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74.17 -1 -15
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PUTNAM COUNTY DEPARTMENT OF HEALTH
Q; DIVISION OF ENVIRONMENTAL HEALTH SERVICES
APPLICATION TO CONSTRUCT A WATER WELL
Blcas- .Drant.0zLyPe:.
Well Location:
Street Address: Town/Village . Tax Grid # —J `[ l 1 rt-1 -..
Some . �a Map Block Lot(s)
Well Owner:
Name :75,-n tc h r i S-b
Address: Va l It �� y
E(t f,cylt
�SoniCC set pct. (� V. lv (a� 1 '
Use of Well:
_.k Residential 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 _gal.
Reason for
Replace Existing Supply Test/Observation Additional Supply
Drilling
New Supply (new dwelling) Deepen Existing Well
Detailed Reason
Wei r was of ; 1 . d - o r Si, in Met Cc,
r o (e. w r n{ at
for Drilling
Well Type
X Drilled Driven Gravel Other
Is well site subject to flooding? ................................................. ............................... Yes No )c
_
Is well located in a realty subdivision? ...................................... ............................... Yes No _X
Name of subdivision Lot No.
Water Well Contractor: t3ca, r--. 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: j3o o i 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. Any revision or alteration
of the approved plan requires a new permit. Well to be constructed by a water well & iller certified by Putnam
County.
Date of Issue 1 J O Permit Is uing Official:
Date of Expiration / o Title:
Permit is Non-T U ^
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WP-97
DAIIIM ESfADI.I: >ilE D
11/1 111 FIFF ICE OF
A% :,Ii(IWN ON IIIE TOWN
W1Y R1 AINDE U ANI) /f1R IJN-
IIIINS. I- A`,'EMENIS. RIGHT -
ANY.
;D BY A POINT OF REFERENCE,
ENCROACHMENTS, IF ANY,
IF OFFSETS SHOWN ARE AT
NE S.
R ON THE SITE MAY NOT BE
.ED IN THE PUTNAM COUNTY
AS MAP NO. 815.
LED IN THE PUTNAM COUNTY
3/4' ].PIPE
7, EPA FOR
)=L/ /K) 77
I
LANDS NOW OR FORMERLY OF
' LEW,CS
LIBER 588 PAGE 413
! LOT 17, MAP NO. 815
5p'_ �24s7' ro
s j'
y i
•
A. 4 a
1/2' ].ROD AND 1'1 , i , o
PLASTIC CAP SET 'u 1 /2' =.LROD AND
N2T+?34OE PLASTIC CAP SET
R NO PHYSICAL BOUNDS
El 'LANDS NOW OR FORF
'"'`�� �''� -- w❑ ❑OED CANT"ESSx
t: L [ BER 685 PAGE S
� ME STG39Y AREA -LOT 56. MAP NO. 8
p FRAME'
NO 42
ICA
__
kA1.' 1 AREA '� \C.79'-. Iws1
PROPERLY LINE
g °S 1000 ACRES 0 1' LOPE
i + FOUNU� i
' OF P& AY VALLEY LOTah� MAPt44� &5
MEW YORK $ a�,I r 1 t lYJzzL .!
.1�4 ---_ 1� frGlGC9E 6
� Y'?4 19916 1/2' LROD 1 UP0. LANDS NOW OR FORME
FdUNO �'3��.. �. w PHYStcnt eaR+DS ;'LIBER AR� E 3!
Ie�
E EL F ,'r�/ 52,7MW0- a?%I %�� '1 2' I.RDD LOT. 55, MAP NO. Off
ru / lt9 r:
ru
ri
r; o% ,95i� �i
ru LANDS NOW OR FORMERLY OF
R'I:BY CERTIFY IN MY cqi lltma couIILy ;bepu 't:ukui11 u ��aP�� 72
)RTIES LISTED BELOW U.POLE Division of Environmental Heal B
❑F AN ACTUAL FIELD Ya T AAfiB. 815
1996 AND COMPLIES oz ?]
vEYS EXCEPTED BY ipproved as noted Cor conformance with Tm�c p�y�Cy,•
OF LAND SURVEYORS. h
WITH TITLE TO THE applicable Rules and Regulations of the ISSUED BY STEWART TITLE INSURANCE COMPANY, 6-ATED JULY 23, 1946
C We� ar tmen�al AS TITLE NUMBER 96A _- 6733 P.
SUfl'6�EY� � i �•1
GLZi 8°i4lVY l a (91,4) 496 -3367
.y+ n THE ALTERATION OF THIS SURVEY HAP BYITHO
ANYONE OTHER THAN II1C ORIGINAL PREPARER
iVY A.
/ IS NISLEADIN4 LUNfUSING AND NOT IN THE GRACE P.L.S
ONLY COPIES FROM 114E ORIGINAL OF THIS GENERAL WELFARE AND BENEFIT OF THE e
SURVEY, MARKED WITH AN ORIGINAL LAND PUBLIC. 11 IS A VIOL.AIHIN (IF SECTION 7209, PROFESSIONAL, LAND SURVEYOR
!!V ANTHONY A. S9 PACE, P.LS..LIC. No. 58187 SURVEYORS RAISED CHEYISSCD SCAT. SHALL sue - DIVISION 2, ru ME NEW YORK SIAIC NEWyYNDSOR. NEW YORK - 12553
BL CONSIDERED III Of vAIAD IRItC IXn'M S. CWN. AI ION LAW.
I'y'y6 NY AMIitliNr A 10RAI1. 1'1 '.
-
S�.
i'
_ .. V. r BRUCE R > : FOLEY
Public Health Director
yLORETTA MOLINARI R.N., M.S.N.
Associate Public.. Health Director -
Director of Patient Services
DEPARTMENT OF HEALTH
i 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 Fax (845) 278 - 6648
Preschool (845) 228 - 5912 Fax (845) 228 - 6113
September 17, 2001 NP7
Mr. & Mrs. Elliott
42 Somerset Lane
Putnam Valley, New York 10579
Re: Well Permit Application for Elliott
42 Somerset Lane, (T) Putnam Valley
Dear Mr. & Mrs. Elliott:
This Department has approved the well permit for a well at the above referenced project.
Please be advised that if site conditions and/or site plans change and/or are revised, thereby
compromising the minimum required separation distances, siting approval of the wells must be
re- approved by this Department.
.„ The;well. must be drilled= a.minimul'n 15' -0" fromboth property'I7nt3s as sllowri on the stamped
approved plan.
The above well to be drilled will be required to be sampled for the parameters listed in Table 2 of
Bulletin RS- 21(attached). The existing well is to be abandoned in accordance with PCHD
regulations.
All necessary Town permits* for the installation of the well are required to be issued prior to well
construction.
Should you have any questions, please feel free to contact the writer at ext. 2157.
Very truly yours,
Adam B. Stiebeling
Assistant Public Health Engineer
ABS:cj
cc: (T) Putnam Valley Building Inspector
Public Health Director
LO1 ETT - MO. LINARV 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)278w6085
Early Intervention (845)278-6014 Fax (845) 278 - 6648
Preschool (845) 228 - 5912 Fax (845) 228 - 6113
Memo
a To: Mr. & Mrs. Elliott
From: Adam & Stiebeling, Assistant Public Health Engineer
Date:- September 24; 2001
-Subject: Abandoning a Well
Attached please find excerpts from New York State Department of Health 10 -NYCRR Appendix
5 -B "Rural Water Supply."
Dug wells are to be filled with earth.
Drilled wells .are to be filled with concrete in its entirety.
The casing can be cut below grade provided the well head is sealed with concrete..
Enclosed are: - -- - - -- -- _
a. Application to Abandon aWell (WA -97)
b. Well Abandonment Report (WAR -97)
If you have any questions, please contact me at ext. 2157.
ABS:cj
encl.
1V
TAB(. 17
mi ll `s
LANDS NOW OR FORMERLY OF �•�
LEWAS
WITH OFFICE OF LIBER 588 PAGE 413 \
LOT 17, MAP NO, 815'
' �246f1icFTTO � ��
:.IIl1WN NN 1lIF TO 50
WN `� PARTW2a5L44F
i KI.C(IRDE U AND /OR I1N- b
{N;. l- ASFMENTS, R1f,HT- GARDENt ; %� �•• �� � �� ® � � c
Jf. 112' TROD AND AND �..-`� N2703WOF 311.14'
t /2' LRDD•
BY A POINT Of REFERENCE, PLASTIC CAP SET PLASTIC CAP SET
ENCROACHMENTS, IF ANY, _ .� NO PHYSICAL BCUNDS
OFFSETS SHOWN ARE AT �l t LANDS NOW OR FORMFRLI
�--- WOODED CAAT"ESSA
ON THE SITE MAY NOT BE LIBER 685 PACE 894
CWH srmy r AREA LOT; 56, MAP ND. 815A
B IN THE PUTNAM COUNTY O DHEZLAG
1S MAP NO. 815. �2 It s\ SJ'2�0
=D IN THE PUTNAM COUNTY fir•
3/4' I -PIPE �R11'£1✓AY � �CgME vS'�D
FOUND Pr) , . AREA I,j PROPERTY tiNC 1.
FPARED FOR g; J0 oS% e
N
>. 000 ACRES o LPIPE
ELLIOTT �^ FDUND
OF PUTNAM VALLEY !` LOT,fd� MAPAKJ 815 ,1 ffu
NEW YORK $ As
,/UL Y?$ A'� 1/2' LRDD 3. ` uya �J LANDS NOW
,tpO/ARl�FORMERI. Y
FOUND ��r NO PHYSICAL BOUNDS ., CPV7ItYv
eE T - -15f11 ,
S21-PM �W 3J11�f l �D�oDD LDTB 55, 6 AP NO. PAGE
nd9
ru `� \�S
' LANDS NOW OR FORMERLY OF
tLBY CERTIFY IN MY o� rf�Gilrlla I:OtCf1�;y Lt3ptit! CZ;Uiti11Z UT � �,pvE 72 -
RTIES LISTED BELOW U.PDLE -, Aviaion of Environmkital Heal
OF AN ACTUAL FIELD T ��PP�POfi®. 815
1996 AND COMPLIES o
/EYS EXCEPTED BY c Ipproved as noted for conformance With 7111E IMCK,•
F LAND SURVEYORS. rn pp gulations of the ISSUED BY STEWART TITLE INSURANCE COMPANY, DATED JULY 23, 1996
wlTF1 TITLE TO THE � Applicable Rules and $e
l (+ t It spa rtmenta AS TITLE NUMBER 96A 6733 - P.
SURYEr09. 1
iL'1't+PANY 496 -3367
DAPAM Rtutz�� ,f• Tfi.t7, f
THE ALTERATION N THIS SURVEY MAP BY
MCA&
,, NTHONY A.
(//]// �
IS Y MISLEADING. CONFUSING NOD NOT IN THE
- �•'l�CKJI , ONLY COPIES FROM THE ORIGINAL OF THIS GENERAL WELFARE AND BENEFIT OF THE ORACE, P.L.S.
LL �lf SURVEY. MARKCO WITH N ORIGINAL LAND PUBLIC. I1 IS A V[OLAIInN OF SECTION �zD9. PROFESSIONAL LAND SURVEYOR
V! ANTHONY A. SD ACE, P.L.S. LIC. No. 56187 SURVEYORS RAISED EMPOSSED SEAT. SHALL SUB - DIVISION 2, OF n¢ NEW YORK STATF. NEW wM� �w YORK - 12553
'
BE CONSIDERED In BI'. vAuD IR11E COP1L;, F.DUCA1111N LAW, --
-._ - -� - (fl 19'I6 BY ANhAIN'f A \(IHAI I, I'1
f
a111M E;fAW.t;IITD
LANDS NOW OR FORMERLY OF LEWIS ` '�' �-
VI III T]FF ICE OF '
LIBER 5 t
E 413
i LOT 17, MAP NO. 815 ((( a
5Q' A7245/ FT TO
SIIIIWN UN THE TOWN -__t PAR7f,dCWLAAE
r kh'(1RDEU AND /OR UN- GARDEN . 0, � �®
44%. I-ASEMENIS, RIGHT-
JY.
112' IC AND S p�O7 •'ail F 014114f 1/2' LROD, AND
11r A POINT OF REFERENCE, PLASTIC CAP SET �Y PLASTIC GAP SET
'ENCROACHMENTS, IF ANY, ^
R NO PHYSICAL BOUNDS
OFFSETS SHOWN ARE AT l LANDS NOW OR FORMFRL'
ON THE SITE MAY NOT BE m 4 ,' WOODED - CANTAA9ESSA
LIBER 685 PAGE 894
~ rCNE S70?Y AREA LOT 56, MAP NO. 815A
R9AME �T� "
D IN THE PUTNAM COUNTY ® � !( �y �a��
IS MAP NO. 815.
:D IN THE PUTNAM COUNTY NO. 42
�r �P.{� [,gyp
3/4 FOUNDPE DRIVE4AY AREA
,a VSLI
...,,��� 4 F PROPERTY LiNC
50AHED FO/9 000 A CRES
�bmL�O® �i A l l.P[PE
FOUND
zori4 m4PA14'�t 8X5 ,'
9FPU7JlG4M YALI-EY
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vu AM T`: S LANDS: NOV OR FORMERLY
1!2' I.RUD .23• ura
Ind - 150 • FOUND �ti ND PHYSICAL BOUNDS c•v7AYv
✓ L16ER 689 PAGE 31
EE I / } i aJ2%7t�3W W 311.V 1 �UUriroOD LOT 55, MAP N0. 815A
s,
Iu
ri
o P91 AAA
m �� o ® a
ru p LANDS NOW OR FORMERLY OF c
''EBY CERTIFY IN MY g/ ruwxaiu VounTy Lej�atrl:mratat uI aL (ya F
ZTIES LISTED BELOW U.POLE -, A.vieidn of Environmental RealthpES.ektV18W 272 -
OF AN ACTUAL FIELD o LOT 19, MAP NO. 815
1996 AND COMPLIES v
JEYS EXCEPTED BY c Approved as noted for oonformanoe with 7771E PgCICY
LAND SURVEYORS. _ applicable gales and Regulations of the
WITH TITLE TO THE ISSUED BY STEWART TITLE INSURANCE COMPANY, DATED JULY 23, 1996
`
Putfilm C t It , Departmentm AS TITLE NUMBER 96A � 6733 - P.
SUN6�i'A19. j 8 f ' csw� 496-3367
:OAPavr
OA40AN = 4.�tm.t1 ra A Tit �.� �" (�� n�(
// �f ANY AL {£RATION OF I E SURVEY MAP 8Y 1 `YTHVI `1Y A.
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as
APPENDYX E
Date
RE: Department of Health Review of Proposed
Sewage Treatment System for Property
Name. 1 IU f
Address: 6 nv V .Cs qe,. d �
La
v Tax Ma #: �-�
Dear JJ 17
�Please' beL Ovised-.04t."an application fora Construction Permit relative to the_construction.of a
a zand/or well proposed for the ca `oned ro has been made to the �utnaii'Counf
P Po P P Pte' Y "
°aartment of Health. Attached please find a copy of the latest site plan.
you have any questions, concerns or information which may bear on the Health Department's
.;view of this application, you may call the Health Department at (914) 278-6130.
Very truly yours,
By: LOm 4- a ✓ , , h n,t
Title: L!(�t 6 Wag_
Received By:
Address:
Tax Map #:
I.
August, 1999
AppndxE
S/b:d S89882S6:01 i26L- 8L2 -9te 18830 AiNrM WUNIr*d:WOU SEs80 T002 -02 -9nu
SHERLITA AMLER, MD, MS, FAAP
Commissioner ofHgalth _...._....
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
DEPARTMENT
OF HEALTH
1 Geneva Road, Brewster, New York 1009
ROBERT J. BONDI
CounlY., secutiv
ROBER V IS, PE
Director of nMental Health
ADDITION APPLICATION RESIDENTIAL ONLY
STREET ` L SU pYl�(/C T l TOWN WT A((EI TAX MAP#7q •) - ) -
NAME. E, `� (,O-FT- PHONE_ YLK ytoa I I PCHD#
MAILING
ADDRESS �T-v2Yn£(/L8
DESCRIPTION O LL--
ADDITION
� 4
NUMBER OF EXISTING BEDROOMS _5 ' PROPOSED # OF BEDROOMS J
(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.,. I Geneva Rd, _
Brewster', -NY' '10-5'09; Ph6ne (845)27 8_'613 0.- -
1. Certified check or money order for $106.00.
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
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
3 •i A.
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health.
DEPARTMENT .OF HEALTH
1 Geneva Road, Brewster, New York 10509
Town Legal Bedroom Count
Re: ELL-1 off'
-ROBERT-1- BON DI
County Executive
(Owner's Name)
Tax Map #:
Address: 42- SOnge s6T L. w_ c
Town: `P Lt M AAN VALL -611
Year Built:
Accordi to records maintained by the Town, the above noted dwelling,
is- 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: j 1` �L�Y(r 7L AA2
_ � O
Building Inspector 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
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
Mr. Elliott
42 Somerset Lane
Putnam Valley, NY 10579
Dear Mr. Elliott:
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Re:
ROBERT J. BONDI
County Executive
ROBERT MORRIS, PE a
Director of Environmental Health
June 10, 2008
Addition — A- 101 -08
42 Somerset Lane
(T) Putnam Valley, TM # 74.17 -1 -15
I have received and reviewed the plans for the proposed addition to the above mentioned
residence. Based on the information submitted, the above mentioned addition cannot be
approved for the following reasons:
1. The legal bedroom count for the dwelling is three. The potential bedroom count of your
proposed addition is four. The proposed room titled playroom is considered a potential
bedroom.
The-add tioin -of apotential- -bedroom requires t hi -s.DPpartrnent's_approVal. :of. arevised _:
septic system plan from a professional engineer
Please review the proposed floor plan to reflect no more than three potential bedrooms, or have a
professional engineer or registered architect design a sub - surface sewage treatment system
meeting present code requirements for four bedrooms.
GDR:kly
Sincerely,
Gene D. Reed
Sr. Environmental Engineering Aide
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
i b
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
Mr. Elliott
42 Somerset Lane
Putnam Valley, NY 10579
Dear Mr. Elliott:
ROBERT J. BONDI
County Executive
ROBERT MORRIS, PE
Director of Environmental Health
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
July 3, 2008
Re: Addition- A- 101 -08
No Increase in Number of Bedrooms
42 Somerset Lane
(T) Putnam Valley, T.M. # 74.17 -1 -15
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 July 2, 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
maintained.
plumbiilg`fixttlres must be updated with water saving devices, i.e.; ,new 11ow 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 (845) 278 -6130, ext. 2261.
Sincerely,,
Gene D. Reed
Senior Engineering Aide
GDR:kly
cc: BI, (T) Putnam Valley
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
*"
Public Health Director
Thomas Elliott
42 Somerset Lane
Putnam Valley NY 10579
Dear Mr. Elliott:
Associate Public Health Director
Director of Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921
Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085
Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648
WIC (914) 278 - 6678 Fax (914) 278 - 6085
May 5, 1999
Re: Addition- Elliott- Somerset Lane
No increases in Number of Bedrooms
(T) Putnam Valley Tax 4 74.17 -1 -15
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 May 5 1999 The addition is approved with the following
conditions.
1. The total number of bedrooms must remain at T ee without prior approval by
this .department.
2. The. area of the existing,sewage.disposal system, and its expansion area, must be
malntalned:
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 Valley.
If you have any questions, please contact me at your convenience.
ML:kg
cc: BI
Very truly yours,
Michael Luke
Public Health Technician
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— — — — — — — — — — — — — — — — — — — — — — —
PUTNAM COUINTY DEPART'. ENT OF HEALTH
HOUSE PLANS APPROVED FOR
BEDROOM COUNT ONLY;
BEDROOMS
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Signature & Title ate
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DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road
Brewster, New York i0509
Tel. (914) 278-6130 Fax (914) 278-7921
PROPOSED ADDITION APPLICATION (RESIDENTIAL ONLY)
BRUCE R. FOLEY
Public :Health . Direc't'or
STREET `( Z Sc , Pf s -L " L" TOWN P, y • TX MAP # %t(- 17 _ / - / s^
NAME
MAILING ADDRESS
041 PHONE S z a S6 P CHD #/ -2 ,` —?'7
DESCRIPTION OF ADDITION Z �(O '" �' `' �� ✓\° ° ^^ S
NUMBER OF EXISTING BEDROOMS PROPOSED # OF BEDROOMS 3
(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 dorm and the following to Putnam Coiirity Health Dept., '4 Geneva Rd:;
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.
OFFICE USE
Comments
Feb 98
mil. Ac il,a, F'ublrc.'';11r�alth!;'Uur.; rte.., :.
9 e
PUTNAM COUNTY DEPARTMENT OF HEALTH -
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
IN\TITIAL INDIVUDAL ADDITION/REPAIR FORM
SECTION A: GENERAL INFORMATION
Name of Project 7 Sam -sew T TM#
Year of Construction Size of Parcel
SECTION 'B. TOPOGRAPHY (Please check all appropriate boxes)
1. M ily ❑Rolling ❑Steep Slope L- Gentle Slope ❑Flat
2. ❑Evidence of wetland []Low area subject to flooding ❑Bodies of water
❑Drainage ditches ❑Rock outcrop
YES NO
3.
Property lines evident?
P Y
4.' Water courses exist on or adjacent to parcel: ❑ Ly'
5. Existing individual wells within 200ft of the existing SSTS? ❑ ❑
SECTION C. EXISTING SUBSURFACE SEWAGE TREATMENT SYSTEM(SSTS)
1. Physical character of existing SSTS area.
A. ❑Level Gentle Sloe ❑Steep slope
B. ❑Well drained Moderately well drained
❑Somewhat poorly drained ❑Poorly drained
C. Area available for SSTS. (Primary & Reserve)
❑Extremely limited L1Somewhat limited ❑Adequate _ft x ft
D. INSPECTION Date IAM—' Inspector. /77_
No e� idence of failure ®Evidence of failure ®Evidence of seasonal failure
S�
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------==----------------=---==---==--==--=------ ------==-------- - - - - -- - -- - - -- -- - - - - --
(Indicate North)
10
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------------------------------------------------------------------------------=----------- - - - - --
(1) Indicate location of SSTS
A. Size and type of septic tank gallons
[I'Metal ®Concrete CIPlastic
B. Type of absorption area
1. Fields ft. 2. Pits 3. Gallies ft.
(2) Indicate setbacks, front street, backyard, and side yard dimensions
(3) Show location of well
(4) Show location of driveway
(5) Note physical features (steep slopes, rock outcrops, streams /wetlands)
SECTION E. EXISTING WATER SUPPLY
CIPWS 13 Shared well Individual well
M/Drilled ® 0-Casincy above ground
C0V24ENTS :
REPAIRS ONLY:
As Built. Inspection Required:
Status:
As Built Submitted:
As Built Inspection Done: Inspector:
BEAR/NG BA6S-
NORTH ORIMIAT)DN IS BASED ON DATUM ESTABLISHED
FROM DEED OF RECORD.
DEEO OF/LcW)?O,
BEING LIVER 1314 PAGE 125 FILED WITH OFFICE OF
THE PUTNAM COUNTY CLERK.
TA X L O T O ES/ C+� V A T/ O/ 1�
SECTION 74.17, BLOCK L LOT IS AS SHOWN ON TT$ TOWN
PUTNAM VALLEY TAX MAPS.
aSWWAL MARIW7ES-
L THIS SURVEY IS SUBJECT 10 ANY RECORDED AND /OR UN-
RECORDED COVENANTS, RESTRICIIONS, CASEMENTS, RIGHT -
OF-WAYS, AND AGREEMENTS, IF ANY,
2. UNLCSS ILLUSTRATED AND NOTED BY A POINT OF REFERENCE,
UNDERGROUND IMPROVEMENTS OR ENCROACHMENIS, IF ANY,
ARE NOT SHOWN HEREON.
3. ALL BUILDING AND IMPROVEMENT OFFSETS SHOWN ARE AT
RIGHT ANGLES TO PROPERTY LINES.
4. ALL HEDGES AND GROUND COVER ON THE SITE,NAY NOT BE
SHOWN ON THIS SURVEY.
1. 'SECTION A. PUTNAM ACRES -, FILED IN THE PUTNAM COUNTY
CLERKS OFFICE ON JUNE 4, 1957 AS HAP NO. 815.
2. 'SECTION B, PUTNAM ACRES', FILED IN THE PUTNAN COUNTY
CLERKS OFFICE AS MAP NO. 815A.
3/4' 1.1
LAND SWVEYPREPARED FOR
THOMAS ELLIOTT
LOCATED /N 7NE TOWN OFAM" YALLEY
HI MAY COUNTY NEW YORK
WALE r- SO' .94 420,, ,sue
SCALC IN FEET
ti•
CE9 17R OAT,0V;
L ANTHONY A. SORACE, P.LS„ DO HEREBY CERTIFY IN NY
PROFESSIONAL OPINION ONLY TO PARTIES LISTED BELOW
THAT THIS SURVEY IS THE RESULT OF AN ACTUAL FIELD
SURVEY COMPLEIED ON JULY 27, 1996 AND COMPLIES
WITH MINIMUM STANDARDS FOR SURVEYS EXCEPTED BY
NEW YORK STATE ASSOCIATION Of LAND SURVEYORS.
THIS CERTIFICAI)ON DOES NOT RUN WITH TITLE TO THE
LAND.
• 77ltaS/AS E.ZGbTT
• VEWART MWAMM440FCY.'WAW
• tn9V7B9 ~A&W 424QFCO °AM;
/75 �AACIORA
SURklEYNo. 964.9 -18
Sl/RYEYGf4.
0
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IIIC CAP,SLT
LANDS NOW DR FORMERLY
CfiN %it{ EZ4
LOSER 685 PAGE 894
LOT 56, MAP Na 815A
LANDS NOW QR FOR4ERLY
CAS
LIVER 689 PAGE 31
LOT 55, NAP N0. 815A
717L POLV'Y
ISSUES BY STEWART TITLE INSURANCE COMPANY, DATED JULY 0, 1996
AS TITLE NUHBCR 96A - 6773 - P.
(914) 496 3367
ll[ AL IERAImIi O' 7103 SL4VEY NM BY
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ANTHONY A. SORACE, P.L.S. LTC. No. 50)87 SURWIMS RAISED ONFOSSC0 SUAL Wit
K COMUCRED lb DE VALID ERLC CUPICS.
SUB- DIV(SIEM t ff IN( IIEV YMV VKIC
EDUCAIIOI LAW,
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