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DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
STP;_ET :
NA;' :
MAILING ADORcSS
Description of,Addition
J
BRUCE. R. FOLEY. R.S
Acting Public Health Dire;,,;,
N APPLIC ION _ (RE'S`IDENTIAL ONLY)f
TOWN �7`7��OfV TX hIAP <�-
PriONE : C� '(Po?a� FCHD PERMIT % — /4
oN ,��vse /V\j soar o 9
Number of existing bedrooms S
from Certificate of Occupancy or
Certification from Building Inspector
Proposed number of bedrooms 3
Any addition which is considered a bedroom requires T"ormal 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 PUTNA -M COUNTY HEALTH DEPARTMENT,
4 GENEVA ROAD, BREISTER, NY 10509, Phone 278 -6130 with the following information.
I. Cent if i ed. Check fOF �$I bb-. 66.
2. Sketch of existing floor plan (all living area including basement, if any)
Non - professional draeting is acceptable.
3. Sketch of proposed floor plan.
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..
5. Copy of Certificate of Occupancy from Town or Certification from Building
Department of legal bedroom count of dwelling.
OFFICE USE
Comments and /or conditions
application
August 1995
July 1935 (Revise:;)
A
F, MM
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road
Brewster, New . York 10509
TeL (914),278-6130 Fax (914) 278-7911
June 18, 1998
Antoinette Nielson
40 Cameron Road
Brewster NY 10509
Re: Addition - Nielson, Cameron Road
Increase in Number of Bedrooms
(T) Southeast, TM# 36.14 -1 -6
Dear Ms. Nielson:
BRUCE R. FOLEY
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 latest revision date of June
16, 1998 and this Department's approval stamp.
Based on the information submitted, the'above mentioned addition is approved with the following
conditions:
.The' total. numb er, of bedrooms_must remain_at three 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.
WHAn
cc: BI (T)
Very truly yours
l
William Hedges
Sr. Public Health Sanitarian
I
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278-6130
Putnam County Dept. of Health
4 Geneva Road
Brewster, NY 10509
Gentlemen:
BRUCE R FOLEY. R.s
Acting Public Health Direct,.
Re:
Residence
Tax Map
To�ti�n
According to records maintained by the To%vn, the above noted dwellinc, -
i
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.
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DEPARTMENT OF HEALTH
Division of Environmental Health Services
110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310
APPLICATION TO CONSTRUCT' A WATER WELL
PCHD PERMIT #
WELL LOCATION
Street Address Town/Village/City Tax Grid Number
40 Cameron Rd. Putnam Lake Brewster.NY
WELL OWNER
Name Mailing Address
William & Annette Nielson 40 Cameron Rd. Brewster
OPrivate
N70Pub.lic
$ OF WELL
1. primary
- secondary
'RESIDENTIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP
O BUSINESS O FARM O TEST /OBSERVATION
O INDUSTRIAL M INSTITUTIONAL O STAND -BY
O ABANDONED
O OTHER (specify,
O
AMOUNT OF USE
YIELD SOUGHT 5 gpm /# PEOPLE SERVED /EST. OF DAILY USAGE_gal
40 REPLACE EXISTING SUPPLY O TEST/ OBSERVATION CI ADDITIONAL SUPPLY
O NEW SUPPLY NEW DWELLING) Ll DEEPEN EXISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
Present supply is a "point": They are out of
wter.
This is .a family with 3 children.
S ' �� .bP mod %✓
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WELL TYPE
DRILLED
DRIVEN. E]DUG [:]6RAVEL
� OTHER
IS WELL SITE SUBJECT TO FLOODING? YES x. NO
IF WELL,IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No.
WATER WELL CONTRACTOR: NameP •F . Beal & Sons,Inc. Address:P.O.Box B. ,Brewster,NY
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO -2 79- Z s�
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
DISTANCE TO PRdPERTY FROM` NEARES ,-wATE'K MAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION 'PROVIDED
,;,/y J4 �— ❑ON SEPARATE SHEET(® � a
(date) ignatu
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 72 �- �--
Date of Expiration 19 !2 Permit Issuing Officia `���
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller