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HomeMy WebLinkAbout1042DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.48 -1 -40 BOX 11 01042 y T �I� ' I . 'I I 16 16 a L I i 01042 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO ABANDON A WATER WELL please print or type PCHD PERMIT # w —jq' Well Location: 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 Part 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 information delineated on the application for this permit has been completed. hhq Date of Issue White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -97 Street Address: �$ y�- _ /Tax Grid # ylat(s) i 1►T.ownNilla�gle iT CDC IN W� I 1 �u r k PG'T e,r50 t, ►v y I a563Map Block Well Owner: Name: Sc, G:s� Address: I4- Corrw�,iico��+,i'���t 5�,�,��ia�i✓3 Well Type: Drilled Driven Dug Gravel Other Depth Data: Well Depth ft Static Water Level ft Date Measured Use of Well: Residential Public Supply Air /Cond/Heat Pump Abandoned 1 -prima . Business Farm Test/Observation Other (specify) 2- secondary Industrial Institutional Standby Water Well Name: Address: Contractor: Anne- 15,, D�; IV; n� P�-� „� i1 ul1• � Reason For �Y I i1 i nub a new Uie-11 Abandonment: Description of Work To Be Performed: t' e vhcu :. ci e- o,l e ffmt PU -A al, & A Ve- eQ Fill ,u; VN C CM6 /1� . a•q-ltC. ?!re i!t�. 4 Date: 111311+ A licant Signature: Pp g 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 Part 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 information delineated on the application for this permit has been completed. hhq Date of Issue White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -97 ED a PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES -- - -- - - ^ "APPLICATfON-TO CONSTRUCT A WATER WELL please print or type! Well Location Street Address: Town/Village: Tax Map # ;tS. + 1+ Ccrn Wa 11 CcU; � Map Block Lot(s) Well Owner: Name: -gam• b, 5en� „; ne. Address: k 4- "r rv;ot << �rw -�{j (�Fecs:;� ll1'f (v�56 Phone #: "�-►5 -s1 Fc-atn c:, sty. Use of Well: _Residential _Public Supply Air /cond /heat pump Irrigation -Prima Business Farm Test/monitoring _Other(specify) 2- Secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People served---t Est. of Daily usage 5®0 gal. Replace Existing Supply Test/Observation Additional Supply Reason for Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason eh welt ; 5u • l!; ut'EZ? e rv. c, ,)ri o key ttis►�ev� o. 1 r d� -Eo L, W- S,,cX% CL2 tat t' for Drilling Well Type Drilled Driven Grave ther w�shi is n�c C,,,c1 Is well site subject to flooding?.: .................................................................................... Yes No _ Is well located in a realty subdivision? ........................................... ............................... Yes _ No ✓ Name of subdivision Lot No. Water Well Contractor: Ncr:+tnctA A4e-(-50,-1 Address: 15A &jrer Is Public Water Supply available on site? ....................................... ............................... Yes _ No Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Date:. Applicant Signature: _ PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions. of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department: 3) Submit a Well Completion Report on a form provided by the Putnam Countv Health Departmen take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Commissioner of Health., Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue 11/3 % Permit Issuing Officia P Date -of Expiration Title: �T 2 Permit is Non White copy - HD file; Yellow copy.- Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 II ;� Rev. 3/06 W 2 t i� U ���- �> � i�M'�I�fi�� 1N �"� rya �� V-� CGSi rv� -}- ice, i h/ f >7w ✓�` Sl 01 SU IV\ R s - �ev►i���-a , ' , d - 1 j)} I i I i i 1 f f Sl 01 SU IV\ R s - �ev►i���-a , ' , d - j)} I i I Sl 01 SU IV\ R s - �ev►i���-a , ' , d - 53 cV C 540 0 - 111.67 53 - --- co _ 5401 - -__ 5317 -- - -�_ 5402 5375 co CO __- -- 4%j 5403 - - - -� -- i 5374 - -__ .116.73 5404 .5373 5405 5372 O, REBECCA WnTKNBERG, RN, BSN Public Health Dbvdor ROBERT MO11;t1W E Director gfEn*omneW Health Joseph Francise, Jr. 14 Cornwall Court Brewster, NY 10509 Dear Mr. Francise: DEPARTNIENT . OF HEALTH 1 Geneva Road,. Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 April 13, 2012 Re: Addition — Francise No Increase in Number of Bedrooms 14 Cornwall Court (T) Patterson, T.M. 25.48 -1 -40 MARYELLEN ODELL COS&YEWX&t W 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 April 12, 2012. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at three without prior approval by this 2. The area of the existing sewage disposal system and its expansion area must be maintained. 3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc ... 4. 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. 5. This approval is valid for two (2) years and expires on April 12, 2014. Any permits or variances required under the jurisdiction of the Town of Patterson. If you have any questions, please contact me at (845) 808 -1390 ext. 43157. Respectfully, oseph S. Paravati Jr., P.E. Assistant Public Health Engineer JSP:cw cc: BI (T) Patterson i b 1d 1 ADDITION APPLICATION RESIDENTIAL ONLY r STREET %�, TOWN TAX MAP NAMeNG ' PHONE" MAIL ADDRESS_ /y ✓��� °a/ - DESCRIPTION OF ` ADDITION NUMBER OVEXISTINA'.�"°BEDROOW 3__I_PROPOSED # OF BEDROOMS_ (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 Health Dept., 1 Geneva Rd, Brewster, NY 10509, Phone: (845) 278 -6130. 1. Certified check or money order for $100.00. _ _..... 2.._ Sketches of existing floor plan (drawn to scale, all living. area including basement, to be shown aiid'dimensioiiedand'use*of each room specified). -,(-S- e*e 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. Include date of installation known. 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 COMMENTS hU.») b r' Town Legal Bedroom Count & Proposed Addition Status Re: - (Owner's Name) Tax a r # a &" Address: ZZ7 /1,7,,,,� eSe 1� Town: Year Built: According to records maintained by the Town, the above noted dwelling, is 42C in compliance with Town Code. Is not in compliance with Town Code. The Legal Bedroom Count is: This information-has been obtained_ rom: Certificate of Occupancy: Other: The plans for the proposed addition are considered: New Construction Addition to existing house only Teardown and/or re -build allowed under Town Regulations �., J�4 Bui in nspect Date 6. I IN i 614882e44e MORLIN430ADOUX 5400\ P�^ROP6�St 901.1 moco ~am w w Z w cc Q iron CORNWALL 12/10/99 3i38PM JOB 68U Page bid . � �• r, 5315 5374 -I -- - 7e12' SteTi c ( 5 0' WiA e ) 'o h 5404 5405 AkAGE � A�BvvF O Q SL--b I PAPA 0, p fl a 2� pipe ROAD __.._..._. _.._ SURVE•Y..'..OF P._R0P..ER-7- -Y y 'PRE-PARED FOR RAYMOND F. 49 MARY .ANNE SAV /O A ND MICHAEL FRANCES M. 81ANCA BEING LOTS 5401 - 5404 INCL. SHOWN ON ' SE VEN TH MAP, OF PUT/VA" LAKE rr TOWN OF APA T TERSON PU rlm M couly T Y, NEw YORK SCALE". / "7 20' Soid mop filed March 20, /93/ as Mop No 149 f' Legend stone wov iron pin Mound -- . hedge snow fence .- pole 0 wires , m -- - - - -- 9rhYy only to: Raymond F. AMoryAnne Savio Michael J B Frances M. Bianca, Commonwealth Land Title Insurance Co. for rifle No R434 036F, and to the Dole Funding Corpp. James C. Edgett, the surveyor who made Note: All cprtllications hereon are in ac'cordan'ce /s map, do hereby cert/ly that the survey with the minimum standards for surveys as the property shown hereon was completed adopted by. The New York State Assoc /etion jpc g� /97.a• of Professional Land Surveyors and are valid for this map and copies thereof only /f, said map or copies bear the impressed seal of the surveyor whose signature appears hereon. � Unauthorized alteration or addition to this sw l'roik License No. 37p_72 r mop Is a violation of Section 7209 (2) of Office of James C. Eiigett. The New York State Education Law. Land Surveyors 3A Oak Street. Brewster_ New York JOB No. 74099 REBECCA W TENBERG, RN, BSK Public HealthDka*r ROBERT MORR1% PE Director ofLwk mneWdl Health March 9, 2012 Joseph Francise, Jr. 14 Cornwall Court Patterson, NY 12563 Dear Mr. Francise: DEPARTMENT OF HEALTH 1 Geneva. Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278-7921 Re: Addition — Francise 14 Cornwall Court (T) Patterson, TM 24.48 -1 -40 MARYEGLEN ODELL COWAyEWaWW I have received and reviewed the latest set of plans for the proposed addition at the above mentioned residence. Based on the information submitted, the above mentioned addition cannot be approved for the following reasons: 1. The upstairs living room is a potential bedroom. 2;. "The legal,bpdroom coo nt for the dwelling "is three.._Tlie potential. bedroom. count of your. proposed addition is four. 3. The addition of a potential bedroom requires this Department's approval of a revised septic system plan from a professional engineer. Please revise the proposed floor plan to reflect no more than three potential bedrooms, or have a professional engineer or registered architect design a sub - surface. sewage treatment system meeting present code requirements. If you have any questions, please contact me at your convenience Sincerely, seph S. Paravati, Jr., P.E. Assistant Public Health Engineer JSP:cw . cc: BI (T) Patterson Y� .