surface water discharge, what is the stream class designation? .................... N/A 17. Waters index number (surface) ........................ : ................................................. . N/A 18. Is project located near a public water supply system? ....... ............................... Yes Serviced 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 22. Date test holes observed Lci - l6 - y b 23. Distance to sewage system Name of Health Inspector M. B u d z i n s k i P. E. 24. Project design flow (gallons per day) ................................. ............................... 800 GPD 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... No 26. Has SPDES Application been submitted to local DEC office? 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 Individual Lat 29. Is Wetlands Permit required? .............................................. ............................... 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 pote,,itially 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 13,0p, Block t Lot 1 e 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 21Q,�.S of the Penal Law. SIGNATURES & OFFICL4L TITLES: Peder rscott Agent for Applicant Mailing Address: 3871 Route 6 ......................... Brewster, New York 10509