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HomeMy WebLinkAbout2605DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 52. -2 -52 BOX 22 02605 �L ' ' :: r � ' �, � IIr a �. 1 : r Jr ■, V., .� . -� I ,,.. , r - IN i b i 111 MIN lm'LT #� 02605 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES SITE LOCATION 13 OWNER'S NAME MAILING ADDRESS i OFFICIAL USE ONLY w i C,, co pet TM# �j — Z — S2— c d— 1 . I 'A9 —L-.p err" o PHONE — .S`2 (o — P-Z i 2 PERSON INTERVIEWED PCHD Complaint # Name & Relationship (i.e., owner, tenant, etc. DATE TYPE FACILITY f - A4 C, PROPOSED INSTALLER I UL E'�CCc(r",1 PHONE 41-4 Z ADDRESS Q MAJ— .4e--�Q l( i GISTRATION# 0-4 Proposal (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. BSS ... dr`,4 as- owner, of r'epOjVi SIGNA' !av► rte,/ j tions Sta n thI"s corm. TITLE 11'13� 4 Proposal approved with the following conditions: Procurement of any Town permit, if applicable. 0> Submission of as built repair sketch in duplicate showing: a. Owner's name DATE b. Site. Street Name, Town and Tax Map number. C. Locatol of installed components tied to twof xed points (e.g.,house comers). d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6 deep e. Installers' name and number. 3. System repair to be pe ed in accordance with the above proposal and conditions. Propo l approved s Signature & Title COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99ML DATE L 4L lw*vw "16 "U17 zo Irv, "iLi"7NI Wfamawm— tfocce :?4.f -• I WIC" Vol M-A-� P.F. BEAL .& SONS, INC. 4 PUTNAM AVENUE ARTESIAN WELLS BREWSTER, NEW YORK 10509 WATER TANKS WATER SYSTEMS COMMERCIAL WATER SYSTEMS JET•PIl0.SPS...: .. .. .. ? /./I::GOMpfled A a �. SUBMERSIBLE PUMPS WATER CONDITIONING EQUIPMENT TEL. (845) 279 -2460 - 2461 • FAX (845) '279 -6613 COMPLETE INSTALLATION, REPLACEMENT AND REPAIR SERIVICE Lars Linber 141 Wic t Valley Tax Gri # 52. -2 -52 1 S�5 ,r pP��aSsd l I `� LORETTA MOLINARI R.N., M.S.N. Acting Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 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 May 13, 2003 Lindbergh 48 Peekskill Hollow Rd. Putnam Valley, NY 10579 Re: Addition - Lindbergh, 139 Wiccopee Rd. No Increases in Number of Bedrooms (T)Putnam Valley, 52. -2 -52 Dear Mr. Lindbergh: ROBERT J. BONDI County Executive 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 this Department dated May 12, 2003 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. Very truly yours, Michael Luke ML:lm Public Health Technician cc:BI BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Services DEPARTMENT OF - HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845).278-6130 Fax (845) 278 - 7921 Nursing Services (845) 278- 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 ADDITION APPLICATION (RESIDENTIAL ONLY) STREET l 3y Wic(onee Rcfi TOWN j X MAP#_ - NI ANM r�- JeYlh9f-oh PHONEJEt SZ6- 8MCHD# 1-0 MAILING ADDRESS .. w DESCRIPTION OF ADDITION NUMBER OF EXISTING BEDROOMS 3 . 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„ 4 Geneva Road,` Brewster, NY - -'10509,' Phone 278 -6130. 1. Certified check or money order for $100.00. . /2. Sketches oF6xisting.floor plan (drawn to scale, all living area including basement) *Non- professional sketches are acceptable. !i. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map *Non - professional sketches are acceptable. W ✓4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of goo 2 installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. V/ 5. Copy of Cert. Of Occupancy from Town or Certification from Building Dept: with legal bedroom count of dwelling. OFFICE USE Comments Feb98 Whouseguidelines a:; i (053 BRUCE R. FOLEY LORMA MOLINARI R.N., M.S.N. Public Health Director �� Associate Public Health Director w .i 0 Dirgcin 'Rtiir►ii .- ServMees.-' .. .. - �r -- DEPARI`1VLENT -::OF HEALTH 1:- Geneva Road Brewster," . New York .10509 Environmentil - Health (845) 278 - 6130 Fax(945)278-7921 Nursing "Services (&45)278'-`6 558 , WIC (845) 278 -6678„ ' Fax (845) 278 - 6085 Early Intervention .(80)278-6014 Preschool (845)278 -6082 Fax(845)278-6648 Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Re: .Residence Tax Map 2 Town M Gentlemen: According to records maintained by the Town, the above noted dwelling IS \ IS NOT in compliance with Town code and the total number of bedrooms on record is This in formation has been obtained from: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: • i' Building Inspector BFhouseguidelines �XST D�GK . e tlli- a KD RCo t 11 I 11 I t 16 off If 11 11 : I I I l I► I I ,� �� A 'tom LMNG,Rt�j — — o +1 Lrj aa:Rr1 i i 1I II II x Ii h II 1 i ' II ti tl II I II � II II z II 1111 li II 11 ., 40 I p� — G'" ax6 FL T lb o, 100 t,f c 10 O PUTNAM COUNTY DEPARTMENT OF HE . 1 USE PLANS APPROVED FOR — WJVH 1 .c , . FKn o )ROOM COUNT ONLY; _ _., nature Ti a .: FI K/2T FLOOR IAN Yy "= 1 ! 0" - - h r i l J � I I � t m I I � 1 f I t r PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY: t 3 BEDROOMS i Signature & Title Date n v r. co s ,TTO La I Fob_ DF�h --- Ui mr, cl) Fob_ DF�h i N 00 C�ac- --- Ui mr, c 13 i N 00 C�ac- 1 12;x„ i jr P I F-4 T P 7 i I 4 - ---- -1 - - - LlVlrjv,"j- - o ++ ! I ILI (y.L_;e r It it I. I :•� �!� I 1 ' i Pyl KI.14� c 1 it 0 _ 2 /'� GOTTNGE FIlz6t FLDDP, PION A 1 'U`" a { nc�lber kl a :i F �� U. , d ;; o ;; a :i F BRUCE R .. FOLZY < _....... • . , Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 LORE`I'TA --MU NARI R.N., 'M.9. r 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 Intervention (845) 278 - 6014 Fax (845)278-6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 July 12, 2002 Mr. Lindbergh: 48 Peekskill Hollow Rd. Putnam Valley, NY .10579 Re: Addition- Lindbergh, 139 Wiccopee Rd. No Increases in Number of Bedrooms (T)Putnam Valley, TM #52 -2 -52 . Dear Mr. Lindbergh: 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 July 12, 2002 . 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 --- . -.. Jhe_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. Very truly ours, William Hedges WH :lm Senior Public Health Sanitarian cc: BI -- - BRUCE` K FOLEY° Public Health Director LORETTA MOLINARI R-N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278.6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 , ADDITION APPLICATION (RESIDENTIAL ONLY) STREET TOWN - MAP9 .�2 NAME HONE 2 L — 8---�7 Z- PCHDfr MAILlNTG ADDRESS DESCRIPTION OF ADDITION Cog yal(n _ dA c: �Cy a NUMBER OF EXISTING BEDROOMS _3 PROPOSED # OF.BEDROOMS 3 (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., 4 Geneva Road, 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 #) *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 cr —rrsr Feb98 BFhouseguidelines x ro { 7 d BRUCE R. FOLEY LORETTA MOLINARI R.N. M.S.N. Public Health Director uL _ -- _ --� - Ass oc_ i ate Public He4lt 4" Qirer f or U!Miv Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva. Road Brewster, New York 10509 Environmental Health (845)278-6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 6678 Fax (845) 278 - 6085 Early Intervention (845)278-6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 June 26, 2002 } Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Re: 139 Wiccopee Road Residence Tax Map 52--9-52 Town of Putnam Valley Gentlemen: According to records maintained by the Town, the above noted dwelling IS 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: r-e- OTHER f, BFhouseguidelines Building PUTNAM COUNTY DEPARTMENT OF_.HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES a' Date 1 d. p e : Property of Located at � � roc ;ree _( (T) �'^^ °"`�' Section Block 1 Lot 9 Subdivision of �se o��e �es• Subdv. Lot # l Filed Map # Date Gentlemen: This letter is to authorize a duly licensed professional engineer or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County )apartment of Health, and to sign all necessary papers on my behalf in ;onnection with this matter and to supervise the construction of said system or systems in "conformity with the provisions of Article 145 or 147,.Education Law, the.Public.Health Law, and the Putnam County Sani- tary Cod ,ounters lddress Very truly yours, Signed wn 4.. e� of P f el Address 4 T To � Tele one ZG.S -�9 Telephone 7s&3 rf 7CT "zr�Aiz GFIFM; �`+hll x4 A 'Y:.. { Y }Ll 11`"'+#.b � F: .`T 'X '3 '� h s^+•^ M 4 �aHR��kS� "i � —S h s• t r� ) x � �i s s � ;. ..y <� f I ...:...:.. .:::.:::..... .... TNAIM COUNTY: DEP - i F VATf f�N = vq l! -,1 ' �' z1 r -- _..... ROUSE PLANS APPROVED FOR -I! /�`cc ;p BEORCON COUNT ONLY; I FUTMAH VN — _BECRC D HORTH.--.ELF�YATIOH IL---11 I L--j - ---------------- --4r- APPROVED FOR &F-YATIOH V4 Dg PLANS 64 CO�NT ONLY; DA LI HM +H 71 H Y HOLK) L-/) I PUTNAM COUNTY'DEPAF�n� OF PLANS APPROVED FOR BEDE!-o,,j COUNT ONLY; BDROOMS RirattRtureP Title G" I Ve /' 'TUI -LAY-3 APPROVED FOR, BEDII"�04l COUNT ONLY; 7 I r 1 V I P ' G "94 .. 'Yk:, 111 C! �✓- i, P Il.CO FI-- 1-► 117U���GH 4Y .r,� . •�s s�t`+,� � n '4` 4 r "a, . rlVll�IAY DlfPt DEFAR't�P OF I q DhMw d ea WAlt7bM. � N.Y U6U k �PwvW aR � 1 �� l�.I w CERI�[Cr►18 OF OO , . � 3 A 4, f� •� ray 4 "�'� � S apw'AQCl�if !W@P FO-PIMA". DIdlO,AL S1'Iel�Il x9, n t Fti�YN I1e�e 1�f.v�i {Zed W�pn. .. • . I�t I (t Tw Map Z Bleek p� LN Ouli�r /Appri+eetNeaa� � �� l°h�a4 ��NAdM FwOwtl_0 Nerhba � � p _ � s � x Date e[ PtevMn Appiov�l - . c/ 3 �a �tta%tIF AJiw. 1r oac�w Tov. 4 0300 d vsio I Fee :Enclosed_ Diiq tjM fP�C i�eri�i2 u } Seefie. 0�4 Depth Vel�oe' Number 4d Fbi* G P D 6 d Q P(HD b Wilco Fm d d Sept mb soul ow siebm to dailelet 1 6 6, T .� ^J37 f D Z`i Al. To M erh rT Ad�ioa W�Mr SMhn - Peiie Sepp4; Fees AddimI ol_ 0" fep.eftnt tlmt C"ti Oapafti M flientRtad t pate in good, am of th.e. aA c"y " 1 X"OVEO 1x00 CONSTRU -raliecable for cause or idly IN r"WirN a' now awml Apl Rev. 10/88 clan, o y YON cl MKhwill i —Pei t' Ild6r, will he tpu- a.06wo *373 E . M of the buiW04 r Si WIWn Lndwtikin and It Imf , Any clMn94,6 alteration of 60flftruction only. TIM PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date G Re: Property of�� Located at. f.V.` Cc P -e � (T) E yXej Section 2l Block 1 Lot Subdivision of e�-� Subdv. Lot # Z- Filed Map # Date Gentlemen: This letter is to authorize a duly licensed professional engineer or. registered architect (Indicate to apply for`�.a Construction Permit for .a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with"the provisions 6f�Article'145or 147, Education Law, the.Public.Health Law, and the Putnam County Sani- tary Code. OF V �r A• C o r ne: 4, P.E. No 43 GFESSit�I',� 2 Cf Address Telephone' 9 Very truly_ yours Signed h� �1 GOO / //� l // �ITown �Telerphone !- PETER C. ALEXANDERSON County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225-0310 Mr. Frederick A. Zenz PE 292 Main Street Nelsonville, NY 10516 June 28, 1989 ENID L. CARRUTH, M.P.H. Public Health Director JOHN KARELL Jr., P.E. Director Re: Proposed SSDS - Redman Wiccopee Road (T) Putnam Vall Dear Mr. Zenz: TM #21 -1 -9.a 9.2 Review of plans and other supporting documents submitted at this time relative to the above- captioned project has been completed. Comments are offered as follows: 1) Dose calculations must be shown on plans. 2) Pump pit detail must be shown on plans. 3) A construction permit should be submitted instead of a repair permit-. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very truly yours, Lawrence C. Werper LCW:jr Assistant Public Health Engineer a*m,S NAME SITE IMTION 03,Crvec_4 MhjLIM ADDRESS PERSON INTERVIEWED 'PUTNAM COUNTY HEALTH D.EPARTH.W DIVISION • ENVIRMWiTAL HEALTH SERVICES 225-0310-, MR (51� DISPOSAL�S( 15 WM I I Name & -7 14 Ive Pew, s&3 P7 &f A-)Y, NY- IvO36 PQM CA3hVlalnt'# RO,ati,onship (i.e, ownerltemt"FECK) TYPE FACILITY PHONE Proj?094 (include sketch locating t�l'�djdacent wells) 16_ _4 NOTE: Repair must be in same location of same type s original sewage disposal system. Different location may reqQire\gubmitta proposal from licensed,professional engineer or registered architect. 1� 1, V F"i'l k m a4k ig Proposal approved Proposal Disapproved Inspector's Signiture__& Proppsal a W �aved with the ollowing conditions:, 1. Procurement of any pexmit, if applicable. 2. Submission of as bui repair sketch in duplicate showing: 1 a. Owner's name. b. Site Street Town and Tax Map number. c. Location of ;3inslled ccmponents tied to two fixed points (eig.jkc j - d. System descrip ion (e.g., 1250 gal. concrete septic tank,, three pt drywells surr d.:d(by one foot + gravel). e. Installer's name and number. 3. System repair . to be performed in accordance with the above proposal a T as evangair or re 4-MA a t f wrier merraba fe-, f-hd* =hewm rN-,nA4H^na. Date corners). t 61 diam. x 61 deep conditions. SIGNATURE TITLE —DATE CPBS6 Wifte (PCH)); Yellow (3m 81); Pink (Ap plicmit) ��. "'�b�r 'K4'c'.r.[:.�,iS'..Sac'Y. r.G..,a. .� .fc r .-ia*s s^a �.., i... _. .v. +,•9+srt.rF ::. 1.' ^. PETER C. ALEXANDERSON County Executive ENID L. CARRUTH. M.P.H. Public Health Director JOHN KARELL Jr.. P.E. DEPARTMENT OF HEALTH °ire °t °' `. Division Of Environmental Health Services 110 Old Route • Six_ Center, Carmel, New York 10512. (914) 225 -0310 June 28, 1989 Mr. Frederick A. Zenz PE 292 Main Street Nelsonville, NY 10516 Re: Proposed SSDS - Redman Wiccopee Road (T) Putna alley Dear Mr. Zenz: TM #21 -1\.� 9.2 Review of plans and other supporting documents submitted at this time relative to the above-'captioned project has been completed. Comments are offered. as. follows: ; 1) Dose calculations.must be shown on plans. 2) :Pump pit detail must be shown on plans. 3) A construction 'permit should be submitted instead - of--- a_..reparr _.perm_i.t :.._........� . _ _......... ., _ _..__.. _ -Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very truly yours, Lawrence C. Werper LCW:jr Assistant Public Health Engineer . Ana \i OpgMIS NAME SITE LOCATION MAILING ADDRESS PERSON INTE- a.. DD DATE :W47,01-10D INSTALLER PUTNAM QTY HEALTH WARD WT DIVISION OF ENVIRONMENTAL HEALTH SERVICES 225 -0310 TROPOSAL -FOR PHONE Iei .s'���° 75t3 TO I- T PCE D Complaint # tie Relationship (i..e, owner,tenant, etc.) TYPE FACILI' Y % PHQNE f° Proposal (include sketch locating NOTE: Repair must be in same locat Different location may require submi registered architect... 5 -e Gg�i'�a VI _#__ adjacent wells). .and of same type as al of proposal fran 1 17 sewage disposal system. professional engineer or 0 Proposal approved Inspector Proposal Disapplov '­__­P Date to a roved with the following conditions: 1. Procurement of any Town pern 't, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name. b.' Site Street Namezr, own and Tax Map number. c. Location of ins d co mponents tied to two fixed points (e.g.,house corners). d. System descrip on (e.g„ 1250 gal. concrete septic tank, tbi� ;e precast 61 diam. x 61 deep drywells surr ded by'one foot + gravel). e. Installer °s // and number. 3. System =repair be performed in accordance with the above proposal~ and conditions. I, as own w, 041, Lbporw a t of owner agree to the above conditions. SIGNA73RE TITLE QPiES: V&te (PaD); Yellaw (fin HL); Pink ( .icant) DATE i .,�4\ �iRvss A_4F- p2- lo, < -v DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 .- ° -� APFi CATION TO CONSTRUCT -A WATER- -WEL PCHD PERMIT WELL LOCATION Street Addr own Villa C y Tax Grid Number WELL OWNER }� �Ht - 1 ing Address 04. i ,�, 1151 l vate 7, 1� O Public USE OF WELL 1 - primary 2- secondary RESIDENTIAL DPUBLIC SUPPLY 0 BUSINESS O FARM 0 INDUSTRIAL d INSTITUTIONAL OAIR /COND /HEAT PUMP 0ABANDONED O TEST /OBSERVATION O OTHER (specify O STAND -BY O AMOUNT OF USE YIELD SOUGHT p,A .5- gpm /# PEOPLE SERVED /EST. OF DAILY USAGE 012 gal PLACE EXISTING SUPPLY. E3 TEST/ OBSERVATION' M ADDITIONAL SUPPLY O NEW SUPPLY N DWELLING D DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR, DRILLING Se•e. S. WELL TYPE DRILLED DRIVEN DUG GRAVEL D OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Fy - ® �t Lot No. WATER WELL CONTRACTOR: Name 4& Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NAME OF PUBLIC WATER SUPPLY: l,,' TOWN /VIL /CITY - DISTANCE- O_'PROPERTY-FROM NEAREST -WATER MAIN: - _.....___.�_. -- ..... _.. LOCATION SKETCH & ,SOURCES OF CONTAMINATION PROVIDED N SEPARATE SHEET (date) (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted un4e.r 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 provi ed by the Put m County Health Department. Date of Issue: 1 —� 19_ ' Date of Expiration: 19 / Periffit Is-suing 0 ficlaj Permit is Non - Transferrable White copy: H.D. F le Yellow copy: Building Inspector Rev. 10/88 Pink Copy: der Orange copy: Well Driller �Qoss Ft:;YF R.- 106 - ,97 DEPARTMENT OF,HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APEI;iCA`�ION -TO .CONSfiRiJCT A ` 4JA�TER �nTELL `. PCHD PERMIT #W-d- WELL LOCATION Street Addre T wn Vi age City Tax Grid Number WELL OWNER Nameing Addre s 11-9 A W_ A)-Y— 9+ri`vate ❑ Public USE OF WELL 1 - primary 2 - secondary ESIDENTIAL ® BUSINESS 0 INDUSTRIAL ❑ PUBLIC SUPPLY O FARM CIINSTITUTIONAL ❑ AIR /COND /HEAT PUMP O TEST /OBSERVATION ❑ STAND -BY ❑ ABANDONED ❑ OTHER (specify, AMOUNT OF USE YIELD SOUGHT!jj&n�gpm /# PEOPLE SERVED � /EST. OF DAILY USAGE, k0b.-Igal PLACE EXISTING SUPPLY ❑ TEST/ OBSERVATION 13. ADDITIONAL SUPPLY ❑ NEW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR •DRILLING ems. WELL TYPE DRILLED DRIVEN []DUG ® GRAVEL .0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: _ of /jw„e Pct/w, Lot No. WATER WELL CONTRACTOR: Name da 16e tye ' Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NAME OF PUBLIC WATER SUPPLY: N TOWN /VIL /CITY DISTANCE 'TO PROPERTY 'FROM - NEAREST' WA!'ER "MAIIV: ." _.._...._ _ .... _ LOCATION SKETCH &.SOURCES OF CONTAMINATION PROVIDED ' GeN SEPARATE SHEET ti ( at ) (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 pr ided by the Put m County Health Department.-. Date of Issue: _:z_a 19e Date of Expiration: 19 '-Permit Issuing f c1l a Permit is Non - Transferrable White copy: H.D. File Yellow copy: Building Inspector Rev. 10/88 Pink Copy: Owner Orange copy: Well Driller AJ PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION.TO. CONSTRUCT.A WATER.WELL please print or type PCHD Permit # Well Location: Street Address: Town/Village Tax Grid # 141 Wiccoppe Road Putnam Valley Map 52. Block -2' Lot(s) -52 Well Owner: Name: Address: Lars Linbergh 148 Peekskill Hollow Rd, Putnam Valley, NY 10579 Use of Well: x Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought 5 -10 gpm # People Served Est. of Daily Usage _gal. Reason for x Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason Shallow hand ducf well is yield. for Drilling Well Type x Drilled Driven Gravel Other 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: P. F. Beal & Sons, Inc. Address: 4 putrm Ave., bra tax 1rfm Is Public Water Supply available to 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: :1/19/.04 - ... - Applicant SignaWre: 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 County Health Department. During all well drilling operations, the applicant and/or well driller shall 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 Public Health Director. revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well dr ller cert ed by Putnam County. Date of Issue Permit Iss l "cial: Date of Expiration/ Title: / Permit is Non- Transferra e White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEIPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION O' O ABANDON A WATER WELL please print or type PCHD PERMIT # A k) of —0_V Reason For Shallow hand dug well is going dry. of Work To Be Performed: Fill well from bottom to top with concrete. 2/5/04 Applicant Signature: o Beal ,,PNUI W111 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 Wfowation delineated on the application for this permit has been completed. 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OCCD DING ': NILLAPE LILAC — STRGX /VATER t!M —•- SCALED DIMNSSOX iemR 6tm L[XIr — SPECIAL OIStaICi LIM —E— LCULArro AREA l.«IC. Dl. S 53 SCALE I TOWN OF PUTNAM VALLEY 10 TENIER SiR[ET O1D:70RN YAINC OPIOIXAL LOT LINE ----------- �SCMDOL 0 7-1 LINE —SC VISUAL CENiRDID PRDPERTr LINE ARCEI lONBARY — ARCCL [R 23 6Z 63 - 0 PUTNAM COUNTY NEW YORK p1 °'E' °I mraM ° ° " +- o-MneAr..R -si SI StAI[ IIAII CIORI. - N,RSI 1N Trr, �X �y. } P.F. BEAL.& SONS, INC. 4 PUTNAM AvENuE —ARTESIMWELLS BREWSTER. NEW YORK 10509 WATERTANICS JET PUMPS HYDROFRACTURING SUBMERSIBLE PUMPS WATER CONDnWNING EQUIPMENT TEL. (845) 279-2460 - 2461 FAX (845) 279-6613 COMPLETE INSTALLATION, REPLACEMENT AND REPAIR SERIVICE Lars Linbergh 141 Wiempee Rd, Putnam Valley Tax Grid # 52.-2-52 a, El SQS a. c 4: C 03./,01/04 MON 09:11 FAX. FROM TINY HOUSES, INC. �I i' of ' PHONE NO. : 845 526 4753 st 1 ea 0gas p' a Dsr o -numl me PGuire y th ro a A�0410hed in ' r Pe r&pe# e RG :H. P !e�' ireme�rs • 9rd 'Moved / • rook+ nno NS � � 4 b * :d ! + eqr 5894100 f40 ° M• "a. eler of top 1 t ® �N 14 (a 002 Feb. 26 2004 04 :20PM P1 y e° v '/ Story far1n4 Prr1� dlpd V AT S/6 ,71,05 ,0l It /.7- 4r ' P T" L, ' 1 re � 1d%ri v P.F. BEAL .& SONS, INC. 4 PUTNAM AVENUE ARTESIAN WELLS BREWSTER, NEW YORK 10509 WATER TANKS WATER SYSTEMS COMMERCIAL WATER SYSTEMS r,JEi F11MPS�_.�;. -,, • „«,,:.. :.:;; a�fr�aorJd9l� - HYDROF 0���:lzj.zoo:l��Pif;: RACTAJRING ... SUBMERSIBLE PUMPS TEL. 279 -2460 - 2461 WATER CONDITIONING EQUIPMENT FAX 279 -6613 COMPLETE INSTALLATION, REPLACEMENT AND REPAIR SERIVICE January 22, 2004 Putnam County Health Dept. Attn: Theresa 1 Geneva Road Brewster, New York 10509 Dear Theresa: As per our phone conversation yesterday, enclosed please find our check #61672 in the amount of $50.00 to be.added to our check #61663 in the amount of $100.00 for the permit application submitted for Lars Linbergh (copies enclosed). Very truly yours, P. F. Beal & Sons, Inc. Margaret 0. Mejias /mm enclosures Lars Linbergh PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL -... -- - - - - - :.. o• � -v.- l° iii 7�t<t .....s- :=� -.. .:.:,,.- -._<�. Well Location: Street Address: Town/Village Tax Grid # 141 Wiccopee Road Putnam Valley Map 52. Block -2 Lot(s) -52 Well Owner: Name: Address: 148 Lars Linbergh Peekskill Hollow Rd, Putnam Valley, NY 10579 Use of Well: X Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Yield Sought 5 -10 gpm # People Served Est. of Daily Usage _dal. Amount of Use Reason for X Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason Shallow band dug well is yield. for Drilling Well Type x Drilled Driven Gravel Other 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: P. F. Beal & Sons, Inc. Address: a m,rm Aw- ,_ PrPwRtPX, rust 1cF0 Is Public Water Supply available to 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;: ____I./ _9 .Q4T._ .._ .A licant 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 County Health Department. During all well drilling operations, the applicant and/or well driller shall 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 Public Health Director. 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 Date of Expiration Permit is Non - Transferrable Permit Issuing Official: Title: White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 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 P.F. Beal & Sons, Inc. c/o Philip Beal 4 Putnam Avenue Brewster, NY 10509 February 9, 2004 Re: Proposed Nell: Linbergh 141 Wicopee Rd. (T) Putnam Valley Dear Mr. Beal, ROBERT J. BONDI County Executive I have received a well permit application (WP -97) and a certified check in the amount of $ 150.00 for the above referenced proposed well. Comments are offered as follows: 1. A well abandonment permit (WA -97) is to be submitted. If there are any questions please contact me at (845) 278 -6130 ext. 2235. Upon receipt of a well abandonment permit (WA -97), this application will be considered further. Very truly yours, Brian R. Stevens Public Health Technician cc: RM,file 0. NATIONAL FLOOD•INSURANCE PROGRAM FIRM FLOOD INSURANCE. RATE MAP TOWN OF PUTNAM VALLEY, NEW YORK. PUTNAM COUNTY PANEL 3 OF 6 (SEE MAP INDEX FOR PANELS NOT PRINTED) COMMUNITY-PANEL NUMBER 361030 0003 B AIA EFFECTIVE DATE: 1 SEPTEMBER 4, 1987 Federal Emergency Management A genc y ry S. determine if flood insurance is available in this community, contact: jour irance agent or call the National Flood Insurance Program at (800) 638-6620. tol APPROXIMATE SCALE 400 0 400 FEET -F==r 4 SPECIAL FLOOD KAzAw AREAS irIuNo,%TED{ BY 100-Y M FLOOD ZONE A No bm Mod clev9lom deftm*wd. ZONE AE B— food ekt d— de..,[,.& ZONE AN ZONE AO PmW &pft dt W 3 lea (=,Dy Omla Fa _d** demMrod .j�- vladdm oho dftwmbcL ZONE A" named. I zoKE V C.." Food side Kwmy hosed yy} ZONE VE C..W 11—d bee ==b,= acdoW; fimoothd FLOODWAY AREAS IN ZONE AE '.i OTHER FLOOD AREAS ZONE X Area of Soayrw Food; 4100-Y d.W,.( I- dun I f- .4 pmftmd by VOIR ROAD OTHER ARIAS ZONE X cl�.*.d w b. ou old. so -4r =HE D A— In fii flwd h-6 are -6111z W.4 b. p—Lble. UNDEVELOPED COASTAL BARRIERS. IUCCOPEE �o BROOK Wwam kknowl 06wWW ft%Wd Am&: I 100 SIV RESERVOIR IM IM «� W.Wd I" .�j � bi. n—* W.Md wWft . Sp.W P.W!, «aa)mem to ACCESS ROAD A— Fl B—fty 578 574 Moo&�W ftundW Z— D 8—,dy I CIO ZONE "0 C-\, 0 Bmndy Rd Ha.W' CO Arced =-A CMWd AE 3—k-I .W=Fk Vfthn Sp d K.-d Z— j, 513 B- Food M,,W. w. 11-f- 1. fw�t Seak. Li- :EL 987) Rd 8—th. In Fee Whw Ur&j; Vdd, Z—.. 9 FIM7 X Gratim Rd..me Mark •MI.5 M— Mile VdW D.— -( " IAM--d P44-1 C-&& n NOTES TO USERS r.6 mw b f.— in dnd " Kaw Rood w— mw-; ft, *%r4V d— Wdfv a � nbjw w ftocfi . MWWw* tm WW d S P" ZONE AE This is an official copy of a portion of the above. referenced flood map. it was extracted using F-MIT On -Line. This map does not reflect changes or amendments which may have been made subsequent to the date on the co title block. For the latest product information about National Road Insurance Program food maps check the FEMA Flood Map Store at www.mso.feme.gov S. I AE determine If flood Insurance 13 available In this community, contact your rance agent or call the National Flood Insurance Program at (800) 838.8620. BONE X .. ....... .. ._ .� .s•r. -. AISpROXIfv{diESCALE ";: . -..;. ... , .Ir, 400 0 400 FEET IIIIIIIIIIIIIIIII NAnSNK FLOOD INSURANCE PROGRAM I FIRM FLOOD INSURANCE RATE MAP TOWN OF PUTNAM VALLEY, NEW YORK PUTNAM COUNTY PANEL N OF 25 Ise. — .root RESERVOIR ACCESS ROAD `tom COMMUNDI -PANEL NUMBER IM h'c c °gF „�a,� °ANE 361030 0011 C 9 MAP REVISED: qO JUNE 20,2001 4jy� co Fedcn! Emergency Management Ageacy yp`L ZONETNe le an oalolel eopy of a portion of the eb— referenced flood map. N G extracted using F- M 0M — l , mep doee not reflect oh,n err amendments vMch may have been made eubsequem to the date on the title dock. For the latest product information about National Flood Insurance Program Good maps check the FEMA Flood Map Store et vawv.msc.femagov. I Deed I rota/ = 784.44' ----- " " - - - -- Survey rota/ = 766'(%) �— NB976'Z01� 36.50' the - romobrs of 9 Stan W S8477140 E jd 7o'``` U42;'207 A 0o' ` 14a 70' x -«.! Found s87yr40 E 8270' - Gaoeim /y along centalh,.S-y" v S3271001f 59.24' I 51438'00-W 19.33' ®� S3236'00'W 4a 50' S05 46 00'W 19.40 t-, 6a 0. 5 I�I I I �4p Pabo eo`1 /A I L Ob! qny 1. 0 a�.z� � 1® SJamJ ie/d/ �° LHOeWv r or 'sT, F e " " i Z bb w, A o j s Foot V j Retaking rm% 0� r armedP nd awind Parr/ o war Farowd 0 z.Ymr . Lred 4� N �C7 501ff 4150' si rdth sign #—A bt 2'402 2563' y A �O � 011 - �°r 90'W 7720' y �. 001W 5160'