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BOX 28
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BRUCE R.. FOLEY ! . _..._.....
LORETTA. MOLINARI RN . M.S.N.
;;�,<, "Associatet7ealth Uirrector `� ^�'a`
Director of Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
Environmental Health (845)278-6130 Fax(845)278-7921.
Nursing Services (845)178-6558 WIC. (845) 278 - 6678 Fax(845)278-6085
Early Intervention (845)278-6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648
Putnam County Dept. of Health
4 Geneva Road
Brewster, NY 10509
Re: lo? �O(.
Residence
Tax Map
Town
maintained by the Town, the above noted dwelling
Gentlemen:
According to
IS X(
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:
I
ASSESSORS RECORD:
OTHER Imo'' _ S 1 LA- G 1 aoa.
j
Building Inspector
Public Health Director
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509.
Associate Public Health Director
Director of Patient Services
Environmental Health (845) 278 - 6130 ' Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648
ADDITION APPLICATION (RESIDENTIAL ONLY)
STREET D t OWNRjMM I MAP# I
NAME J ('� I PHONE q 70" CHD#
MAILING ADDRESS /J W 4 —U 20CP—kd Y— V yJ
DESCRIPTION OF ADDITION D f 9 �& Ncis4er
NUMBER OF EXISTING BEDROOMS 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 form and the following to Putnam County Health Dept., 4 Geneva Road, Brewster,.NY
10509, Phone 278 -6130.
1. 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.
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Public Health Director
LOkEITA �MOLiNARI R.N., M.S.N. ,
Associate Public Health Director
Director of Patient Services
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 (845) 278 —6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648
May 2, 2001
Janet & Glenn Mirel
12 White Rock Rd.
Putnam Valley NY 10579
Re: Addition - Mirel -White Rock Rd
No Increases in Number of Bedrooms
(T) Putnam Valley Tax # 73 -14
Dear Mr. & Mrs. Mirel:
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 form this Department dated ..May 2.- 2001 The addition is approved with the following -
conditions:
1. The total number of bedrooms must remain at three without prior approval
by this department. -
.. ..?; -' i,h °- area of the. -Ms Se�vFt "1:'U'le !?�al'u StG1fi. � aA- . . _.
__ .._.. �,' . _. K _ . G , v anu' itJ "K�1u81,vll dr. a; uli St i3�
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 other permits or, variances. required are the responsibility of the applicant and the jurisdiction. -. - -- -
of the Town of _Putnam Vallev.
If you have any questions, please contact me at your convenience.
Very truly yours,
Gx�
Michael Luke
ML:kg Public Health Technician
cc: BI(T)
DEPARTMENT OF HEALTH
Division of Environmental Health Services
110 OLD_ ROUTE_,S,IX CENTER, CARMEL,., N.Y. 10512 _(914) 225- 031.0..
z ` APPLICATION ' TO CONSTRUCT A WATER 'WELL ®
PCHD PERMIT #
WELL LOCATIO
Street Address Toga Village City Tax Grid
'
Number
S- � � 17
WELL OWNER
'Name. Mailing Address
r\ W-fu-Ar ,.
IFrivate
D Public
USE OF WELL
primary
2 - secondary
P.BESIDENTI E3 PUBLIC. SUPPLY ®AIR /COND /HEAT AT
® BUSINESS O FARM O TEST /OBSERVATION
® INDUSTRIAL O INSTITUTIONAL D STAND -BY
®ABANDONED
D OTHER (specify,
AMOUNT OF USE
YIELD SOUGHTgpm /# PEOPLE SERVED �'� /EST. OF DAILY USAGE &Nal
AKREPLACE EXISTING SUPPLY ® TEST /OBSERVATION 0. ADDITIONAL. SUPPLY.
O NEW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
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WELL TYPE
ILLED ODRIVEN
ODUG. ®GRAVEL.
OOTHER
IS WELL SITE SUBJECT TO FLOODING? YES _NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No.
WATER WELL CONTRACTOR: Name ��.- O - Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _7.k NO
NAME OF PUBLIC WATER SUPPLY: �� TOWN /VIL /CITY
z DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
SEPARATE SHEET `
(date) 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
thirt! (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 shall take appropriate action to assure that
any and all water or 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.
Date of Issue: 4V7 4::� %G r 19 % Q _
Date of Expiration 19 �,� Permit Issuing Officio
Permit is Non - Transferrable
White copy:
HD File
Pink copy: Owner
y`3/89
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1
Yellow copy:
Bldg. Insp.
Orange copy: Well Driller
TITLE NO.
This is to certify that I have surveyed ARISTOTLE -BOY',
Zol //'7 6 RNAZOS, P.C.
fvr 1,,cll 2 Q's '31yown 6/1 IXe
map 3-.00 &WIn Ot VQ11CY, LAND SURVEY" • PLANNERS
7A a,-,i G, A/. Y
LICENSED IN
Filed in the fwA?am County Clerk's Office Division of Land Records as Map
I have located all existing buildings and lines of possession and have shown their positions hereon.
Survey completed: -7une 9,/986
Map drafted: dune on scale of one inch to 30 feet.
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I hereby certify this survey to: fZIW Ahsl-qcf N.Y.S LiC. 46553
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This it to cc, oly th,t I h#vc i:,Ivcyed ARISTOTLE BOURNAZOS, P.C.
Zol V'7 61vet 2 as 3AQ-.WA CA Mc
Cr.r6.'A ad"m VQ//'y' LANO SURVEYORS- PLANNERS
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Filoo In Ins IWO— County Clalk's Office Division of Land Records as M.0
I have located all o,isling buildings and linos of oossesslon ano have shown that( positions notoon.
Sun,GyCoMpI4jG,: )Vnr 9,/166
Mapdrallod: 7vne 1{1166- on scale of one inch to 30 feel. '7 1
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