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HomeMy WebLinkAbout0482DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13.08 -1 -103 BOX 6 wn P.- A �'ti i T IN 1 -� , 19 111 1 6 i�, � L �' 1 1 00291 'c� PU'Y'NAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT # Located at CQ 1yti�;1Ji L c6 j a— Town or i age a t t e r s o n 'Owner /Applicant Name D or s e t Hollow Builder s Tax Map 13, 0'6 Block Lot 103 Formerly Van Cleef Estates Subdivision Name Dorset Hollow Estates Subd. Lot # 10 Mailing Address 15 West Hollow Road, Brewster, NY Zip 10509 Date Construction Permit Issued by PCHD !z 30 oD Separate Sewerage System built by Dorset Hollow Builders Address 15 West Hollow Road Brewster, NY Consisting of 1250 Gallon Septic Tank and -40 !o L F of 24" wide trenches and 100% reserve. Other Requirements: Town Water Suu ®Iv: x Public Supply From W a t e r Address Has erosion control been completed? Yes Has garbage grinder been installed? N o or: Private Supply Drilled by Building Type Residence Number of Bedrooms 4 of Patterson District Address 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 ounty Department of Health. Date: I 0-0 Certified by P.E. x R.A. (Design Professional) Address 3871 Route 6, Brewster, NY 10509 License# 059346 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 revocatiqn','�odificatiqn or change is necessary. By: "ek"tJ Title: Date: 24 vo 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 EEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Dorset Hollow Builders 5,;�-o 2, 10.J Owner or Purchaser of Building Tax Map Block Lot Dorset Hollow Builders Patterson Building Constructed by Town/Village B10-Ai .J1 014�_Jrl� Van Cleef Subdivision Location - Street Subdivision Name Residence A3 Building Type Subdivision Lot I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health; and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system.. p©y_,_, Corporation Name (if corporation) Address: I �S- State aeeij 51?a�Z, IJ `� Zip _L�a5-6� -t> a1L6,'7- 6 L) i L.1'J C�,--.S Corporation Name (if corporation) Address: ► 7 w,5 tao -,.) 20 State gds Zip l05 09 Form GS -0; 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 (Q14) 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 13 TAX MAP NUMBER: 13.08 -1 -103 6 Bonnie Court E911 ADDRESS: Patterson TOWN: AUTHORIZED TOWN OFFICIAL: (Signature) / DATE: a 3 06 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 VERFRIvI) r. rv. J1,u I I 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, New York 10509 0 OA FE I JO8 NU. S 2-I D� A rrEN n N RE; Septic As —Built tor. HOnv -Ester — Lo - ((3 WE ARE SENDING YOU 1% Attached ❑ Under separate cover via the following items: ❑ Shop drawings ❑ Prints ❑ Plans = Samples ❑ Specifications ❑ Copy of letter ❑Change order ❑ COPIES I DATE NO. DESCRIPTION l 1 Certificate of Construction Compliance 3 I 1 Guarantee of Subsurface Sewage Treatment System 3 1 As —Built Septic Plan Fee: $200 Z THESE ARE TRANSMITTED as checked below: L4 For approval For your use As requested C For review and comment r FORBIDS DUE G Approved as submitted r Approved as noted Returned for corrections Resubmit copies for approval C Submit copies for distribution Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS COPY TO If enclosures are not as nnte a �:.... __....... _ _. PUTNAM COUNTY DEPARTMENT OF HEALTH 9 • P DMSION OF ENVIRONMENTAL HEALTH SERVICES . FINAL SITE INSPECTION Date: 8 '7 oa Inspecte y: Et) Street Location 3oyv.v/,6 GT, Owner 7jo2s��- �lo9�ati✓ idiGr7�7Pc Town Permit # � ov TM # ; pg.— 1 — 0 3 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 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 engt required ! } D c> Length installed -Vo 2. Distance to watercourse measured- ► O o Ft.......... 3. Installed according to plan ......... ............................... 4. Slope of trench acceptable 1/16 -1/32" /foot ............. 5. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 1000/c 8. Size of gravel 3/4 - 1' /2" diamete a ................... 9. Depth of gravel in trench 12" minimum... ................ 10. Pipe ends capped ......................... ............................... g. Pump or Dosed Systems ize 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 located per approved plans ... ............................... b. Number of bedrooms ....................... ............................... I.V. 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 & dinto exist watercour g. Footing drains discharge away from STS area ............... h. Surface water protection adequate .. ............ .................... i. Erosion control provided ................. ............................... Rev. 6/97 0 BRUCE R. FOLEY Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road ` Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (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: 8Z7 ZO a To: W_ Sco-TT J2�e,' �c�'eSET a tt C5 From: Gene D. Reed Putnam County Department of Health /For your information For your review As discussed Fag #• 2.76 -9.166 No. Pages (Including cover sheet) Please respond Attached as requested Please call Notes/Messages 40 7— Jr. S . Q�� rO &&;2 k- El Lr ✓ ' . ✓ ' I �r ✓r �NOW, z-11 7 i In the event of transmission /reception difficulties, please contact this office at (914) 278 -6130 ext. 2261. 07/31/00 16:13 a c Q H. ATTENTION PW SCOTT 4 19142787921 PUTVAM COUNTY DEPARTMFNT OF HEALTH DIVISION OF ENVIRONMENTAL REA1LTEI SERVICES All information must be fi41y completed prior to any inspections being made. For: Fill Trenches W-MM PCHD Construction Pern it # 1 Located: 41 Don n"e, ePs (T) M Owner /Applicant Name: _ D04k+ vl V w trt t t TM 07.9%ock l Loth L03 . Formerly: 1% q"- .Su U VOiO-11 Subdivision Name: ef of a w Subdivision Lot # i 3 Is system fill completed?� Date: Is system complete? _ _ ----! e 5 Date: f 1 1 ° Is system constructed as per plans? Is well drilled? N Date: Is well located as per plat s? N Fk Are erosion control mean ues in place? I certify that the system(s), as fisted, at the above premises has been constructed and I have inspected and verified their completion 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: 3 4 LOO • Certified by: �'� s� PE ✓RA Design Professional Address: 3$7 t R� N-�E CD , 6WS"r�2, Licic � ' 0-i-q3 Y- (y Comments: t c ° -ttA -M OL-f P7, KUA_ 1-d cAe±Z to Form FIR -99 "I �q PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ,pCONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at 6 Bonnie Court Town or Village Patterson Subdivision name D o r s e t. H o 11 o w E ,1 bbd. Lot # 13 Date Subdivision Approved 1998 Owner /Applicant Name Dorset Hollow Builders Tax Map 13. 0 8 Block 1 Lot 103 Renewal Revision Date of Previous Approval Mailing Address 15 West Hollow Road, Brewster, NY Amount of Fee Enclosed $ 3 0 0. 0 0 Building Type Residence Lot Area . 9 2 A c No. of Bedrooms 4 Zip 10509 Design Flow GPD Soa Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of 1250 gallon septic tank and 24" wide trenches (7 rows @ 58 LF) and 1007 reserve. Other Requirements: 406 LF of 77 To be constructed byDorset Hollow Builders Address 15 West Hollow Road, Brewster,NY Town of Patterson Water Supply: X Public Supply From W a t e r District Address or: Private Supply Drilled by Address 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 IV Address 387 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 w onsidere necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe i pprove discharge of domestic sanitary sewa 1 . �� �( By; Title. r/ � It- Date: 6 13�IM White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 IG�NM7Q1. 17MI1 11�IBAiM{ MIMIMINMMIII/. IIMIMIMIMIM3MIMIMIMIMIMIMIMIMIMI /11!1M Vii! i e � ®� �D >d � � ®. � ° ov � � � /® J ,i _ y s i ® I� s �� ' �/' -o � C ® � y � S '1111/11?1li171lV 3yl'IIK'i1t�/lii!r MIJJ101�ltlllllil GliltiPHllfW` /i/VlilViill'17111'YI1/1�li/YlG Ni�/y1C� JI Vti1I1i 11111 V 1i111111tiIHillflllCi f9 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO ABANDON A WATER WELL please print or type PCHD PERMIT # W 4 "_o Well Location• • Street Address: TownNillage Tax Grid # 13, oi3 63° K (e Cou/�,1- CA, t t,��GO Map Block I Lot(s) (03 Well Owner: Name: Address: (067DI -S tvT I' O(LCL, 6U f S (A Br k 0CWW AW &XiJ SQL k' Well Type: Drilled Driven Dug Gravel Other Depth Data: Well Depth u:5-ft Static Water Level 4D ft Tate Measured Use of Well: ,Residential Public Supply Air /Cond/Heat Pump Abandoned 1- primary Business Farm Test/Observation Other (specify) 2- secondary Industrial Institutional Standby Water Well Name: • I Addte�s � � (jC° Contractor: t`�vl�,l.7�,(tr Reason For 5(;" ,; (,U[ j 4AJ Z-�- Abandonment: ILA U�( /�� �� & j�A� �YSZ Description of Work To Be Performed: �1r Date: c`)O Applicant Signature: -- PERMIT This permit, to abandon one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code, Subpart 5 -2 of Pant 5 of the New York State Sanitary Code and/or Part 75 of 10 NYCRR and provided that: Within 30 days of the completion of the abandonment of the water well, the applicant shall submit to the Department a certified statement that the ' rmation delineated on the application for this permit has been completed. 6A /w ✓P - Date of Is e Permit Issuing Official Title White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -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 WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via ❑ Shop drawings ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ C)9_'0'P Q- 5\'=�1o© dEETT[E °3 OCR 4 ° e GvlMUTTId DATE JOB NO. IS1 'C ATTE N RE: 9 the following items: ❑ Samples ❑ Specifications COPIES DATE NO. 1 QDESCRIPTION y P v MKN axft 'r THESE ARE TRANSMITTED as checked below: • For approval • For your use ❑ As requested ❑ For review and comment ❑ FOR BIDS DUE REMARKS ❑ Approved as submitted ❑ Resubmit copies for approval ❑ Approved as noted ❑ Submit copies for distribution ❑ Returned for corrections ❑ Return corrected prints ❑ PRINTS RETURNED AFTER LOAN TO US COPY TO SIGNED If enclosures are not as noted, kindly no us at once. CITY DEP,�aTMf T ti 2 D P o� ENTAL PROtfc�`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, P.E Putnam Co. Health Dept. 4 Geneva Road Brewster, NY 10509 Re: Dorset Hollow. Lot 13 Bonnie Court Patterson, Putnam East Branch Reservoir DEP Log # 10165 (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 slope in the primary area should be regraded to meet the maximum of 15 %. 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 BRUCE R. FOLEY Public Health Director- DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 �+ b' f 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 May 3, 2000 P.W. Scott 3 871 Route 6 Brewster NY 10509 Re: Proposed SSTS: Dorset Hollow Builders 6 Bonnie Court, Lot #13 (T) Patterson, TM# 13.08 -1 -103 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) SSTS area is to be graded to 15% with the addition of RO.B. fill. Fill specifications are to be noted on the plan. 2) Well abandonment permit application is to be submitted. 3) Standard construction notes 1 -15 are to: be provided on the plan. 4) Absorption trench detail is to note clean crushed stone (dust free) or washed gravel. Upon receipt , of a submission, revised to reflect the above comments, this application will be considered further. RM:tn Ve ly yours, Robert Morris, P.E. Senior Public Health Engineer PHONE (914) 742 -2001 FAX (914) 742 -2027 April 27, 2000 .. -�_L.. - :,. a--. m,—.. r2r". s�nrY' M'! n:'. �"? 3�?; r•. y{ ytrVs+::: e: a« tivr:: � .L:L�MF- m4.:�:!W'14.i6ifltlq[�Il THE CITY OF NEW YORK DEPARTMENT OF ENVIRONMENTAL PROTECTION JOEL. A. MIELE, SR., P.E. Commissioner Robert Moms, P.E Putnam Co. Health Dept. 4 Geneva. Road Brewster, NY 10509 Re: Dorset Hollow. Lot 13 Bonnie Court Patterson, Putnam East Branch Reservoir DEP Log # 10165 (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 slope in the primary area should be regraded to meet the maximum of 15 %. 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 ... 7n '.J 7b Cr nn 17 IfiLJ r«,rn r 11_tirc . vin i 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 [t Attached ❑ Under separate cover via ❑ Shop drawings . ❑ Prints ❑ Plans ❑ Copy of letter ❑ Change order ❑ 119"TT[E n O[P DATE ,- Aq- X000 JOB NO. 99— 159 ATTENTION t Q n /�/� . E 1," o �r J RE: Dorset Hollow Estates -Lot (formally Van Cleef Estates) Subsurface Sewage Treatment System (SSTS) Application for Approval of Plans (PC -97) I the following items: ❑ Samples ❑ Specifications 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) 1 House Plans (2 sets) 2 1 Letter from G & E Development,LLC, Re: Public Water 1 1 Check #q69- 1g50o3b for the amount of $ 30o.00 1 1 Short Form EAF THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ For your use ❑ As requested X1 For review and comment ❑ FOR BIDS DUE • Approved as submitted ❑ Resubmit copies for approval • Approved as noted ❑ Submit copies for distribution • Returned for corrections ❑ 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 not at once. 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 June 7, 2000 PW Scott Engineering 3 871 Route 6 Brewster NY 10509 Re: Proposed SSTS: Dorset Hollow Builder ''. Bonnie Court, Lot #13 (T) Patterson, TM# 13.08 -1 -103 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 slope in the primary SSTS area is to be regraded to 15 %. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM:tn VV e Ztrulyyour Robert Morris, P.E. 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 6 Bonnie Court TN Patterson Tax Map # 13.0 8 Block 1 Lot 103 Subdivision of Dorset Hollow Estates (formally Van Cleef Estates)' Subdivision Lot # 13 Filed Map # 2 7 71 Date Filed 12/24/88 Gentlemen: This letter is to authorize P e d e r W. 3. c o t t, P. E . , R. A. a duly licensed Professional Engineer X or Registered Architect to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. Cour P.E., gffea: ., #_ Mailing Address 3 8 7 1 Route 6 Brewster State New-York Zip 10509 Telephone: (9 14) 278-2110 ,I- Mailing Address: Dorset Hollow Builders 15 West Hollow Road, Brewster:' State New York Zip 10509 Telephone: ( 9 1 4 ) 2 7 9 - 1 3 3 9 Form LA -97 Department of Environmental Protection 465 Columbus Avenue Valhalla, New York' 10595 -1336 June 27, 2000 Robert Morris,-P.E. Putnam County Health Department 4 Geneva Road Brewster, NY 10509 Re: Joel A. Miele Sr., RE: Commissioner Bureau of Water Supply . William N. Stasiuk, P.E., Ph.D. Deputy Commissioner_ Tel (914) 742 -2001 Fax (914) 742 -2027 0 CITY DEPAft l N z ENTAL PRDTE�`O www.d.nyc.ny.us /dep (718) DEP-HELP Dorset Hollow Bonnie Court Lot 13 (T) Patterson . East Branch Reservoir DEP Log # 10165 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 13- Dorset Hollow Estates ", prepared by P.W. Scott, Engineering & Architecture, P.C. dated 3/15/00 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 toy , P. . Supervisor Engineering Design & Review bxc: Simroe Lloyd/Coughlan File. ITY DEPA* T ti z DEC ENiAI PRDSE�`O� PHONE (914) 742.2001 FAX (914) 742 -2027 May 26, 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 13 Bonnie Court Patterson, Putnam East Branch Reservoir DEP Log # 10165 (Joint Review) Dear Mr. Morris: WILLIAM N. STASIUK, P.E.,Ph.D. Deputy Commissioner Please note the following comment regarding the system design above referenced: Bureau of Water Supply • The slope in the primary area should be regraded to meet the maximum of 15 %. 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 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 # 13 (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. PO BOX 352 BEDFORD, NY 10606 r 9 `� .. Cr Z: - .777SYCN. Cl _ .... App=- 1' �.vT,e.'- $�G' L1C•rU /.� / -r'on/ Gn2,•� =- �= -==�`� ?.�� i�.4�,dy2'.N�:..� ,4(/.t !.f//��r�-,A1�iycM/ • >. ZO 2 /0605 y� ::.cy -.ad at �.C.�a°*'.i� c� // C KN_ ti✓�LL f /�L �J^ ut?L:. /3. y 3Z.^.cic % Z^.t / (__ndi=- Z _ n e=azz c=uss s t--eeL) qtr cf P=-e=ScaKir'c Ylct F—' G•�2Q'/l N ., UP'"? :scu--mm m '-z Su��-�*�'^. Date cf Perms:. tic n Test //1 1-3/ A< , i 0� Ile 2 3 � ' NC'L'S : 1. Tes'rs to be at sate de-- ..`i =ti ap;rcd=tely equa3. so.,:'- rats _ . are cbtainea .at eacz per=laticn 'cast :pole. ' .� data t }� L= 6---':-; for review. _ ,2. kept.: maw, -emits to be nzr>- J:-- . t--o of hole. Z z1acse Deptun is .Wp-ter �"�""1., W(P-r— = ZeVeI Vc. G�c�:rc S=---ace. Zm i.-:&.es ' Sc--! . Rate St:.rt ^D 1Tt�-;� Sta.T t Stto-O Droc 711 Y-inl .Z Dr--_D .Lnc ^FS G -IPS in=, es - .. I - I�•;�,{ -.10 ; y3 ;/' /.� jam" .. .� j .. 3 " • . � , i 0� Ile 2 3 � ' NC'L'S : 1. Tes'rs to be at sate de-- ..`i =ti ap;rcd=tely equa3. so.,:'- rats _ . are cbtainea .at eacz per=laticn 'cast :pole. ' .� data t }� L= 6---':-; for review. _ ,2. kept.: maw, -emits to be nzr>- J:-- . t--o of hole. TEST PIT DATA R' TO EE SU -01,E • 'II, H, APPY - 7 TION LOT DESC PI'IO N JF SO= L \' ii=,:,k= IN MS" K- S DAL G.L. /NG Address 387/ gor1r: g y yr . 3' .... ; 5' ✓����� BY fUr1 M DUArM -10 ORGY: I 7' <,a All r D �, SSIOii 9' - sq.ft /gal. ' L%eckcd 10' e Date INDICATE I�rJL'i� AT 1*1 -rCd GRCONI7V-."DR IS F L\ =ULNT.T'RM - LNDICATE L= 'IU WaICH PdATE.R = v-M RISES ��.. BI—ING M ==M DEEP HOLE OSSE.RGATIONS MADE BY: DAM DESI N Soil Rate Used -7 .Min /1" Drop: S. D. Usable Are: Provided No- of Bedro= z/ Septic Tank: Capacity ii D r ga-l-s. Type �/• ��� Absorption Area Provided By L.E. :c 24" width Other Narm /NG Address 387/ gor1r: g .... ; THIS SP.ACE FOR USE BY fUr1 M DUArM -10 ORGY: D �, SSIOii Soil Rate Approved - sq.ft /gal. ' L%eckcd by Date 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 nor set Hollow Estates, 3. PROJECT LOCATION: (formally Van Cleef Estates) Municipality Patterson County P u t n a m 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) Lot # Y3 - Dorset Hollow Estate's (formally Van Cleef Estates) 6 50jiNae C00r-t, >?a,Eergo,�, lJ y 5. IS PROPOSED ACTION: t_1 New ❑ Expansion ❑ Modificationlalteration 6. DESCRIBE PROJECT BRIEFLY: ' f Construction of subsurface sewage treatment system - for single- family resid'e.nce and connection to public water sppply. 7. AMOUNT OF LAND AFFECTED: Initially ci.S acres Ultimately c0. acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ® Residential ❑ Industrial ❑ Commercial 11 Agriculture ❑ Park/Forest/Open space ❑ Other Describe: 10'. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? ❑ Yes ® No If yes, list agency(s) and-permiUapprovals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ® Yes ❑ No If yes, list agency name and permit /approval Subdivision.approval from Town of Patterson Planning Board /PCDOH 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? ❑ Yes ® No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE ApplicanUsponsor name: P• W A S c t t, P •-A • Date: Signature: If the a ion 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-C1-05? Explain briefly. C7. Other impacts (Including changes in use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑ Yes ❑ No If Yes, explain briefly PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (aj setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been Identified and adequately addressed. ❑ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. ❑ Check. this box' if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Name of Lead Agency N Title of Responsible Officer Signature of Preparer (It ditterent trom responsible officer) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: Dorset Hollow Builders Lot # 13 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.51. Address: 3871 Route 6 6. Drainage Basin: East Branch Reservoir Brewster, NY 10509 7. Type of Project: X . Private/Residential Food Service Apartments Institutional Office Building Realty Subdivision Commercial Mobile Home Park Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) .......:............... ............................... Type I Exempt Type II, Unlisted X 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... No 10., Has DEIS been completed and found acceptable by Lead Agency? ............... N/A 11. Name of Lead Agency Town of Patterson Planning Board 12. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? .......................... ............................... Yes: 13. If so, have plans been submitted to such authorities? ........ ............................... Yes— Subdivision 14. Has preliminary approval been granted by such authorities? Yes Date granted: 1998 15. Type of Sewage Treatment System Discharge ................. surface water X groundwater 16. If surface water, discharge, what is the stream class designation? .................... N/A 17. Waters index number (surface) ................................ ........... ............................... . N/A 18. Is project located near a public water supply system? ....... ............................... Yes 19. If es name of water Supply 1 Town of Patterson byrsystem yes, pp y Distance to water supply 20. Is project site near a public sewage collection or treatment system? ................ No 21. Name of sewage system Individual Lots Distance to sewage system 22. Date test holes observed q -AS -96 23. Name of Health Inspector M - B u d z i n s k i P. E. 24. Project design flow (gallons per day) ......... ........................:...... .. ...................... 800 cPD 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... No 26. Has SPDES Application been submitted to local DEC office? ......................... N/A Form PC -97 27. Is any portion of this project located within a designated Town or State wetland? No 23, Wetlands ID Number .......................................................... ............................... N/A 29. Is Wetlands Permit required? ............... Indiv...........idual ...............Lat ..... ............................... 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, landf lling, sludge application or industrial activity? ............................ Yes/N6 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? . ............................... Me 36. Tax Map ID Number .......................... ... ............................. Map i ,o Block I Lot to3 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 nts made in are punishable as a Class A misdemeanor pursuant to Section Z5of the nal Law. SIGNATURES & OFFICL4L TITLES: Pede�Scott Mailing Address 3871 Route 6 . ..... ............................... Agent for Applicant Brewster, New York 10509 North NI o _ LOCOON DESCRIPTION - FROM POINT a A B. 1 DB71 3.6, -7, 26,_10., 2 DB -2 40' -1" 31'' =4. 3 DB -3 44'73" 37' -0" 4 DB -4 49, -0), 42' -31$ 5 DB -5 55' =0`' 47' 11,> 6 DB -6 59' =10" 53' -0;' 7 TRENCH -1 91' -0°' 53' -0" 8 TRENCH- -2. ' 93' -10" 54' -9" 9 TRENCH -3 96' -5" 59' -0" 10 TRENCH =4 100' -0" 63' -1" 11 TRENCH75 102' =9 66' -8" 12 TRENCH -6 1.05 -8" 71' -3" 13 TRENCH -7 . 108'' —Y 76' -4" 14. TRENCH -7 65' -3" 60' -4" 15 ST 36, -6„ 1 7,_0;, 16 .ST . 46,_0„ . 14' -3 "... a