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73.05 -2 -18
BOX 27
03337
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DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
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WELL LOCATION
Street Address" Town Village Ct Tax Grid Numbe
as
d BOX 3C CO-* pta&n -PAL 16 A 41 V 10 6
WELL OWNER
Name
CA AR C7'Lt
Mailing Address
Cf-DA-S . l v� .' wgM
C3 Private
O Public
-USE. OF WELL
07 primary
'2 - secondary
'V RESIDENTIAL
0 BUSINESS
0 INDUSTRIAL
❑PUBLIC SUPPLY. QAIR /COND /HEAT..PUMP
❑ FARM ❑ TEST /OBSERVATION
b INSTITUTIONAL ❑ STAND -BY
13ABANDONED
0 OTHER (specify
Q
AMOUNT OF USE
YIELD SOUGHT
5 gpm /# PEOPLE SERVED.A/ /EST. OF DAILY USAGE Jr-o ?gal
REASON FOR.
DRILLING
NEW SUPPLY p PROVIDE ADDITIONAL. SUPPLY
0REPLACE EXISTING SUPPLY DEEPEN EXISTING W L
O TEST /OBSERVATION
DETAILED
REASON FOR
DRILLING
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t �s
` „4j;`�
.
An, A- r �` o ` ,o.
WELL TYPE
DRILLED
DRIVEN EIDUG
DGRAVEL
a
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES X NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No.
WATER WELL CONTRACTOR: Name R � ;.1 ,'f r Address:
1 -1' lay �C
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
^s_'�.71��L'Kl��^�L�V1 LL�11�L"��l'1�1 \�J�. WLi1 L'1\ 1 "lLi1N ate~ ^f � V w. G•.�m -��.. M_.'T.r+,. .... r..r.. v'.•- KM�•vwn.. 0...`,�p•v Ot^ ^^�•,�. ••
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
ON REAR OF THIS APPLICATION EJON JEPARJWE S ET
(date) (s gnature)
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 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: c7co. -.e ,0 19�
Date of Expiration s..p /a 19 ermit Issu' g ff
Permit is Non - Transferrable White copy: H.D. File
Yellow copy: Building Inspector
2/87 Pirk Copy: Owner
Orange copy: Well Driller
O
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__ -�ti YP iP i�.`l.•.m- J.a.v.•r �.T w,r .a +S ^Tm-.er YTr�C. ^Yyi.. ..�
BRUCE R FOLEY. P..s.
Acting Public Health Director
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
Putnam County Dept. of Health
4 Geneva Road
Brewster, NY 10509
Gentlemen:
Re: ,. A�4p_ O G L—
Residence 4— CO0 A4 -R ,tr Doe %
Tax Map JJ -
Town
According to records maintained by the Town, the above noted dwelling
IS-
IS NOT
I
in compliance Nvith Town code and the total number of bedr-ooms on record
is c
This information has been obtained from:
CERTIFICATE OF OCCUPANCY: �— -
ASSESSORS RECORD:
OTHER
Building Inspector
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DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, . Brewster, New York 10509
(914) 278 -6130
BRUCE R. FOLEY, R.S
Acting Public Health Direct(.,
PROPOSED ADDITION APPLICATION _ (RESIDENTIAL ONLY
STREET: L� IZ. Q 172• TOViN TX MAP # 09
NA,m� E:�AfjiEc CARko ( PHONE'Sa, SS 2 PCHD PERMIT #l�� �7
MAILING ADDRESS _ 59 CeCMK Ikk I_ MCz.- Q�TIK)Qv\ Ai le Y fv,y-
`f I
Description of-Addition ►' e�. it I�OI
Number of existing bedrooms �o Proposed number of bedrooms
from Certificate 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
An accordance with applicable sections of the Putnam County Sanitary Code.
Please submit this form and the following to PUTNAM COUNTY HEALTH DEPARTMENT,
4 GENEVA ROAD, BR3EgSTER, NY 10509, Phone`278 -6130 with the following information.
-- 1_ Cert,�f�2_C,_�r:�Prj�?nr. C1Or,,OC�, � ..._ ._... ...- : . -._.._ .; .�. -_ -. _...,,,_:�..__• -__ _..._.., -._—.�
2. Sketch of existing floor plan (all living area including basement, if any)
Non- professional drawing is acceptable.
3. Sketch of proposed floor plan.
Non professional drawing is acceptable.
0 Copy of survey showing well and septic location, to the best of your
knowledge. Include date of installation if known.
Include all wells and septic systems within 200 feet of property line. Any
questions please contact this office.
5. Copy of Certificate of Occupancy from Town or Certification from Building
Department of legal bedroom count of dwelling.
OFFICE USE
Comments and /or conditions
application
August 1995
July 1996 (Revised)
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road
Brewster, New York 10509
Tel. (914) 278-6130 Fax (914) 278-7921
December 16, 1997
Daniel Carroll
59 Cedar Lake Dr.
Putnam Valley, N.Y.
Dear Mr. Carroll:
BRUCE R. FOLEY
Acting Public Health Director
Re: Addition - Carroll
59 Cedar Lake Dr.
No increase in number of bedrooms
(T) Putnam Valley Tax # 73.5 -2 -18
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
latest revision date of December 16,1997 and this Department's approval
stamp.
Based on the information submitted, the above mPn*_i^r_e.d addi-ticr. is approved
1. The total number of bedrooms must remain at Two 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.
Approval is granted for sewage disposal only. 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.
WH /kg
cc:BI (Putnam Valley)
Very trt�l� -ire — _.....
William Hedges
Sr. Public Health Sanitarian
D
Exist -7' 141, 1 01
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EXISTING DW I . 1;
BATH �D SO
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Enlarge Opening
INSTALL Header
II
4,_9'
2 Rel-ve E,tst. Door
inst.., Arcl,
Elm 'E.'st closet
XIST11 HOUSE
81 2S.F.
ou'l 6'— 3'
L
1 Existing Fcr)!!!y',' RM.
FRONT ENTR
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Meet E.-st.;FObr, HL
tt PROPOSED
ADDITION
453 S.F.
Re n iove Exist. Ext. Walls
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6'-7 3/4' 5'-3 112'
PLAN VIEW
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SCALE:
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tl0TE: Proposed DeCk 12'
51-jKOND FLOOR PLAN To Be Added To Exist.
Deck At Sliding Door
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W.O. Ng 4225 TM. 54 -06-12
NOTES
this
I.
Alteration of this document, except by o licensed Load
and
Surveyor, is illegal.
With
This mop is certified only to
2.
A// certifications are valid for this mop and copies
as
DANIEL ✓. CARROLL
thereof only if said map or copies bear the impressed
pro.
SHEILA H. CARROLL
seal of the survomr Whose signature appears hereon.
Rev
ALBANY SAVINGS BANK
3.
Underground improvements , easements or encroachments,
Rev.
COMMONWEALTH LAND T /TLE INSURANCE CO.
if ony, are not shown hereon.
for their Tit /e Np KPP- H46166/
4.
The premises hereon is Lots 104, 105 B 106 as shown
KENNETH PREGNO AGENCY LTD.
on that certain moo entillpd,.
r:i'li>
C/erh s Office on ✓0nuary 30, 1931.
Land Surveyors
Q
U. S. Route 9
Cold Spring, N.Y. 10516
(914) 2 65 -92/7
W.O. Ng 4225 TM. 54 -06-12