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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
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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
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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
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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
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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:
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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..
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Address
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ROUSE PLANS APPROVED FOR -I! /�`cc ;p
BEORCON COUNT ONLY; I FUTMAH VN
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APPROVED FOR
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64 CO�NT ONLY;
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PUTNAM COUNTY'DEPAF�n� OF
PLANS APPROVED FOR
BEDE!-o,,j COUNT ONLY;
BDROOMS
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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.
Date of 4ssue Permit Issuing Official Title
White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WA -97
T- ackngi)4 esteceipt of lthi§ reppft,`,�;:`.'911
r
;02/96 = 4
>M -
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'
FDA A......... P➢NP SES ➢XLi REVISIONS SPE I L DISTRIC N ORMATION L GEND
OArE DES[RUIION .III DESCRID,ION STATE LINE DISPUtro APEA ••••••••...,yEi4ND3 LIME t SYN60.
P07 TD BE USED FOR C NYFTAXCf$
4a 4 42
PRELIMINARY � 52460
�AV ww +
PREPARED eE
JAMES E. SEEALL;COMPANY
COUNTT LINE - -- - — 1I1-3. DVNEa3NIP .r. -�.5,. YIL.P,. L01 —ER 6
T. I— - - - - -- ROAD R.D.V. 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,
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}
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.
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PHONE NO. : 845 526 4753
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Feb. 26 2004 04 :20PM P1
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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
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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'
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