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51.18 -1 -1
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BRUCE R. FOLEY, R.c
Acting Public Health Oire
DEPART:ti4E \T OF HEALTH
Division Of Environmental Health Services
Geneva Road, 6revrter, New York 10509
(91") 278 -6130
R,RQPCS- =Q AD`DITIO,�; APP: ICATIC?; _ (RESIDENTIAL ONLY)
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ADDRESS
Description of Addition
N,--ber of existing be..ro - -:s 1�7 Proposed number of bedroons
f rom. Certificate of Occupancy or
Certification from Building Inspector
�:-:y addition which is considered a bedre•cm re;uires formal approval of plans
(Construction Permit) prepared by a Professional Engineer or Registered Architect
4r1 accordance with ap?lic=_ble sections of the Putnam County Sanitary Code.
Please submit this fora and the followir,_ to PJfK -A%M COUNf y HEALTH DEPAFITMEW,
_.......,.. 4 G =VA RO,D, BREVSTER, N; 10509,- Pl:on_ 278- 5130-with tne,follow.ing--in-formaLion.
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 proposed floor plan .
Non professional drawing is acceptable"
4. Copy of survey shorting 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 Tarn or Certification from Building
Department of legal bedroom count of duelling.
OFFICE USE
Cornents and /or conditions
application
August 1995
July 1996 (Revised)
DEPARTMENT OF HEALTH.
Division of Environmental Health Services
4 Geneva Road
Brewster, New York 10509
Tel. (914) 278-6130 Fax (914) 278-7921
March 17, 1998
Jack Adams
43 Pine Hollow Road
Putnam Valley NY 10579
Re: Addition - Adams, Pine Hollow Road
No Increase in Number of Bedrooms
(T) Putnam Valley TM #51.18 -1 -1
Dear Mr. Adams:
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
March 16, 1998 and this Department's approval stamp.
Based on the information submitted, the above mentioned 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.
Approval is granted for sewage disposal only. 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.
Very truly yours,
Michael Luke
ML:tn Public Health Technician
cc: BI (T)
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, MY 10509
Re:
Residence q -6
Tax Map
Town
Gentlemen:
BRUCE R. FOLEY, R.S.
Acting Public Health Director
According to records maintained by the Town, the above noted dwelling
V/
IS NOT
in co pp * nce with Town code and the total number of bedrooms on record
is
This information has been obtained from:
CERTIFICATE OF OCCUPANCY:
ASSESSORS RECORD:
OTHER
Building Inspect
DEPARTMENT OF HEALTH
Division of Environmental Health Services
110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310
:.- .AuFLICA`'I'I NI TO 'CGIdSiRu °i . niAfiER � dE1�I;` ...;.. -...- 1a...-
PCHD PERMIT #
WELL LOCATION
S reet Address own Vill
aj t E �000 R .,
ge City
Tax Grid Number
-S- II
WELL OWNER
Nam _
T1 I A
Mailing Address
V
Private
O Public
USE OF WELL
1 - primary
2 - secondary
URESIDENTIAL
® BUSINESS
® INDUSTRIAL
O PUBLIC SUPPLY O AIR /COND /HEAT PUMP ® ABANDONED
O FARM O TEST /OBSERVATION O OTHER (specify
O INSTITUTIONAL O STAND -BY
AMOUNT OF USE
YIELD SOUGHT _5 gpm /# PEOPLE SERVED_ - � /EST.
O REPLACE EXISTING SUPPLY ® TEST /OBSERVATION
O NEW SUPPLY NEW DWELLING WDEEPEN EXISTING WELL
OF DAILY USAGE 1
13 ADDITIONAL SUPPLY
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
ZLFON o ' 4- rw4s 'f
WELL TYPE
WDRILLED
O
DRIVEN ODUG
O
GRAVEL
O
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES ✓ NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No.
WATER WELL CONTRACTOR: Name ' o C mfrs Win Sin Address: Sr •
\T
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES V/ NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
DISTANCE TO PROPERTY. FROM NEAREST WATER MAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
[]ON SEPARATE SHEET
g
,�-
(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.
thirt; (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: ,iii 19 <�P'22
Date of Expiration 19 Permit Issuing Official
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
Inspector
TOWN HALL
VALLEY. N.Y. ,... -..
(914) 526 2377 ;
TOWN OF PUTNAM VALLEY Grp- -2p
BUILDING,- ZONING, AND SANITARY DEPARTMENT
Date: May 81 1990
A
{
Putnam County Health Dept,
110 Old Route Six Center
Carmel, N.Y. 10512
Att: Wm. Hedges, Health Sanitarian
Re: Peyser - Northview Est.
TM# PV- 26 -5 -11
Dear Mr. Hedges:
The proposal to redrill a water well on the above
noted property has been reviewed and approved by this
department.
Very truly yours,
r ! �Ct, ✓�
MARVIN 0 DEL
Building & Zoning Inspector ,
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