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62.10 -1 -351 36 & 37
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DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
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PCHD PERMIT
WELL LOCATION
j,�tre t dress o To i
la a Cyy Tax Grid Number
r
WELL OWNER
=X-4_rC_- , ing Address
u c.
[Private
O Public
USE OF WELL
1 - primary
2- secondary
RESIDENTIAL ❑ PUBLIC SUPPLY
0 BUSINESS O FARM
0 INDUSTRIAL O INSTITUTIONAL
O AIR /COND /HEAT PUMP 0 ABANDONED
O TEST /OBSERVATION O OTHER (specify,
O STAND -BY O
AMOUNT OF USE
YIELD SOUGHT_ gpm/ # PEOPLE
SERVED ----/EST. OF DAILY USAGE =ro a gal
REASON FOR
DRILLING
❑ REPLACE EXISTING SUPPLY ❑ TEST /OBSERVATION ADDITIONAL SUPPLY
O NEW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL
DETAILED
REASON FOR
DRILLING
---
61 Z7
WELL TYPE
UMDRILLED
DRIVEN
DDUG
GRAVEL 0 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: Nameo004 _C Address:-
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _�NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
DISTANCE TO PROPEURT° FROM INE kRES'T WATER MAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
ON 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
thirt3, (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
any and all water or waste products from such well
property and in such a manner as not to degrade or
Date of Issue: l2 - 19
Date of Expiration ( 19
Permit is Non - Transfer able White
3/89
shall take appropriate action to assure that
drillin operations be contained on this
other is ontaminata surface or groundwater.
Permit Issuing Official
copy: HD File Pink copy,:...'Owner.
Yellow copy: B1dg.'Insp.
Orangee�-copy;:.Well Driller,
ALLEN BEALS, M.D., J.D.
Commissioner of Health
ROSERT MORRIS, P.E., MPH
Director ofEnvironmental Health
DEPARTMENT OF HEALTH
1 Geneva Road,. Brewster, New York 10509.
Phone # (845) 808 -1390 Fax # (845) 2787921
December 4; 2014
Mr. & Mrs. Kenneth Silverman
170 West Shore Drive
Putnam Valley, NY 10579
Dear Mr. & .Mrs. Silverman:
MARYELLEN ODELL
County Execufiie
Re: Addition— A- 166 -14
No Increase in Number of Bedrooms
170 West Shore Drive
(T) Putnam Valley, T.M. 62.10 -1 -35, 36; 37
This Department has 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 December 4, 2014. The addition is approved with
the following conditions:
1. The total number of bedrooms must remain at four without prior approval by this
Department.
r
2.— The The area of the existng 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 modifications only and does not validate any construction shown
as existing that has not obtained proper approvals from other agencies having
jurisdiction.
5. This approval is valid for two (2) years and expires on December 4, 2016.
Any permits or variances required under the jurisdiction of the Town of Putnam Valley are the
responsibility of the applicant.
If you have any questions, please contact me at (845) 808 -1390 ext. 43261.
Respectfully,
Gene D. Reed
Principal Engineering Aide
GDR:cml
cc: BI (T) Putnam Valley
ALLEN BEALS, M.D., S.D.
Commissioner ofXealth
Director ofEnvironmental Health
V.
CDARYELLEN ODELL
County Executive
DEPARTMENT OF HEALTH
Geneva Road, Brewsier, New York 10509
Phone # (845) 8084390
Fax # (845) 278 -7921
ADDITION APPLICA'T'ION RESIDENTIAL ONLY
STREET 170 W EST 51400E DWI V E TOWN PU TtJ AM V,ALI fTAX MAP # &Z- 10- i -:35,3 137
NAME 6fZtiM i5LL/ 51 W62MA.t -1 PHONE`3 i 4 )416)-& 310 PCHD #zj_4166:` -1��
MAILING M2 4 AA 25 - V_ ENNC-TH 5t L, .V60AAA s
ADDRESS 170 Vu EST- 51402E 01z►V15, PuTNb -M VAL1JFY, N.4• 1
DESCRIPTION OF
ADDITION t44-ADj>rno0 ►a BaseME��,%ifzsTLir•� S�caNi� F(ao2S
*NUMBER OF EXISTING BEDROOMS -4 NUMBER OF PROPOSED NEW BEDROOMS 4
* (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, _
i3rewster9 iv iv5vy;'rnorie.
1. Certified check or money order for $100.00.
2. Sketches of existing floor plan (drawn to scale, all living area including basement, to be
shown and dimensioned and use of each room specified). (See Section 3.c 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)
4. Copy of survey showing all well and septic locations on the subject property to the best
of your knowledge. Include date of installation known. Contact this office with any
questions.
5. Copy of Certificate of Occupancy from the Town or Certification from the Building
Department with legal bedroom count of dwelling.
OFFICE USE
CONMNTS
4.
ALLEN BEALS, M.D., J.D.
Commissioner of Health
,R,0_13 ±'•-RT MO RCS P �'
Director of Environmental Health
d
MA.RYELLEN ODELL
County Executive
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Phone # (845) 808 -1390
Fax # (845) 278 -7921
Town Legal Bedroom Count & Proposed Addition Status
Re: D(ZU � L,(- 1:5 L vE(yRA (Owner's Name)
Tax Map # &-Z, 1 o I 35, 3C,, , 37
Address: 110 W E-5'C Soo 26 D 2 ( V j5
Town: P q -r t,3ANt VA LLC
Year Built:
Accor:zmpliance rds maintained by the Town, the above noted dwelling,
is with Town Code.
Is not in compliance with Town Code.
7 77
The Legal Bedroom Count is-
This information has been obtained from:
Certificate of Occupancy:
Other: ` I s
The plans for the proposed addition are considered:
Addition to existing house only
Teardown and/or re -build allowed under Town Regulations
Building Inspector Date
5.
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ALL SUBSEOUEN i" REVISiON.'ALTERATIONS TO THESE HOUSE
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SUROCT to any easements, rights-of-ways, and /or
I .9,;vements, that the utility companies may'have.
SURZU to such facts disclosed by on accurote,
L�P , -to-ddIe:-I1`t10 search.
off'.17;UY shown hereon ore not- to be used- for
. coq7struction purposes and /or fence installation.
ass Q
"Y "a
-TAX MAP DATA:.
Section: 62.10
Block.. I
Lob. j5.35 J7
Deed Ubdr. .794, Page. 232
Deed.Libe• 1730, Pogo., 338
Deed Libor 1626 Page: 140
A. map entitled 'Mcawgna Lake Park
Estate" 'filed in the.Patham County
CleWs office on 29. December 1923
as map number 59C.
Individual Lot
Survap; of A
and
for.
located in the
rown o• f Puthom Volley
OUjjA_'_
.PWhom e New -Xork
tale:' rr 40. dote. 10 Ally. 2006
WrECEDE•. SURVEYNG.
HOWARD W. WMPMP4 P9.M. 010
LICEIMSCO LAND SUMVEYON
62 Main Street Walden, N Y 12586
tel.: (845) 77B-.7643