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HomeMy WebLinkAbout3254DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 71-1 -42 & 71-1 -43 BOX 26 03254 I �r I . ' If r . ., . 03254 ;4 SHERLITA AMLER, MD, MS, FAAP _ Commis_sioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health ROBERT J. BONDI _ CouniyExecutive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ADDITION APPLICATION RESIDENTIAL ONLY STREET TOWN PUTNAM' _% TAx MAP# '73,-1-'1R4- `13 NAME L b S PHONE W X7 PCHD# MAILING ADDRESS tj DESCRIPTION OF ADDITION 1 nA 0 NUMBER OF EXISTING BEDROOMS J 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. for! -- a*nd the. foilowir.g to Putnam County Heai_th Dept., I - Geneva Rd, 1. Certified check or money order for $100.00. 2. Sketches of existing floor plan (drawn to scale, all living area including basement) 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 locations 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 Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE COMMENTS Environmental Health (845) 278 -6130 Fax (845) 278 -7921 / Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 �.2 e —'1 �G/ 3 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 7 SHERLI17A AMLER, MD, MS, FAAP Cnrrzmissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 PUTNAM COUNTY DEPT. OF HEALTH t GENEVA ROAD BREWSTER, NY 10509 To Whom It May Concern: ROBERT J. BONDI County Executive Re: 290 Church Road Residence TAX MAP# 73.-l-43 TOWN of Putnam Valley According to records maintained by the Town, the above noted dwelling, IS .�.- .c....v. ..c ... ... .. .-��� •�,�T7TTV "C T':'�r�71 - ,.� --.� _... .,e .� .. _.. ,. _ o- ... ... . X-£ 11Y ClV1V1YLIEEil1'l�,��" "rrilrr � �r�c•�:v�u�, IS NOT IN COMPLIANCE WITH TOWN CODE LEGAL BEDROOM COUNT IS 3 This information has been obtained from: CERTIFICATE OF OCCUPANCY: OTHER: Assessor' Assist. Building Inspector, John W. Allen October 4, 2005 Date CERTIFICATE OF OCCUPANCY Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 kn 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 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO.00NSTR.UCT A, WATER WELL _ -'_lint pleaswe pr or type Well Location: Street Address: TownNillage /a Tax Grid # �v 2_qy re-171i ' 2_ � Map Block Lot(s) Well Owner: Name: a� Address: )7 Use of Well: esidential Public Supply Air /Cond/Heat Pump Irrigati n 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought 5' gpm # People Served --- Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) _ Deepen Existing Well Detailed Reason zw` oi�N 6h-61 for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes N-d _- Is well located in a realty subdivision? ...................................... ............................... Yes NO Name of subdivision Water Well Contractor: Address: /Y ........... Yes Is Public Water Supply available to site? � - of Public Water Supply: TownNillage _ Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. -CO 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_T =-, well drilling operations be contained on this property and in such a manner as not to degrade or'oiherwso::. 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 orf pm be amended or modified when considered necessary by the Public Health Director. Any revision gpalte atiQil of the approved plan requires a new permit. Well to be constructed by a water well driller certi &d bi4irtmun County. v, Date of Issue 2`� 0 Permit Is g Official: Date of Expiration 2 Title: Permit is Non - Transfer a le White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owtdr; Orange copy - Well driller Form WP -97 7 F' ,t Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health December 7, 2005 Cary Fields 286 Church Road Putnam Valley, NY 10579 Dear Mr. Fields: r County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Re: Addition — Approval - Fields No Increase in Number of Bedrooms 286 Church Road (T) Putnam Valley, T.M. 73.1 -42 & 43 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 the Department dated December 7, 2005. 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 . _ .. _...._.- ... __.� .__ .___.__....._ ..._ ._ �..R;.._._._,.... ._ ...��:... :.. _ ._ _._.... 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 your convenience. Very truly yours, Michael Luke Public Health Sanitarian ML:cw cc: Building Inspector, (T) Putnam Valley Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ___ A_P_ PLICATION. TO CONSTRUCT A_W.. ATER_MWLL 7.9J .'V:.?wa.q'c ��-.. w.. .- `,C.�f .. a•':f -s, r_ m..;-0.r d1 ..i•v4�..`;.�I'_.:c:..ri+.:�aYe re�4.lq •W..�s .:.C{i�'�wQPCfR S![G'�N.Q�o..�a r� . .. ..�}.. 4 �•��.. �i.,. y. •Sp`�m w. yYflc:s'v-:tr: please print or type - JC Well Location: Street Address: TownNillage /a ? g Tax Grid # �v -73 ,_ I --"'1 3 26766 +ww rev ,,, U' Map Block Lot(s) Well Owner: ne Address: Use of Well: '-� esidential Public Supply Air /Cond/Heat Pump Irrigatioin 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought ; 5 gpm # People Served ---- Est. of Daily Usage gal.' Reason for Replace Existing Supply Test/Observation - Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason PrI for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ........................... ............................... Yes No x ":- ................................ ............................... Is well located in a realty subdivision? ...... Yes No � Name of subdivision Lot Water Well Contractor: Address: / S Is Public Water Supply available to site? .................................. ............................... Yes No _,k Name of Public Water Supply: TownNillage Distance to property from nearest water main: co Proposed well location & sources of contamination to be provided on separate sheet/plan. T :?_. 3llnn ry;9� 1Iy/��11 1 .,�/s� / ��� / / ♦,;�� !,;�'1 /F/L��, ?�,( /y% /i%_� .'AM�V aturF.�_/ %'Y =i�. -- LG�Y.�'i :��'� j'''! / V �,'R-- :1r+�G1liL1;:F ` �i /..^y.`"_- .k���"?'...wr..rr`.d. •� .. "v' "' ..�.... _. .- _ 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. j A Date of Issue Permit Is ing Official: Date of Expiration ;�,j 21 Title: Permit is Non White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owddr; Orange copy - Well driller Form WP -97 1 DIVISION OF ENVIRONMENTAL HEALTH SERVICES John M. Simmons, M.D. Deputy Commissioner of Health NAM ADDRESS � - H wzc No. Street - FIELD ACTIVITY REPORT - n TH No. MAILING ADDRESS P.O. Box Post Office Zip Code WDAVD-N-106: "I Sheet of Orig. Routine Orig. Complain Orig. Request Compliance Complaint Comp Final Group Illness Construction Reinspection PERSON IN CHARGE Field, Sampling Only OR INTERVIEWED Field Conference Name and Title Other DATE Y-A TYPE FACILITY TIME ARRIVED 6 C TIME LEFT Explain FINDINGS: tA_ 4 .4 77 � TF - 777 e INSPECTOR: S 11, cf- PERSON IN CHARGE OR I acknowledge this Field Activity Report. SIGNATURE: 6/86 TITLE: (1• TELEPHONE: 'C �A rl 0-13 ")� Lv DEPARTMENT OF HEALTH V1 Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 L�PPLiC AT ION TO 'CON8TROCT' A WATER 'WELLr � PCHD PERMIT #(i � WELL LOCATION Street , ress To Village City Tax a� Grid Numb = WELL OWNER N Mai ing Add ess 1 rivate D Public USE OF WELL 1 - primary ®- secondary eRESIDEArTAL. 0 BUSINESS 0 INDUSTRIAL D PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP ❑ FARM 0 TEST /OBSERVATION 0 INSTITUTIONAL ❑ STAND -BY Q ABANDONED 0 OTHER (specify O AMOUNT 'OF USE YIELD SOUGHT /C7 T: -gpm /# PEOPLE SERVED /EST. OF DAILY USAGE oQ.5 'gal REASON FOR DRILLING UNEW SUPPLY OREPLACE EXISTING SUPPLY WROVIDE ADDITIONAL SUPPLY ❑:DEEPEN EXISTING WELL ❑TEST OBSERVATION DETAILED REASON FOR DRILLING WELL TYPE DRILLED O DRIVEN ODUG GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES 1/ NO IF WELL IS LOCATED .IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: � _� Lot No. WATER WELL CONTRACTOR: Name i'( �'�+�G ��- xa�etiaow Address: 2/ IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO" PROPERTY TY fRUM- NEAREST WATER MAIN: " LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON REAR OF THIS APPLICATION []ON S TE (date) (sign�t) 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 appl i cant - s.ha'1 l : 1. . Pump the well until the water i s, clear.. 2. Disinfect the well in accordance witCthe 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. Date of Issue: S 19 �� H& Date of Expiration: /-&-Q D'S 1970 Permit ssuing ffici Permit is Non - Transferrable %bite copy: H.D. File Yellow copy: Building Inspector 2/87 Pink Copy: Owner Orange copy: Well Driller �,� �j� '...o � -ara\\ —.. � .._ . ' c. _ .. a .. .. _ - ... .. r._ ,_,_ y. ;yi. r, ..... - .f<... .. -` C!r - . �' �y�g. ...�. a:. � �' ..o..a- =. -- _- .: : o.: � �i �' f � r.. \ � 1 i s � �� `-� �� _ �-" ��. �i0 I � I "� �1 __ �� 5� �� r,� 0 �� b oNS `� �y f I Sz L .4 --.. .4•"wet.,• y.�— .. <. - . 1r � -.'E.a ...p ../LA..'r �. . _. .. . -. .- y, e / r.'a't � .. ! r •. 11►� -.... .Y��`O�- _..err. � - � . �r . $.s _.a• ..fly.... -_ ..�_ -. _� a _ .-. 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