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HomeMy WebLinkAbout1964DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36.31 -1 -24 BOX 18 01964 :Eii mom, so rriss Ill r I r M , :;.; f I . ti ._ . jl� �6 Is r IN , MEN ,� 01964 BRUCE: Public Health Director Terry O'Brien 6 Dryden Rd. Patterson, NY 12563 Dear Mr. O'Brien: LORET'TA.:-MOLINARI R.N.; M.&N. Associate Public .Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10.509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 March 17, 1999 Re: Addition- O'Brien- Dryden Rd.. No Increases in Number of Bedrooms (T) Patterson Tax # 36.31 -1 -24 I have 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 form this Department dated March 17 1999 The addition is approved with the following conditions. 1. The total number of bedrooms must remain at Two without prior approval by this department. 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. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Patterson. If you have any questions, please contact me at your convenience. Very truly yours;..__....._._........... _ William Hedges WH :kg Senior Public Health Sanitarian DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 BRUCE R. FOLEY, R.S. ­-Acting - Public- Health`-Direcroi'' ' ADDITION APPLICATION = (RESIDENTIAL ONLY STREET: TOWN TX MAP # 31 - j NAME:_ OEt` °Gy PHONE PCHD PERMIT # MAILING ADDRESS �5aM g lr' cf e i-, 1z:56 3 (n� Description of Addition I;00 ��,0,0V� 1 -(-�oo; %J'ba,,, Number of existing bedrooms _ Proposed number of bedrooms Any addition which is considered a bedroom requires formal approval of plans (Construction Permit) prepared by a Professional Engineer or Registered Architec. in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to PUTNAM COUNTY HEALTH DEPARTMENT, 4 GENEVA ROAD, BREWSTEP,, NY 10509, Phone 278 -6130 with the following information. 1. Certified Check for $100.00. 2. Sketch of existing floor plan (all living area including basement, if any) Non - professional drawing is acceptable. 3.-..Sketch- of...pro osed floor. plan. - ` ' .a. s..a. • .t ..� -v vim, s L - Non professional drawing is acceptable. 4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of installation if known. Include all wells and septic systems within 200 feet of property line. Any questions please contact this office. OFFICE USE Comments and /or conditions application August 1995 i. 'a {n -r g 9 tj .o !S71 47 -30re- .RAJ CLOD LO.00• iP�•J Qe.D 0 ] Lj J v J v 8 C-- 0 r-_- — , Fre.., w. f- S s AJtIWi 1 0 11 C. 0 0 0 m - -- i � I ��d7 -J 71' 47'- 30 �a Fc.eo 1 - —MAP oT SO Pk- LOTS 0"' c -3075 c -3076, c 3P7 11'1P `C, of P U V AM LA DE (F 1 LE 0 14°J- S) -moo .:..,.J cc PgTT EtLSorJ R%-[.�ti•1 Go.�..:T7', a.y SCa-, L I -C B.:�' DEGE-o%Zef.7� i%83 - 1Cdre -. I2-YDE rz0AT) �. 1�•4�: i rr 1 A'Ll 41 �rt�r•ok:,.;r..,� :. uvr.enh b.ta.J (� (? '` 1 rJ d. ,t 2� � roi• Sf',•�an tiar�.o� tfo.�n 2n ��JL� yJfJ�y .�•1 TT:t �ilo��t`� 5 ID 6r-,- 7.119831 <a C. a•. A- coME2��2a sn � iPu,d ..,fF or Go�p,a: oa.f'T� l.A►.�D 5v*ZJEyo2- UCEw)SE l,}� �i�°> :..�or4ss�� sal off' c suf.7t�er 270) 41A6E cr3125tiJSTE4, k V0--k - . �a Sa;za�r�. ���s �,.�ao.� �' �•• �.r... 914 -279 - 4 ?73 r 164 4110 10'2 LVI rn CII Oi CA co m r z < z rio" NO > m > rj LF c 1 5 -f v -n 14'9 -65 64 410- 202 - 102 r- -n 0 W4 0 ;u C Wr 6 Dr yam- W. PUTNANII CODUNITY DEPAIRMIENIT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY; BEDIRO 7-P Si�qnalure & Title aEC 22'1 " A O O W Q Vi D r D 0 M Z ° � a G) co rn >W m D o D F-I N r � r A c N Z 6'8 518 210 "4 8'5 "4 0 n r 12'4 10'6 Q l o PUTNAM COU��r��JEPARTMENT OF HEALTH X HOUSE PLANS APPROVED FOR BEDROOM COUNT ONILY; 36 . '� Signature & Title "Date - !� N O PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL ADDITION / REPAIR FORM SECTION A. GENERAL INFORMATION Name of Project Y/� G f� (T)(V) TM# Year of Construction Size of Parcel SECTION B. TOPOGRAPHY (Please check all appropriate boxes) 1. nitzily Molling 7)Steep slope L1Gentle slope nFlat 2. ClEvidence of wetlands Clow areas subject to flooding Modies of water Mrainage ditches M YES NO 3. Property lines evident? ❑ 4: Water courses exist-on,-or adjacent to parcel? - - 5. Existing individual wells within 200ft of the existing SSTS?`� l� ❑ SECTION C.. EXISTING SUBSURFACE SEWAGE TREATMENT SYSTEM (SSTS) 1. Physical character of existing SSTS area. A. Clevel L_rGentle slope ❑Stee P slope e B. []Well drained C well drained IlSomewhat poorly drained Cloorly drained C. Area available for SSTS. (Primary & Reserve) ME-x-tremely limited OSomewhat limited r]. dequate ft x ft D. INSPECTION Date j / % ( 'Inspector MNo evidence of failure ®Evidence of failure LJEvidence of seasonal failure —�`�\.�, -- -��J�, -- - - - - - - - - - - - - - - - - (Indicate North) .n� C H _ -t<<______________ _______________________________ (1) Indicate location of SSTS A. Size and type of septic tank gallons ®Metal Cloncrete LJPiastic B. Type of absorption area 1. Fields ft. 2. Pits 3. Gallies ft. (2) Indicate setbacks, front street, backyard, and side yard dimensions (3)'Show location of well - (4) Show location of driveway (5) Note physical features (steep slopes, rock outcrops, streams /wetlands) SECTI ®N E. EXISTING WATER SUPPLY DPWS ®Shared well dividual well DD- Iled Du g OCasing above ound COMMENTS : �iJt� �� A s WQ �( s w , 5 o 5 S% S DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 1.0509 (914) 278 -6130 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Re: U ( ,6:n2 Residence Tax Map To"M Gentlemen: BRUCE R. FOLEY. P.S. Acting Public Health Director According to records maintained by the Town, the above noted dwelling _......_.:._ISM —�-_ IS NOT in compliance with Town code and the total number of bedrooms on record is This information has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: OTHER 'kl� "�'4zzwr Building- Insclector /Lef p 29'11 3030 3030 29'11 - LIVING AREA 598 sq ft C) CV) co (D O CO) C) C14 • 1 SIT! MAI] PERK - Name & Relationship (i.e, owner,tenant, etc.) DATE TYPE FACILITY PROPOSED INSTALLER � C-:*-b PHONE Pro (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system. Different location may require submittal of proposal from licensed professional engineer or registered architect. -v Proposal approved Proposal Disapproved Inspector's Signature & Title roposal approved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name. b. Site Street Name, Town and Tax Map number. c. Location of installed components tied to two fixed points d. System description (e.g., 1250 gal. concrete septic tank, drywells surrounded by one foot + gravel). e. Installer's name and number. Date (e.g.,house corners). three precast 6' diam. x 6' deep 3. System repair to be performed in accordance with the above proposal and conditions. I, as or eported t of owner agree to the above conditions. SIGNA TITLE DATE [Fri: Mibe MV; YeUcw (fin BI); Pink (AFpli,cs 0 rTE "Oof TO ERSON INTERVIEWED PCHD Complaint # Name & Relationship (i.e, owner,tenant, etc.) ATE TYPE FACILITY ROPOSED INSTALLER L��� �''�7 PHONE roposal (include sketch locating all adjacent wells): 3TE: Repair must be in same location and of same type as original sewage disposal system. ifferent location may require submittal of proposal from licensed professional engineer or egistered architect. roposal approved Inspector's _0 ,.� ' � °1 . ture & Title Proposal Disapproved roposal approved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name. b. Site Street Name, Town and Tax Map number. C. Location of installed camponents tied to two fixed points d. System description (e.g., 1250 gal. concrete septic tank, drywells surrounded by one foot + gravel). e. Installer's name and number. Date (e.g.,house corners). three precast 6' diam. x 6' deep 3. System repair to be performed in accordance with the above proposal and conditions. , as or eported a nt of owner agree to the above conditions. IGNAI TITLE LATE Ci IFS: White WD); YeUcw Mx-n 8I); Pink Ugiiamt) zdotl! CW4.=Awo ALL SEA100fis CONSTRUCTION PC, ,-2 C-RANE ROAD CARMEL, NY 10512 49 14) 628.4944 1� -3G 9 -q2 a DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 Mr. Jack Harney All Seasons Construction RD #12 Crane Road Carmel, NY 10512 Dear Mr. Harney: December 1, 1992 JOHN KARELL Jr., R.E, K.S. Public Health�0irector� u Re: Repair to sewage disposal system Smith, Dryden Road Lake Ca: - e 1 , NY (T) Kent Today, December 1, 1992, I have receive received tie "As- Built" for the repair to the above mentioned sewage disposal system (R- 369 -92). The As Builts indicate the system was repaired according to the approved permit conditions. Approval -by this Department is- fore- --lecati-on .on.l -y.. _ .. ....... . ..:... Insufficient information and area exists to certify the systems adequacies to handle existing flows. If you have any questions, please contact me at yotz- convenience. Very tru 1�� yours, William Hedges Sr. Public Health Sanitarian WH /jp cc: M. BURDICK SHERLITA,AMLER, MD, MS,_FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health ROBERT J. BONDI - "County Executive' DEPARTMENT OF HEALTH September 27, 2005 1 Geneva Road, Brewster, New York 10509 Terry O'Brien 12 Dryden Place Patterson, NY 12563 Re: Addition — Approval — O'Brien No Increase in Number of Bedrooms 12 Dryden Place (T) Patterson, T.M. 36.31 -1 -24 Dear Mr. O'Brien: I have 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 the Department dated September 27, 2005. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at two without prior approval by this Department. 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 proposed changes only. This approval does not validate any construction shown as existing that has not obtained proper approvals. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Patterson. If you have any questions, please contact me at your convenience. Very truly yours, Gene D. Reed Senior Environmental Engineering Aide GDR:cw cc: Building Inspector, (T) Patterson Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 r� Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 SHERLITA AMLER MII;- FvIS-, FAAF' .;. Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health September 1, 2005 Terry O'Brien 12 Dryden Place Patterson, NY 12563 Dear Mr. O'Brien: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: Proposed Addition — O'Brien 12 Dryden Place (T) Patterson, T.M. 36.31 -1 -24 .o_RoBEw .J. ,13OND1 - County Executive w (kQ-r y0r4 V&Vt,,� 1 hart 5 Review of plans and other supporting documents submitted at this time relative to the above mentioned project has been completed. The following comments are offered: J A sketch of the entire existing first floor plan is to be submitted. The extent of the proposed addition is to be shown on the survey (ie. The footprint is to -be `shown). Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM: cw Si ely, Robert Morris P.E. Senior Public Health Engineer Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 i# t6 driveway flaN O bed -1 bed -2 bath I livingroom Kitchen Foyer i> r 1,al QC3dA(I"e-0 Z74 Zq& ) 121- 41, fd -,O-d tR pa7f 'e,P5Q f i t yx 9 t t A NO -Fla O k livinI, groom �G o .I i bath donhg 911 s Kitchen Foyer driveway Y t I I Entrance r t M F 1 t 07Z(CgIOA i dr paTft�rs o- -z r q�- zqo ��'j /2o v� > -311-712? 5 deg e, et"r ��'j /2o v� > -311-712? scan0008.jpg (JPEG Image, 971x1074 pixels) - Scaled (50 %) file: / / /C:/ Documents% 20and% 20Settings /Terry/My%o20Documents... OaZp aJ T2o D 4 0 �^ -p 0 n 4 CD -' 13Ta1 0 hQA j ! ( IN oo i 1 of 2 9/14/2005 8:19 PM tj IRFJ ROD 0 0,0 10 0 Ir *y StA PA F- V6bZLIJ%346 0 OD k:� a c r 0 LC c Ir :,e :A.sc.,�. c r� p.C� qA Ali -,P 4wj C—f I a s e 4 Jo's aP" LA► Nr-) 5vrztj1✓�o2- U�cl .sosr- 0-� JI LLAs 9-:' Do kk, 6er-u) Vor--1 P-a-T ®.a!r.u�►gi' ; WhooG 3�� tb� Ya. s��mcls na/ao.� ' Z7i STEI�6 g14 -'279 - 4-77 -3 L 1J� C-3035')C-307L)C-3 A P "C' P P U W AM LA 1(/,-. (FILE- 0 MAP 14°) • -T) SC--N-1. 1"s sa.' 7 1%5', C-A A T-n�co mk, ll,,bf,4 a%.- -Corp. M.ra1}b..,' 1 r A c- L4,1. k:� a c r 0 LC c Ir :,e :A.sc.,�. c r� p.C� qA Ali -,P 4wj C—f I a s e 4 Jo's aP" LA► Nr-) 5vrztj1✓�o2- U�cl .sosr- 0-� JI LLAs 9-:' Do kk, 6er-u) Vor--1 P-a-T ®.a!r.u�►gi' ; WhooG 3�� tb� Ya. s��mcls na/ao.� ' Z7i STEI�6 g14 -'279 - 4-77 -3 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health - LORETTA MOLINARI, RN, MSN Associate Commissioner of Health September 1, 2005 Terry O'Brien 12 Dryden Place Patterson, NY 12563 Dear Mr. O'Brien: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: Proposed Addition — O'Brien 12 Dryden Place (T) Patterson, T.M. 36.31 -1 -24 ROBERT J. BONDI County Executive Review of plans and other supporting documents submitted at this time relative to the above mentioned project has been completed. The following comments are offered: 1. A sketch of the entire existing first floor plan is to be submitted. 2. The extent of the proposed addition is to be shown on the survey (ie. The footprint is to be shown) ... Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. [:IuRoi Si ly, V Robert Morris P.E. Senior Public Health Engineer Environmental Health (845) 278 -6130 Fax(845)278-7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC(845)278-6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 . Jots No: RRB- OBIS -01 -001 piletNo RRB -04- 299- Obr -01 -001 Specification No 36 GENERAL DRAWING NOTES AND SPECIFICATIONS FOR ..2. -FLOOR ADDITION AND MODIFICATIONS AT: 12 DREYDEN ROAD PATTERSON, NEW YORK 12563 FOR TERRY O'BRIEN- OWNER 12 DREYDEN PLACE. PATTERSON, NEW YORK 12563 ISSUED: OCTOBER 25, 2004 ROBERT .R. BENOIT, P.E. 13 SOUTH LAKE DRIVE PATTERSON, NEW YORK 12563 TEL (845) 278 -0252 FAX (845 279 -1952 General Notes and Specifications File No RRB -04- 299- Obr -01 -001 Specification No 36 1. General Requirements (Note: Pre 2004 Code Requirements applicable for "As Built Structure." N/A denotes "Spec Item Not Applicable ") (a) Applicability- These Specifications are applicable for Drawing Titled: "O'Brien Residence: 2nd Floor Addition and Modifications, 12 Dreyden Road; Patterson, N. Y. 12563' , and dated October 25, 2004 or the latest revision thereof. (b) Work and Requirements- All work is to be good or better for standard practices of the trade and installation. All work and installations shall be L o applicable codes and regulations. Certification of materials shall be by delivery ticket with sufficient information to identify the materials delivered and used in the installation. (c) Dimensions & Discrepancies- `'As Built Dimensions" are from measurements taken by R. Benoit, P.E. and Terry O'Brien, Owner. Dimensional discrepancies shall be resolved before installation of materials and all dimensions verified in the field as necessary. Where +hare is a Hicnrannnt-w hra#sns sin thaca anar i Nnta nnri Cnanifiratinnc V'. YYL•• VY. • ♦h .YYY Ge �Yr Y• YfYY Y..Y Rnat- i••VY\.Y..Y and the drawings,--the requirements-- on the drawings shall take precedence and govern. i) 11e�a ®sti9n�i�a�� Additions. �s�ia- tan�a� to this rrir.a�n�isln� i a violation of New York State Education Law Sect 7299(2) (e) The Engineer has not beer: retained to i Snact the or k in nr c�gress or as finished �' ®U �t�,.•�aE P^91ndofion and Sighs- All new Concrete is to be 3000 psi �.. •�.NVV••• B4 • VN.•N6� compressive strength at 28 days. Bottom of footings are to be a minimum of 1_ t haacn -w i �r n-jaa n ij :fie e. i tie i 4nia9+ie it haail cn:' r - =r a�..:.i i i aciiaai �tti fir as ^,C YYSY •• vI� YYY Y..Y �Y 4Y Y• .Y.Y4Y. YYY YY..• Y \. .Y• YY.. shown on the drawing. S v�aii ind v�,i MV4M� VV v Fram°aFn' `:`� t�::.y"..I, .r°..il ir':i:l- f: Cam..:::.' -'.� .`.t: M�:.i��r �.r. �I. 1 v• ■-vv _ Douglas Fir or Hem Fir, No. 1 or 2 unless otherwise noted. ROBERT R. BENOIT, P.E. . I OCTOBER 25, 2004 Job No: RRB- Obr -01- 001 File No RRB -04- 299- Obr -01 -001 Specification No 36 (a) Floor Structure- Floor Joists Shall be sized and as shown on the drawings. New Floor Sheathing shall be 5/8" CDX. (b) Bearing Walls- All Exterior walls shall be 2 x 6 Stud Construction with %" exterior plywood sheathing . Interior Bearing Walls shall be 2 x 4 Stud Construction. Stud spacing shall be 16" O.C. (max). All wood plates bearing on Concrete slabs or mortared structures shall be pressure treated to prevent rot & decay. Interior Bearing Walls, running parallel to joists shall have at least a double floor joist installed .below the wall. Where bearing walls run transverse to joists, blocking shall be installed between joists below such walls. (c) Interior Partition Walls- (Non Load Bearing) To be 2 x 4 wood Stud construction. Material and grade shall be adequate for the intended purpose. Studs shall be 16" OC unless otherwise noted. (d) Roof Structure- New rafters and ridge structure are to be sized and as shown on the drawings. Sheathing shall be 5/8" CDX Plywood.. (e) Other Structures- All Headers are to be Double- 2 x 10 for Spans up to 8 ft. unless otherwise noted on the drawing. All other structure, such as special Girders and Steel I beams and Flitch Plates shall be as sized and installed as shown-on-the.-drawings.. 4. Insulation & Glazing (a) Glazing- Insulating Double Glazing µ < 0.63. Glass in Doors, walk areas and stairwells to be Safety Glazing. (b) Basement Overhead (Existing)- Recommend Install 6" R 19 Fiberglass (FG) insulation with vapor barrier. (c) 2 "d Floor Exterior Walls (New)- Use 6" Nom R19 FG with Vapor Barrier (d) 2 "d Floor Ceilings Below Aftics Roofs- 9" Nom R30 FG with vapor barrier. (e) Garage 2nd Fl Bedroom Floor- Install 9" Nom R19 FG Insulation. ROBERT R. BENOIT, P.E. 2 OCTOBER 25, 2004 D Job No: RRB- Obr -01- 001 File No RRB -04- 299- Obr -01 -001 Specification No 36 (f) 2 x 4 Exterior Walls- Where only windows are being exchanged out or the relocation of the window is required, new insulation shall be 3 -1/2 " R 11 Fiberglass insulation where such changes are less than 50% of the local gross wall area. 5. Roofing- New Roofing shall be installed on both old and new roof surfaces. Shingles shall be 3 tab 25 yr fiberglass Asphalt roofing Shingles 230# weight or greater. 6. Exterior Finishes, Trim, Gutters & Leaders- Siding and trim shall be Vinyl "Horizontal, Clapboard type siding and approved by the owner for color & Appearance. Siding shall be installed over an infiltration barrier with foam Backer. The intersection between vertical walls and roofs shall be flashed and protected with "water and Ice shield. Lower roof edges with pitches less than 5/12 shall be protected with drip caps and a 3 ft wide water and ice shield covering on the edges. Gutters and leaders shall be installed on all horizontal roof edges. Maximum single pitch length (1/4 "/ft nom) shall be 20 ft without installing a leader to ground. Drainage at grade shalt be as to not cause local "flooding" or flow towards the house. Painting and staining shall be as required by the Owner. 7. Interior Finishes and Applications- All new and modified ceilings and walls are-lo--be. covered with '/2" Gypsum Board . (GB) -except for the Garages urf interior saces between adjacent rooms and ' in Utility Furnace Rooms where 5/8 ". GB FR will be installed. Finished Flooring, Moldings, Trim and other finishes such as tile and sheet goods in Baths and Kitchen shall be as specified and required by the Owner. Painting and staining shall be as required by the Owner. The new interior staircase shall have a maximum rise of 7 -7/8 ", Run Greater than 9" and less than 12" and dimensionally shall lie within an overall tolerance of 1/8" max for dimensional differences between treads and risers. 8. Electrical & Fixtures- All new Electrical work is to be installed to code NEC - National Electric Code and be inspected by Fire Underwriters and receive Fire Underwriters Approval (certificate). All fixtures and switch /outlet types to be approved by the Owner. Smoke Detectors shall be installed in all bedrooms and in halls within 10 ft of bedroom doors. A CO Detector shall be installed in the Kitchen and Furnace Utility Room. All detectors shall be connected to have a common Alarm. ROBERT R. BENOIT, P.E. 3 . OCTOBER 25, 20.04 a Fite No RRB -04- 299- Obr -01 -001 Specification No 36 9. p Plumbing- All DWV, CW, and HW plumbing, Tanks and Fixtures are to be installed to applicable codes and inspected. Heating of Domestic Hot Water and Storage is to be integrated with the choice of Furnace or Boiler and HVAC means, methods and equipment. All fixtures, sinks, tubs and shower stalls as to model and type are to be approved by the Owner. A Plumbing Plan shall be supplied by the plumber as required by the Building Dept. before commencing the work. 10. HVAC- N/A 11. Appliances & Cabinetry - All Appliances and Cabinetry for the Kitchen and Baths shall be approved by the Owner. 12. Decks & Porches & Landscaping- NIA •: ERT R. BENOIT, P.E. 4 OCTOBER 25, 2004 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health �X. s L_ OFtETTAMOLINARI; RN, MSN. Associate Commissioner of Health ROBERT J. BONDI County Executive DEPARTMENT ' OF HEALTH 1 Geneva Road, Brewster, New York 10509 ADDITION APPLICATION RESIDENTIAL ONLY / STREET JOWN TAX MA.P#3('-_-Y 1_ 1_a1 NAMEI2.�-rQr)ce. � ' 1 P,n PHONE —aAS -a 4:-,3-_;�g} ©l PCHD# MAILING ADDRESS DESCRIPTION OF ADDITION NUMBER OF EXISTING BEDROOMS 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 76130. 1. Certified check or money order for $100.00. -� 2. Sketches of existing floor plan (drawn to scale, all living area including basement) -�3. Two sets of Drop floor plan ( awn to sale - with name, street and tax map #) *Non - professional sketches are acceptable 4. Copy of survey showing well and septic to the best of your knowledge. Include date of installation if known. Label all wells'and septic systems within 200 feet of the property line. Contact this office with any questions. Copy of Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count.of dwelling. OFFICE USE COMMENTS Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 1050.9 PUTNAM COUNTY DEPT. OF HEALTH 1 GENEVA ROAD BREWSTER, N.Y. 10509 To Whom It May Concern: ROBERT J. BONDI County Executive RE: / eA e,4-,v c, e Residence TAX MAP# TOWN_ 'r f77,'�s� e, . ) According to records maintained by the Town, the above noted dwelling: IS 11 IS NOT IN COMPLIANCE WITH town code and the total number of bedrooms- is This information has been obtained from: CERTIFICATE OF OCCUPANCY ASSESSOR'S RECORD_ OTHER BUILDING INSPECT Environmental Health (845) 278 -6130. Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 +` ro BUILDING PERMIT Town of Patterson, Permit N0 2 7 57 Permission is hereby granted to: o „e_ —ota -9 to erect - Per Plchiiiled "arid appro7,by (Location) cis Op ui .fsi ctor at /X Building Inspector This Permit must be kept on the premises until completion of all the authorized work. Note: The holder of this permit is required to familiarize himself with all ordinances under which this permit is granted. Any violation of these provisions will result in immediate revocation of this permit. BRUCE R FOLEY Public Health Director Terry O'Brien 6 Dryden Rd. Patterson, NY 12563 LORETfA MOLINARI RN., 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 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 March 17, 1999 Re: Addition- O'Brien- Dryden Rd.. No Increases in Number of Bedrooms (T) Patterson Tax # 36.31 -1 -24 Dear Mr. O'Brien: I.have. received and reviewed the plans for the proposed addition to -the above- mentioned _ residence. -'Fhe'pioposal'f6f the addition has been approved as per plans bearing the approval stamp form this Department dated. March 17, 1999 The addition is approved with the following conditions. 1. The total number of bedrooms must remain at Two without prior approval by this department. 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. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Patterson If you have any questions, please contact me at your convenience. Very truly yours .. ......... ._.._ ........ _.. William Hedges WH:kg Senior Public Health Sanitarian . 15: 71 47' a. LOTS C -3075 C- 3071 )C A P "C' of P U V AM". t....� k (FlLeO MAP 01 14-D--T) -c j.D ? 1158: COT, L4-d. c c r 5rid-, C'OrylplcAr-j err ID tIa Ai! 165- PB-7- 44 • 8�8G, ILI Af • jp De, C.oPmt Due JI LLAe-e Drz)OF, A? 17 3 Co - OO' LA GQ Fn--o"fi- 4z I's 71' 47' 50" ,a (c.00' a. LOTS C -3075 C- 3071 )C A P "C' of P U V AM". t....� k (FlLeO MAP 01 14-D--T) -c j.D ? 1158: COT, L4-d. c c r 5rid-, C'OrylplcAr-j err ID tIa Ai! 165- PB-7- 44 • 8�8G, ILI Af • jp De, C.oPmt Due JI LLAe-e Drz)OF, A? 17 3 M.- 20'2—, 1(76 — 9*8 65 61 51 47 FIRST FLOOR BDRM —UP- 106 sq ft Li L-ij: ­ LBAT H) in Ln N o s6 KITCHEN 175 sq ft ------- rj 911 T2 T8 2'51 LIVING AREA 2012 612 sq ft -X-- LQ FY .2 ri L7- c-3 ct: u.j -JZ C:l I i�, �N vp t-T lA 2U2 lOr6— 918 F- F 65 5'1 5'1 47 — LIVING AREA 292 4 612 sq ft FIRST FLOOR I a 9) LA-1 w i.j 7.:j ri • � C) IRoa R2o0 0 0 o 0 rl g u 9 v i ' �7i' -47 -moo -E co oo; g s f w+ v ' �v s2ca CcD - y� a ' � � � 6T• ltd/ � : i J u .1 c1 0 rn - - • od I e i 1.I - S� - -- si c LOTS 0 C -3075, C -307 , C 3( m A P "C'. o f PUVAMII—Ak (F I LE O rAAP Ily 149--T) f, ..rower cc PAr[Erc..Soa R%'t*•��W CEO J..:T7', sc.a, r 3� per, ,� 7, X98: Kdre, r t4.r%Jko., ttrac L4,1. -rp'r i,ila. �.}° T G£.• 83 •SjS a, 4.7otr: � � � Gtr {� �• �d.f .i� ei r �rtcroac I � r ►•+n tnrs c Cw.sr�. r (� r 'L �rada ��' ar.��rso� SF�o..an!►iero -o�, 7ro•n 2ti aL40&I Moll - 1D 7 , I j AU ccr ;•i�cr�..� ncrc,n i` v;i,d �! a ./� % e '�, :: ;o. 1'ns had ,..J c�, =s TeQr <o� .:'OSEP► -t A. Co N1EC2.�vr. f j;'' sr+ r�ss,� �aP f Gop.ca ou.r:;,c t_Aao SvrcJ�yorZ- Uc# + :a,Aress4� su1 04 �t. s✓r.�4�or 27c ?JIUA6r DRJ\)'-- SW> 13E • j : . whoec. si�•wl..va. aF�s r•,a./�..o� ' �•• r�•.. 91•¢••2'79 x'773 165- PB-7- 44.8Mr. - - - - -- s. , i � a ' � � � 6T• ltd/ � : i 0 rn - - • J . N I 0 IOD , 1 Z � C � I � �' i•1I' � od I e i 1.I - S� - -- si c LOTS 0 C -3075, C -307 , C 3( m A P "C'. o f PUVAMII—Ak (F I LE O rAAP Ily 149--T) f, ..rower cc PAr[Erc..Soa R%'t*•��W CEO J..:T7', sc.a, r 3� per, ,� 7, X98: Kdre, r t4.r%Jko., ttrac L4,1. -rp'r i,ila. �.}° T G£.• 83 •SjS a, 4.7otr: � � � Gtr {� �• �d.f .i� ei r �rtcroac I � r ►•+n tnrs c Cw.sr�. r (� r 'L �rada ��' ar.��rso� SF�o..an!►iero -o�, 7ro•n 2ti aL40&I Moll - 1D 7 , I j AU ccr ;•i�cr�..� ncrc,n i` v;i,d �! a ./� % e '�, :: ;o. 1'ns had ,..J c�, =s TeQr <o� .:'OSEP► -t A. Co N1EC2.�vr. f j;'' sr+ r�ss,� �aP f Gop.ca ou.r:;,c t_Aao SvrcJ�yorZ- Uc# + :a,Aress4� su1 04 �t. s✓r.�4�or 27c ?JIUA6r DRJ\)'-- SW> 13E • j : . whoec. si�•wl..va. aF�s r•,a./�..o� ' �•• r�•.. 91•¢••2'79 x'773 165- PB-7- 44.8Mr. - - - - -- s. , i Job No: RRB- OBR -01 -001 File i o RRB -04- 299- Obr -01 -001 Specification No 36 GENERAL DRAWING NOTES AND SPECIFICATIONS FOR 2 "D FLOOR ADDITION: AND MODIFICATIONS AT: 12 DREYDEN ROAD PATTERSON, NEW YORK 12563 FOR TERRY O'B2RIEN- OWNER 12 DREYDEN PLACE. PATTERSON, NEW YORK 12563 ISSUED: OCTOBER 25, 2004 ROBERT.R. BENOIT, P.E. 13 SOUTH LAKE DRIVE PATTERSON, NEW YORK 12563 TEL (845) 278 -0252 FAX (845 279 -1952 Job No: RRB- Obr -01- 001 F le No RRB- 04- 299- Obr -01 -001 Specification No 36 General Notes and Specifications 1. General Requirements (Note: Pre 2004 Code Requirements applicable for "As Built Structure." N/A denotes "Spec Item Not Applicable ") (a) Applicability- These Specifications are applicable for Drawing Titled: "O'Brien Residence: 2nd Floor Addition and Modifications, 12 Dreyden Road; Patterson, N. Y. 12553 ", and dated October 25, 2004 or the latest revision thereof. (b) Work and Requirements - All work is to be good or better for standard practices of the trade and installation. All work and installations shall be to applicable codes and regulations. Certification of materials shatl be by delivery ticket with sufficient information to identify the materials delivered and used in the installation. (c) Dimensions & Discrepancies- `As Built Dimensions" are from measurements taken by R. Benoit, P.E. and Terry O'Brien, Owner. Dimensional discrepancies shall he rewlwed h= re installation Yf materials and all dimensions verified in the field as necessary. Where fh@ra EM ^ fr'i ci- rannnt -w h @f%A19 =n fh @va (=n=rn1 :Kintoe arm c.n@CifiCntior!S = and the dr aw ings,.. the- ,requirements_ on _the - :drawings shall take v precedence and govern. ln! I Eas0 uf.hoori.znod Additions or �aadigiC- tisoa,5 to thic rirnwihn ig n `e.ei verve �e vrr vei �e er. rr a rve a.e■ • a•arevrra.r . violation of New York State Education Law Sect 7299(2) @ : been retained i r� nett t� :e ! +r is i ) The Engineer has ntea � n to e t to i::�r ' c :{ : �rrgrcY�� or as finished 2r llnMYon 7f9 Fou::dation ar:d Slabs- • •ll new Concrete s to be 3000• osi compressive strength at 28 days. Bottom of footings are to be a minimum of A�'f» E.. E .J., '. a ..:• t 6.....t •: — * -'L-j= a u` rrF'.riilAl i+ilrr+r �Ei r' ir+E+i +ii EEE'lr +i£+E Ei+ttr ++ +f iE+ + rtt+...r �iY.iti iEr ►++i+r'3iitC ni:. :tti. YY.Y ra v.�aYY 4•..V YM� \Y M.�Y�V \M.YVV VV..• Y ♦..V• 1r�Y.. V... V..\V M. �/ YV shown on the drawing. 0 r- ie ae r'4f3 ri—i �'iLTi ai"'sa6iu� n rrser rrie rr r— ^M31 Mtl+ i% :: ur:!Ct.: :t: E..:rI+NEA ."..(:.=..: tom.. Yr �lYMM YLr lrV YMeYY .et1 • RMrrrrrr� , Douglas Fir or Hem Fir, No. 1 or 2 unless otherwise noted. OCTOBER AOBERT R. BENOIT, P.E. rt Job No: RRB- Obr -01- 001 File No RRB -04- 299- Obr -01 -001 Specification No 36 (a) Floor Structure- Floor Joists Shall be sized and as shown on the drawings. New Floor Sheathing shall be 5/8" CDX. (b) Bearing Walls- All Exterior walls shall be 2 x 6 Stud Construction with Y2" exterior plywood sheathing . Interior Bearing Walls shall be 2 x 4 Stud Construction. Stud spacing shall be 16" O.C. (max). All wood plates bearing on Concrete slabs or mortared structures shall be pressure treated to prevent rot & decay. Interior Bearing Walls, running parallel to joists shall have at least a double floor joist installed below the wall. Where bearing walls run transverse to joists, blocking shall be installed between joists below such walls. (c) Interior Partition Walls- (Non Load Bearing) To be 2 x 4 wood Stud construction. Material and grade shall be adequate for the intended purpose. Studs shall be 16" OC unless otherwise noted. (d) Roof Structure- New rafters and ridge structure are to be sized and as shown on the drawings. Sheathing shall be 5/8" CDX Plywood. (e) Other Structures- All Headers are to be Double- 2 x 10 for Spans up to 8 ft. unless otherwise noted on the drawing. All other structure, such as special Girders and Steel I beams and Flitch Plates shall be as sized and installed as shown on the drawings. 4. Insulation & Glazing (a) Glazing- Insulating Double Glazing µ < 0.63. Glass in Doors, walk areas and stairwells to be Safety Glazing. (b) Basement Overhead, (Existing)- Recommend Install 6" R 19 Fiberglass (FG) insulation with vapor barrier. (c) 2 "d Floor Exterior Walls (New)- Use 6" Nom R19 FG with Vapor Barrier (d) 2 "d Floor Ceilings Below Attics Roofs- 9" Nom R30 FG with vapor barrier. (e) Garage 2nd FI Bedroom Floor- Install 9" Nom R19 FG Insulation. ROBERT R. BENOIT, P.E. 2 OCTOBER 25, 2004 Job Noe RRB- Obr -01- 001 File No RRB -04- 299- Obr -01 -001 Specification No 36 (f) 2 x 4 Exterior Walls- Where only windows are being exchanged out or the relocation of the window is required, new insulation shall be 3 -1/2 " R 11 Fiberglass insulation where such changes are less than 50% of the local gross wall area. 5. Roofing- New Roofing shall be installed on both old and new roof surfaces. Shingles shall be 3 tab 25 yr fiberglass Asphalt roofing Shingles 230# weight or greater. 6. Exterior Finishes, Trim, Gutters & Leaders- Siding and trim shall be Vinyl "Horizontal, Clapboard type siding and approved by the owner for color & Appearance. Siding shall be installed over an infiltration barrier with foam Backer. The intersection between vertical walls and roofs shall be flashed and protected with "water and Ice shield. Lower roof edges with pitches less than 5/12 shall be protected with drip caps and a 3 ft wide water and ice shield covering on the edges. Gutters and leaders shall be installed on all horizontal roof edges. Maximum single pitch length (1/4 "/ft nom) shall be 20 ft without installing a leader to ground. Drainage at grade shall be as to not cause local "flooding" or flow towards the house. Painting and staining shall be as required by the Owner. 7. Interior Finishes and Applications- All new and modified ceilings and walls - - are - to - -be - covered =vwth ',�2" Gypsum .Board (GB) except for. the ..Garages . _ interior surfaces between adjacent rooms and in Utility Furnace Rooms where 5/8 ". GB FR will be installed. Finished Flooring, Moldings, Trim and other finishes such as tile and sheet goods in Baths and Kitchen shall be as specified and required by the Owner. Painting and staining shall be as required by the Owner. The new interior staircase shall have a maximum rise of 7 -7/8 ", Run Greater than 9" and less than 12" and dimensionally shall lie within an overall tolerance of 1/8" max for dimensional differences between treads and risers. 8. Electrical & Fixtures- All new Electrical work is to be installed to code NEC - National Electric Code and be inspected by Fire Underwriters and receive Fire Underwriters Approval (certificate). All fixtures and switch /outlet types to be approved by the Owner. Smoke Detectors shall be installed in all bedrooms and in halls within 10 ft of bedroom doors. A CO Detector shall be installed in the Kitchen and Furnace Utility Room. All detectors shall be connected to have a common Alarm. ROBERT R. BENOIT, P.E. 3 OCTOBER 25, 2004- File No RRB- 04- 299- Obr -01 -001 Specification No 36 9. Plumbing - All DWV, CW, and HW` plumbing, Tanks and Fixtures are to be installed to applicable codes and inspected. Heating of Domestic Hot Water and Storage is to be integrated with the choice of Furnace or Boiler and HVAC means, methods and equipment. All fixtures, sinks, tubs and shower stalls as to model and type are to be approved by the Owner. A Plumbing Plan shall be supplied by the plumber as required by the Building Dept. before commencing the work. 10. HVAC- N/A 1.1. Appliances & Cabinetry- All Appliances and Cabinetry for the Kitchen and Baths shall be approved by the Owner. 12. Decks & Porches & Landscaping- N/A ROBERT R. BENOIT, P.E. 4 OCTOBER 25, 2004 a' I WELL UUN1rLt,11Ua r%EXUrki Office Use Only DEPARTMENT OF HEALTH ir- Division Of Environmental Health Services W PUTNAM COUNTY DEPARTMENT OF HEALTH STREET ADDRESS: WNI TAX GRID NUMBEST: WELL LOCATION 6 $ryden Rd Patterson, NY WELL OWNER NAME: ADDRESS: Terrence OtBrien, 6 Dryden Rd.,Patterson, NY 12563 0 PRIVATE ❑ PUBLIC USE OF WELL 1 - primary 2 - secondary 91 RESIDENTIAL D PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED O BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY ❑ AMOUNT OF USE YIELD SOUGHT gpm. /NO. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING c3REPLACE EXISTING SUPPLY ®TEST /OBSERVATION ®ADDITIONAL SUPPLY []NEW SUPPLY (NEW DWELLING) ® DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 220 ft. STATIC WATER LEVEL 20 ft. DATE MEASURED 4/13/94 DRILLING EQUIPMENT ® ROTARY CR COMPRESSED AIR PERCUSSION O DUG O WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE O SCREENED O OPEN END CASING ® OPEN HOLE IN BEDROCK O OTHER CASING DETAILS TOTAL LENGTH — tL MATERIALS: ® STEEL O PLASTIC O OTHER LENGTH BELOW GRADE 0 it. JOINTS: 0 WELDED ® THREADED ❑ OTHER DIAMETER in. SEAL: IR CEMENT GROUT ❑ BENTONITE ❑OTHER WEIGHT PER FOOT – 19– lb./ft. I DRIVE SHOE OYES ❑ NO LINER: CJYES CRNO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (It) DEPTH TO SCREEN (1t) DEVELOPED? FIRST O YES ONO HOURS. SECOND. ...,_ . _,._ . ... ► . _ -. -. -_ __ ... . .. .. _ _ .... ::.:: _. :.. GRAVEL PACK ❑ YES O NO GRAVEL SIZE_ DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM OEM ft. WELL YIELD TEST If detailed pumping METHOD: ❑PUMPED t tests were done is in- t * COMPRESSED AIR , ! ormation attached? O BAILED O OTHER ; 0 YES O NO WELL LOG if more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Water Dear. ing Well Oia- Ineter FORMATION DESCRIPTION Cat ft ft. WELL DEPTH ft. DURATION hr. min. ORAN100'NN It. YIELD gpm. Surface 1 D ill ' n in overburden clay and bl rs , H't ck at 15e 220 6 0 0+ D it in in rock set casing, ro ed, WATER O CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS O COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? ❑ YES ❑ NO STORAGE TANK: TYPE CAPACITY GAI,, . PUMP INFORMATION TYPE Gould(existi*## cry MAKER DEPTH MODEL VOLTAGE HP WELLORILLERNAME P.F. BeaI ons, OAT 6 4 ADDRESS 4 Putnam Ave. SIGNATURE 9 Brewster, NY 10509 3/89 1 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER7:WELL-:.: PCHD PERMIT $' -1/-� / WELL LOCATION Street Address Town/Village/City Tax Grid Number 6 Dryden Rd. Patterson, NY WELL OWNER Name Mailing Address Terrence O'Brien, dl3ryden Rd., Patterson,NY 12.563 O Private OPublic USE OF WELL 1 - primary 2- secondary 01 RESIDENTIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP 0 BUSINESS O FARM O TEST /OBSERVATION 0 INDUSTRIAL b INSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify, O AMOUNT OF USE YIELD SOUGHT _gpm /# PEOPLE SERVED_ /EST. OF DAILY USAGE ISO-ZOOkal ® REPLACE EXISTING SUPPLY O TEST/ OBSERVATION 12. ADDITIONAL SUPPLY O NEW SUPPLY NEW DWELLING 0 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING Existing well is dry, cannot be drilled deenPr WELL TYPE ®DRILLED DRIVEN []DUG OGRAVEL D OTHER IS WELL SITE SUBJECT TO FLOODING? YES _ L NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name P.F.Beal & Sons,Inc. Address: 4PutnamAve.,Brewster,N IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED [90N SEPARATE SHE 2/28/94 011�� (date) gna ure PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of 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 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 attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or 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. .Date of Issue: 19� Date of Expiration 19. Permit Issuing Offici Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller John M. Simmons, M.D. PUTNAM . COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES Deputy Commissioner of Health - FIELD ACTIVITY REPORT - Sheet of INSPECTION NAME �,` Orig. Routine _ Orig. Complain Orig. Request ADDRESS No. Street Town II No. _ Compliance _ Complaint Camp MAILING ADDRESS Final P.O. Box Post Office Zip Code Group Illness _ Construction TELEPHONE Reinspection PERSON IN CHARGE Field, Sampling Only OR INTERVIEWED Field Conference Name and Title Other DATE TYPE FACILITY TIME TIME LEFT 2- { FINDINGS: r � INSPECTOR: Signature and Title PERSON IN CHARGE OR INTERVIFAnTED: I acknowledge this Field Activity Report. SIGNATURE: 6/86 TITLE: TELEPHONE: Explain