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1 t 3 PUTNAM COUNTY DEPARTMENT OF HEALTH
1. �� to DIVISION OF ENVIRONMENTAL HEALTH SERVICES
APPLICATION TO CONSTRUCT A WATER WELL _
please print or typeC��xx
Well Location
Street Address: Town/Villa e: Tax Map # _ p
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0 03 p�ksk l W/01 (
-i Ma Block
t p Lot(s)
Well Owner:
Name:
sr0.
Address:
IISkrl 1-4 kd('Ad ; -J
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Use of Well:
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 .6-` gpm # People Served Est. of Daily usage gal.
_y/Replace Existing Supply Test/Observation Additional Supply
Reason for Drilling
New Supply (new dwelling) Deepen Existing Well
Detailed Reason
s j w f-•-� ;S ru%r-
for Drilling
Well T e
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: 14aanaa. Address: 1�� c, r� d ✓ S� - ern._ UyI .
Is Public Water Supply available on site? ....................................... ............................... Yes _ No
Name of Public Water Supply: Town/Village
Distance to property from nearest water main:
Proposed well Iota 'on & sources of contamination to be provided on separate shoot/plan.
Date: ^ ` /0 Applicant.Signatur
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 Countv Health DeDartmer
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 Commissioner of Health. Any revision or alteration of the approved plan requires a
new permit. Well to be constructed by a water well driller certified by Putnam CAunty. ^ ��
Date of Issue C, Permit Iss ing Offi al: / 1L
Date-of Expiration Title: =g p" t
Permit is Non- Transfelable
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WP -97
Rev. 3/06
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
ROBERT J. BONDI
County EXecu ive
ROBERT MORRIS. PE
Director of Environmental Health
DEPARTMENT OF HEALTH
DRINKING AND RECREATIONAL WATER
Norman Anderson, Inc.
152 Barger Street
Putnam Valley, NY 10579
Subject: Proposed Well Sterling
883 Peekskill Hollow Rd
(T) Putnam Valley
September 15, 2010
Dear Mr. Anderson:
A field inspection was conducted on the above referenced lot by Vincent Perrin, Public
Health Technician. The application to drill a new well is approved with the following
stipulations:
1. The well pump and any electrical components are to be removed from the existing
well during abandonment.
2. Well must be constructed with at least 90 feet of casing 24 inches of which must
be above ground
3. A Well Completion Report (WC -97) shall be submitted no later than 30 days after
the well completion by the permittee.
Please contact me at (845) 808 -1625 ext.46235 if you have any questions.
Sincerely,
Vincent Perrin
Public Health Technician
cc: file
110 OLD ROUTE 6, BUILDING 3 - CARMEL N.Y 10512
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SITE PLAN
V,Aa: P a W-O"
NOTE: Do not scale plan for dirnerist-ns.
Refer to written measurements for accu-=-v,
or contact architect.
Copyright 2010 MICHAEL PICCIRILLO ARC = "--TL
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SITE PLAN
V,Aa: P a W-O"
NOTE: Do not scale plan for dirnerist-ns.
Refer to written measurements for accu-=-v,
or contact architect.
Copyright 2010 MICHAEL PICCIRILLO ARC = "--TL
ZRLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
DEPARTMENT OF HEALTH
ROBERT J. BONDI
County Executive
ROBERT MORRIS; PE
Director of En` nmental Health
1 Geneva Road. Brewster, New York 10509
ADDITION APPLICATION RESIDENTIAL ONLY
STREET TT3 /,G,CK'i A,11t Aat-k 01 TOWN Vey TAX MAP #J- ^7
�" s E�� 40-7Wy 5' S _ _
NAME S4 !Gv E �/� r�/% ss o PHONE �6 �G> 5-7 - 3 `/�f rf PCIID# r"l�
MAILING
ADDRESS S �a G�.��•Yi �ioaD 1 SG�2SD�� /!/�/ /O.srs3
DESCRIPTION OF
ADDITION G�/aSS' Svc v261o•'S G X T,V A/i— c,et�;,�
NUMBER OF EXISTING BEDROOMS . 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., 1 Geneva Rd,
Brewster, NY 10509, Phone: (845) 278 -6130.
11. Certified check or money order for $100.00.
2. - .Sketches-of existing floor plan (drawn to scale,. all living Areaagcluding basement, to be
shown and dimensioned and use of each room "specified).- ,-(See Section 1&of- Bulletin- - `
HA -1)
3. Two sets of proposed floor plans (drawn to scale — with name, street and tax map #)
* Non - professional sketches are acceptable and preferred. (See Section 3.d of Bulletin
HA -1)
J4. Copy of survey showing all well and septic locations on the subject property to the best
of your knowledge. Include date of in stallation known. Contact this office with any
questions.
J5. Copy of Certificate of Occupancy from the Town or Certification from the Building
Department with legal bedroom count of dwelling.
OFFICE USE
COMMENTS
5.
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Water Supply...Section (845) 225 -5186 Fax (845) 225 -5418
Nursing Services (845) 278 -6558 Fax (845) 278 -6026
Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678
Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580
SHERLITA AMLER, MD, MS, FAAP
Commissioner. of Health
- LORETTA MOLINA%tI RN, MAN* y
Associate Commissioner of Health
ROBERT J. BONDI
County Executive
ROBERT MORRIS, PE j
Director of Environmental Health
DEPARTMENT OF HEALTH
1 Geneva Road. Brewster, New York 10509
Town Legal Bedroom Count & Proposed Addition Status
Re: �' (� (Owner's Name)
Tax Map #. S 2. "t-9
Address: 003 i'�i S i L LUDt..l
Town:
Year Built:.
Accordin to records maintained by the Town, the above noted dwelling,
is . in compliance with Town Code.
Is not in compliance with Town Code.
The Legal Bedroom Count is:
This information has been obtained from:
Certificate of .Occupancy:
Other: &T&<5 0 0S
The plans for the proposed addition are considered:
New Construction
Addition to existing house -only
Teardown and/or re -build allowed under Town Regulations
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Nursing.Services (845) 278 -6558 Fax (845) 278 -6026
Nursing Home Care. Fax ($45) 278 -6085 WIC (845) 278 -6678
Early Intervention I Preschool (845) 228 -2847 Fax (845) 225 -1580
a
SHERLITA AMLER, MD, MS, FAAP
Commissioner. of Health
- LORETTA MOLINA%tI RN, MAN* y
Associate Commissioner of Health
ROBERT J. BONDI
County Executive
ROBERT MORRIS, PE j
Director of Environmental Health
DEPARTMENT OF HEALTH
1 Geneva Road. Brewster, New York 10509
Town Legal Bedroom Count & Proposed Addition Status
Re: �' (� (Owner's Name)
Tax Map #. S 2. "t-9
Address: 003 i'�i S i L LUDt..l
Town:
Year Built:.
Accordin to records maintained by the Town, the above noted dwelling,
is . in compliance with Town Code.
Is not in compliance with Town Code.
The Legal Bedroom Count is:
This information has been obtained from:
Certificate of .Occupancy:
Other: &T&<5 0 0S
The plans for the proposed addition are considered:
New Construction
Addition to existing house -only
Teardown and/or re -build allowed under Town Regulations
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Nursing.Services (845) 278 -6558 Fax (845) 278 -6026
Nursing Home Care. Fax ($45) 278 -6085 WIC (845) 278 -6678
Early Intervention I Preschool (845) 228 -2847 Fax (845) 225 -1580
fl
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
Steve Sprague &
Cathy Capasso
55 Edgemont Road
Scarsdale, NY 10583
DEPARTMENT OF HEALTH
1 Geneva Road. Brewster, New York 10509
Dear Mr. Sprague & Ms. Capasso:
ROBERT J. BONDI
r ^: _.County Executive.
ROBERT MORRIS, PE
Director of Environmental Health
February 18, 2010
Re: Addition- A- 024 -10
No Increase in Number of Bedrooms
883 Peekskill Hollow Road
(T) Putnam Valley, T.M. # 52. -3 -49
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 February 18, 2010. 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.
4. The approval is for the proposed changes only. This approval does not validate any
construction shown as existing that has not obtained proper approvals
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 (845) 278 -6130, ext. 2261.
Sincerely,
Gene D. Reed
Senior Engineering Aide
GDR:kly
cc: BI, (T) Putnam Valley
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Nursing Services (845) 278 -6558 Fax (845) 278 -6026
Nursing Home Care Fax (845) 278 -6085 WIC (845) 278 -6678
Early Intervention / Preschool (845) 228 -2847 Fax (845) 225 -1580
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ALL SUBSEQUENT REtil:,ICAiA.LTERATIONS TO THESE HOUSE
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.•a :rnr.w•.. TOWN OF PUTNRiVM VALLEY
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PUTNMM C-6im- i
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Axonometry
12'- 41/2"
Left Elevation
is
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Plan
Front Elevation-
IT-4 1/2"
levation
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P�oposEV Sv�v R�mM �i�DD,rio.v
Cathy Capasso & Step: .4en P. Sprague
883 Peekskill Hollow Road
Putnam Valley, NY 10579
(914) 774 -1958
12'- 41/2"
Right Elevation:
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