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Home My WebLink About2402DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 42.-3-24 BOX 21 Ulm I I ==a 11A]w u a � , r K.71 FileKin& i role , ■ 02402 BRUCE R. FOLEY Public Health Director C DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 110509 LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278,- 6678 Fax (845) 278 - 6085 Early I,ntervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 Mr. & Mrs. Jezik Peekskill Hollow Rd. Putnam Valley, NY Dear Mr. & Mrs. Jezik: August 8, 2000 Re: Addition- Jezik - Peekskill Hollow Rd. No Increases in Number of Bedrooms (T) Putnam 'Valley Tax # 42. -3 -24 I have received and reviewed the plans for the proposed addition of the above- mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp form this Department dated August 8, 2000 The addition is approved with the following conditions: 1. The total number 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 Putnam Valley. If you have any questions, please contact me at your convenience. WH:kg CC:BI Very truly yours, Will Hedges Senior Public Health Sanitarian DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 F= (914) 278-7921 BRUCE R FOLEY Public Health Director PROPOSED ADDITIO \r APPLICATION (RESIDENTIAL, ONLYI STREETPeekskill Hollow RdTOWNRut Val�TXNUP# 372800 42. -3 -24. NAME Robert & Susan Jezi)PHONE 225- 0673PCHD r Too MAILLNGADDRESS 1031 Peekskill Hollow Road Putnam Valley, N.Y. 10579 DESCRIPTION OF ADDITION addition over partial existing and over new garage NI UMBER OF ENISTING BEDROOMS 3 . PROPOSED r OF BEDROOI�iS (FROM CERT. OF OCCUPANCY OR CERTiFICATIO\ FROM BUILDr\G LNSPECTOR) . *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.; 4 Geneva Rd., Brewster, NY 10509, Phone 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) Non - professional sketches are acceptable. 3. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map 9) # Non- professional sketches are acceptable 4. Copy of survey showing well and septic location, 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. 5. Copy of Cert. of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE Comments Feb 99 Jul 13 00 12:20p BUILDING DEPT Ott co IV 0 a -c DEPARTl-,+.EXT OF HEAi.TH Division , Of Envi ;onmental Health Services S Geneva' Roa,, 8; ewster, New York 10509 (91�) 278 -6130 Putnam County Dept. of Healtn 4 Geneva Road 9145268806 SAUCE R. POLEY, R.S. Acting Public,Hcalth Direct0; Br,-wster, NY 10509 R-�:1031 Peekskill Hollow Rd. Residence lzx Map372800 42.-3-2,4 Town Putnam Valley, ;'N. Y. i Gentlemen: According to records maintained by the T oti n, the above noted dwelling I5 �� IS NOT in com liance with Town code and the total number of bedrooms on record This information has been.obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: OTHER F- 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 # LLL LOCATION Street Address wn Vil Mai t Tax GraNumber TELL OWNERS /AT Mail' g 'Ad r s P Private O Public USE OF WELL 1 - primary 2 - secondary RESIDENTIAL 00 BUSINESS INDUSTRIAL 0 PUBLIC SUPPLY O FARM O INSTITUTIONAL O AIR /COND /HEAT PUMP 0 ABANDONED O TEST /OBSERVATION O OTHER (specify O STAND -BY AMOUNT OF USE YIELD SOUGHT J� gpm /# PEOPLE SERVED '_ /EST. OF DAILY USAG `�° sel 0 REPLACE EXISTING SUPPLY O TEST/ OBSERVATION O: ADDITIONAL SUPPLY NEW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR 'DRILLING - WELL TYPE FRILLED DRIVEN ®DUG O GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES _ ��NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. UATER'WELL CONTRACTOR: Name /�&%�r� �' �-�� ,��— �� IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO WPM OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED OON SEPARATE SHEET (date) (signature) 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 dril g operations be contained on this property and in suc a manner as not to degrade or o e w se cont inate surface or groundwater. Date of Issue: 19 �Z Date of Expiration 3.) 19 --fy Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller "rAtA