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73. -1 -48
BOX 26
03256
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03256
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914)-'278-6130
Ti,T C" m s L". t .Ti P a.1-L z
°'-
PCHD PERMIT #� /S.
WELL LOCATION
Street Addres
X-14
Oown/Villa
wn ;"Cc Vt.,,,
Tax Grid Number
1
WELL OWNER
Name �/
ki"Vi t 1 !�
M iling Address
A'j ' V
OPrivate
blis
USE OF WELL
1 - primary
2- secondary
RESIDENTIAL
I BUSINESS
O INDUSTRIAL
O PUBLIC SUPPLY Q AIR /COND /HEAT PUMP O AB ONED
O FARM O TEST /OBSERVATION O OTHER (specify
0 INSTITUTIONAL O STAND -BY O
AMOUNT OF USE
YIELD SOUGHT c gpm /# PEOPLE SERVED 61 /EST.
10'- REPLACE EXISTING SUPPLY.. O TEST /OBSERVATION
O NEW SUPPLY NEW DWELLING), U DEEPEN EXISTING WELL
OF DAILY USAGE Q) O gal
Q ADDITIONAL SUPPLY
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
�,e _ i
LJ
WELL TYPE
13DRILLED
DRIVEN
ODUG
GRAVEL 0 OTHER
IS WELL SITE SUBJECT TO FLOODING? YES V, NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No.
WATER WELL CONTRACTOR: Name
Address : Vhf &9-
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES __6NO aa-S- 31�L los
NAME OF PUBLIC WATER SUPPLY:
TOWN /VIL /CITY
D-ST CE TO °R!3PEp.^1'Y I'?iOI�! NEAREST WATLF ZIATN:
- _ ...
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
C1 ON SEPARATE SHEET
.(date) (sig ature)
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
Department attached to this permit.
3. Submit a Well Completion Report on a form
requirements of the Putnam County Health
provided by the Putnam County Health Department.
During all well drilling operations, the applicant shall take appropriate action to assure that
any and all water or waste products from such well dril ng operations be contained on this
property and in such a manner as not to degrade or o erw a contam' atnne surface or groundwater.
Date of Issue: (f �3 19 F,
Date of Expiration ( Z 19 qr Permit Issuing Official
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
'LORETTA MOLINARI
Public Health Director
•� .. .. i . __ s., i � rte. � t.. fit ♦ . 4.!_ '. .e ri o .•. • s u..
ROBERT J. BONDI
County Executive
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 InterventiowPreschool (845) 278 - 6014 Fax (845) 278 - 6648
December 7, 2004
Modico
274 Church Rd.
Putnam Valley, NY 10579
Re: Addition — Modico, 274 Church Rd.
No Increases in Number of Bedrooms
(T) Putnam Valley, TM #73. -1 -48
Dear Mr. Modico:
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 December 7, 2004. The addition is approved with the following conditions.
1. The total number of bedrooms must remain at two without prior approval by this
Department.
2. The area of tbe_ existing sewage disposal system,_and its expansion rarea, 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 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.
ML: hn
cc: BI (T) Putnam Valley
Sincerely,
Michael Luke
Public Health Sanitarian
1.-
.l s
..Lrj _.. � s n- .t.... .. •T. {- r�..r:l•. yi�.— .-�,:C , .. -: civ ... ... .
LORETTA MOLINARI
Public Health Director
.. f
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
ROBERT J. BONDI
County Executive
Environmental Health (845) 278 - 6130 Fax (845) 278.7921 Q
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648. Z
PROPOSED ADDITION APPLICATION (RESIDENTIAL ONLY) O
Rte"
STREET (h- WA Kd TOWN TX MAP # 73, + I— 4
NAME ✓ ' 1 '' PA0 - PHOAf M, 553 PCHD # 4 c3 q 6 - 0
MAILING ADDRESS
U
DESCRIPTION OF ADDITION DOM 9W
NUMBER OF EXISTING BEDROOMS 2 PROPOSED # OF BEDROOMS 0
(FROM CERT. OF OCCUPANCY OR
CERTIFICATION FROM BUnDING 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
s: c:,nv ;:f `mac I'nuun'ry Satiiiary Curie. _ -
Please submit this form and the following to Putnam County Health Dept., 4 Geneva Rd.;
Brewster, NY-10509, Phone 278 -6130.
l . 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. ;
OFECE USE
Comments
"Feb 98
raft
5673
J
Y
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
Putnam County Dept. of Health
1 Geneva Road
Brewster, NY 10509
To Whom It May Concern:
ROBERT J. BONDI
County Executive
December 1, 2004
Re: 274 Church Road
Residence
Tax Map 73 . -1 -48
Town of Putnam Valley
According to records maintained by the Town, the above noted dwelling,
_r .�S vv
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: 14
ASSESSORS RECORD: xxx
OTHER:
Deputy Zoning Inspector
houseguidehnes
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- ! : PUTNAM COUNTY -DEWMENT OF HEALTH
HCCSE PLANS.APF90VED FW
BEOROONI CQCINT O LY;
-'— BEDROOMS
Stratum a To ate
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PUTNAM COUNTY DEPARTMENT OF HEALTH
HOUSE PLANS APPROVED FOR
BED ROOM COUNT ONLY;
BEDROOMS
Signature & This ' D2te
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Boyd Artesian Well Co., Inc.
Carmel, N.Y. 10512
(914) 225-3196
CERTIFIED
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