Loading...
HomeMy WebLinkAbout3272DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73. -1 -87 BOX 26 03272 }J V . .T Is is ,� , �• LL All - ,� . 03272 PUTNAM COUNTY DEPARTMENT OF HEALTH ,y DIVISION OF ENVIRONMENTAL HEALTH SERVICES o APPLICATION TO CONSTRUCT A WATER WELL rZiiil li. `tr tiV I � Well Location: Street dress: To ills Tax Grid # 7Z- / -F7 S �{ �% Map Block Lot(s) Well Owner: N e: Address: em Use of Well: >� Residenti& 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 gpm # People Served — Est. of Daily Usage 2 a dal. Reason for Replace Existing Supply Test/Observation Additional Supply D'f filing New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? .................... .r z.-.0................... ............................... Yes No �,i, Is well located in a realty subdivision? ...................................... ............................... Yes No x Name of subdivision Lot No. Water Well Contractor: Address: 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' Applicant 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. revision or alteration of the approved plan requires a new permit. Well to be constructed by a water ell iller certifijed by Putnam County. Date of Issue hu J6 Permit Iss Offici Date of Expiration Title: Permit is Non -Trans a rabl White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Il't� flo Ac u" Ca-S 1 vl j 1 Yn4� .t", ©� 416 ��sL,�° r c-q u i i-RJ J'7 r PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO ABANDON A WATER WELL please print or type PCH PERMIT # AV,,j;)g -r3.3 Well Location• • Street Address: TownNillage _ J Tax jjjd # Map Block Lot(s) Well Owner: N e: Address: Well Type: Drill Driven Dug Gravel Other Depth Data: Well Depth ft Static Water Level ft 71Date Measured Use of Well: Residential Public Supply Air /Cond/Heat Pump Abandoned , 1- primary Business Farm Test/Observation Other (specify) 2- secondary Industrial Institutional Standby Water Well Name: Address: Contractor: Reason For Abandonment: Description of Work To Be Performed: o.. _. v._.. _. .w. -..... _ - -• .•`• -az- - "• ' ,. a v.+• -. H.. -• eo- ..- ..._ -. .-e .- am _w .,T.. .. vnvi .....«... a ...• .r •.. Date: dZf/0-3 Applicant Signature: PERMIT 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 irmation delineated on the application for this permit has been completed. 2-/C6 Date oT Issue Issuing Official Title White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -97 Mk r =_ ...M ,..0 +�. a. ,o:a� = -".'. r_ •o-. �.ys ., -r �s.5i.. _ e _ r, r: r: «. = ._:..::. a 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 Interventon/Presched (845) 278 - 6014 Fax (845) 278 - 6648 Norman Anderson Inc. 152 Barger Street Putnam Valley NY, 10579 Re: Proposed Well Owens 451 Peekskill Hollow Rd. (T) Putnam Valley 73 -1 -87 November 21, 2003 Dear Mr. Anderson: ROBERT J. BONDI County Executive A field inspection was conducted on the above referenced lot by this Department on November 19, 2003. The application to replace the existing well is approved with the 1. A minimum casing length of 40 feet is required. A Well Completion Report (WC -97), shall be submitted no later than 30 days after the well completion by the permittee. Please contact the writer at (845)278 -6130 ext.2235 if you have any questions. Sincerely, A f Brian R. Stevens Public Health Technician cc: RM, file SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Thomas Owens 451 Peeksill Hollow Rd. Putnam Valley, NY 10579 Dear Mr. Owens: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 June 13, 2008 Re: Addition — A- 104 -08 ROBERT J. BONDI County Executive .. ROBERT MORRIS, PE Director of Environmental Health No Increases in Number of Bedrooms 451 Peekskill Hollow Rd. (T)Putnam Valley, TM #73. -1 -87 I have received and reviewed the plans for the proposed addition at the above - mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp from this Department dated June 11, 2008. 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 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. This Department recommends you contact your local Building Department to ensure setbacks and other current codes can be met. 5. This 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 GR: lm Sr. Environmental Engineering Aide cc:BI (T)PV .Environ men tal.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 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 SHERLITA AMLER, MD,-,MS, FAAP -- - - '- "" ° " " �z'° '- ""i:oriimiss "loner "ojN a11h ' ""�' ` w'� `hf LORETTA MOLINARI, RN, MSN Associate Commissioner of Health. . • -wy r-R, _ - � S:-.- . ytZu... Y1 • _� t•. .2... sn�ll� c' �.z.i'•:c .?w.r_ County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 16509 Town LeLyal Bedroom Count Re: GWENS (Owner's Name) Tax Map #: 73 .-1-87 Address: 451 Peekskill Hollow Road Town: Putnam Valley Year Built: I A S A According to records maintained by the Town, the above noted dwelling, is XX in compliance with Town Code. is not in compliance with Town Code. The Legal Bedroom Count is: 3 This information has been obtained from: - Certificate of Occupancy: Other: Building Departm—n-n-t Files Building Inspector 5/8/08 Date 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 rrc k-5 k 1// 4//. w I: rn 1-15: 1.� Q, r. PUTKIAM COUNTY DEPARTMENT OF HEALTH HOUSE PLAN. APPROVED FOR BEDROOM COUNT ONLY BEDROOMS 7, M ,A 73, -7 ALL SUBSEQUENT REVISIONALTERATIONS TO THESE HOUSE PLANS MU09E SUBMITTED TO THE PCDOH FOR APPROVAL !Sc. C-A a,11 §-IGNATURE TITLE 6ATt-- Df 17 1�0. I . . . . . .. . . . .4 7 3, k I J-r F-/ r ;..N/ 6� ( ' 'o'P,os ..pp C-D PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY 3 BEDROOMS ;Dqf 73, 7 ALL SUBSEQUENT REVISION/ALTERATIONS TO THESE HOUSE PLANS MUST BE SUBMITTED TO THE PCDOH FOR APPROVAL' ) /r /©t SIGNATURE & TITLE 0 ATE ,1 SHERLITA AMLER, MD MS, FAAP _Commissioner- ofHegltlt_ r.. - ? "F i.. �,.r- v�:-r✓�w %..r .. w a.z..., • w+: « - .. ate. .. . . LORETTA MOLINARI, RN, MSN Associate Commissioner. of Health DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 ADDITION APPLICATION U ROBERT-J. ROBERT MORRIS, PE Director of Environmental Health RESIDENTIAL ONLY STREETS �'s�i % � TOWN TAX MAP# NAME D PHONE �(7 �p , � � 09, MAILING ADDRESS ADDITION y ✓,r✓ G Ale.$ A—F a's`7"i NUMBER OF EXISTING BEDROOMS _PROPOSED # OF BEDROOMS ,-ff (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 foll outing to Putnam. Co.rty,J�Jeal he�:;�a_Gancv N-- - T 0 '09;- Pfione: (845) 'T8 -6 f36. Certified check or money order for $100.00. Sketches of existing floor plan (drawn to scale, all living area including basement) ` 3. Two sets of proposed floor lan drawn to scale - with name � street and tax ma # P p P. ( p ) *Non- professional sketches are acceptable Olt 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. 15. 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 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 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 a ew-- ov ----- ------------ ....... ... ! : y . t f , : I { � , e � , , _t _ � S r ,- OPEC v • , , i , f i f i, i / f i E. , , , m —.—I_ i ? E I f — I �' € � —� J( -� ...__.I �.— � { 1 � 1� I �=T �,ii'"V � r ��' � ' � _. #— —I •` t j_— { i I ,� r �._ I ___ —I -_ _�{ _— -__.1 .. } —. �..� �y --•- f - ----; - e - •' C � I 3 ! ! t f __ I i � E � � �• __`i..__ _..� __....,_ w.) i __ -.. Y..�_Y._ _ ddf � R ! � ? 4 I €— .._._.�._. —_ ..._ _ {�__,.,. I I —. d � f � ! f I t i � —i t . I (1 is I L l i I -► I ��_ ! '_ �_ �''_ - € { { { { {{ a i �, j��! -� -_ -r i _ # L_ _. _ - -�- f -�__— _,►mot , _ Nt � "'. -'_ __.._j_ - ;'d_ t. 1 F.... . ; ._ � f._.._.' i . ILA —9 —_., —.( i t� f_ t ._ E _.._...�__ ..._.r•____.._� 3— � --�, -_ - ' --_ �; *— �_ —_-- ' _ - -_ .- or IL m - - `Street` s ru e A.�F t r 2196 ' Tide;_ �'-�` mown of P4bnam Valley - Departmorit of Health. - Division of S'ani tid DESIGN DATA SHEET Location.. j35es el :'A i/e[te•t� pay SEPARATE SEWERAGE SYSTEM l " Block..... Lootoa at. n i/` . ....... L`at....... } Owner.. ?OS Ph.!?FR'R !S............ Lot Area.. 3, /s 6- i Watorshed...... ............. Bldg. Type fif'ti'rss� Source of water supply: Occupancy. ANE Fsr.��i4y___ drilled- driven -dug woll- spring- public ?� NO. OF ROOMS: ... Bedrooms.. 3c..... Future...S...,." i FIXTURES: Kitchen - dishwashers Ks. Garbage- grinder.::le. Bathrooms.,° Nf Automatic laundry../ s Other..... N.f.� .................:.. SEWAGE FLOW: (200 gal./bodroorq) ..... L`�• • °. �:�`L ..... .. • •. .. . i (Increased capacity required for garbage grinder - 50%) TANK CAPACITY: :..gallons below flow line; depth air space.A.0.0.0 TANK MATERIAL: �:. °� .... total depth.,5:� ;.... liquid depth.. 11e.... width., Ole .... length.. ..(n. o .�4 � .... partition... N47.,u... i SOIL TESTS: lst ..........min.; 2d ........•.min.; 3d ...........min. Soil to 5 -foot depth ..........................how known............... e Tests made by ..... ............................... when................ ABSORPTION RATE allowed ........ g.p.s.f.p.d.; Checked by ............. in Gallons........ Rate.,...... Requires ..... sq.ft. bottom area /trenches Provided by (describe absorption field) ..............................� ........ ..............................0 distribution box provided...•„ USABLE AREA AVAILABLE OPi PREMISES: ... ............................... ,_ .. TtRP_T Gfyn •fiT ..Tx:Ii sh'gw urn sI =_e_cl:?• -natura :.._:...._.,...,.. ....<.._..,.. >_.�..•...,......, artificial.............' 6afta fff drain. ::::::..... :... :�:.e -..�._ .- . �.• -- _ -_ ._; o . Well- drained usable area MUST be provided before approval is issued, SKETCH IS REQUIRED and must show all pertinent features, north point, property lines, existing structures, driveways, water or gas lines, water courses, wolls, springs, dr;; wells or drains for roof or area drainage; DISTANCES BE' =, 4N, SUCIi FEATURES: COMPLETE PLANS FOR ADDZUA9E DRAINAGE OF .SEWAGE DISPOSAL AREA-all details of workable sewage system. DATA SUBMITTED BY: ° Sria'�itF ................ * • . aAW G Owner ( Builder( ); )• 1 corporation, give title ...................... existing field Checked by: records ( ); inspection( )-By ................ .datea:• tot. 03 NOV 14 p!, 00 c 0 u nn o t Al. ;ot ils ik OLD toad rme 13 of YAK. . z 0 M fill. 1,0 1� '4 n 'K 0 Z M, P Z 0 4814 7'- 40 Zm 0 ri cu