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HomeMy WebLinkAbout4108DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.73-1-33 BOX 31 05 I-J PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES �-- �J - ✓ APPLICATION TO CONSTRUCT A WATER WELL please print or type PGPer Well Location Street Address: Tow illage: Tax Map # Map Block Lot(s) Well Owner: Name: Address: / /e Alt Phone M ;� e Use of Well: t -Resid ntial _Public Suppl 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. Replace Existing Supply Test/Observation Additional Supply Reason for Drilling New Supply (new dwelling) :4ZDeepen Existing Well Detailed Reason C, ' Fe- for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ....................................................... ............................... Yes . No Is well located in a realty subdivision? ........................................... ............................... Yes _ Nom Name of subdivision Lot No. Water Well Contractor: Address. t." &-y-4 e CS it Is Public Water Supply available on site? ....................................... ............................... 1yes _ NoLLLC�s 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. pp�"� Date:: .IQ ._ . , 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 Countv Health Deoartmei 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 Commissioner of Health. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue It/ 311J- Permit suing Official: Date-of Expiration )1/ /1 �- Title: 4-1n, Permit is Non - Transferable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -9T Rev. 3/06 _ SHERLIITA E61VII..ER, MID, MS, FAAP �-� �•= •' t ;`birirnssiorrtrriifNz'Ea�`e�'t ...:�::_... •.•• .;.. ]LORE'II I'A MO LIINARI, RN, MSN Associate Commissioner of Health January 12, 2005 Tasche & Laurie Pietris 61 Tanglewylde Road Lake Peekskill, NY 10537 Dear Mr. and Mrs. Pietris: DEPARTMENT" OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT 3. II ®N ®I Re: Addition — Approval - Pietris No Increase in Number of Bedrooms 55 Tanglewylde Road (T) Putnam Valley, T.M. 83.73 -1 -33 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 the Department dated January 11, 2006. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at two without prior approval by this . Department. the- existing sewa g? disposal- systems:nnud' ts._expan.siorrareµ - m.ust 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.). 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 your convenience. Ve truly yours seph S. Paravati Jr. Assistant Public Health Engineer JSP:cw cc: Building Inspector, (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 r SHERLITA AMLER, MD, MS, FAAP _ Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health U C ROBERT J. BONDI I County F,xecutfve DEPARTMENT OF HEALTH �;� L 1 Geneva Road, Brewster, New York 10509 I /a6 ADDITION APPLICATION RESIDENTIAL ONLY STREET55 IW\qkW/ j j&t. I J TOWN PLtAV1Q� V�I(CTAX MAP#9'3, q3— 1-33 NAME 1664\e - 1-LaU.n-C j I '6Jr15 PHO k'i (aql -C 3 PCHD# 0J .. MAILING ADDRESS L K. A-W, Sfcr l ( 10 DESCRIPTION QF n ADDITION 1C�� 5� d(3r�nfC (V\Q 0,M tirl ov-\01 I OQr SpaQ) NUMBER OF EXISTING BEDROOMS_,l 0 PROPOSED # OF BEDROOMS (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPE TOR) "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., 1 Geneva B`revvster;_ - f0509;- Phone:($45) "278 =6130. ...�- ......Q� _.. 1. Certified check or money order for $100.00. 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 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 SHERLITA AMLER, MID, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 PUTNAM COUNTY DEPT. OF HEALTH 1 GENEVA ROAD BREWSTER, NY 10509 To Whom It May Concern: ROBERT J. BONIDI County Executive Re: Residence TAX MAP# 6 3•-) 3` TOWN PLMAM-V-4��Ll According to records maintained by the Town, the above noted dwelling, -C-OMID L,IANICE WIri-'I'& TOWN. CODE. IS NOT IN COMPLIANCE WITH TOWN CODE (LEGAL, BEDROOM COUNT IS 2, � This information has been obtained from: CERTIFICATE OF OCCUPANCY: Pt-- tJ OTHER: .bpft Building Inspector f 21 Date CERTIFICATE OF OCCUPANCY Water Su lm PP1Y Section (845) 225 -5186 Fax (845) 225 -5418 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 NSW. � w �. shed � � �e�' MEN! IN A C) 3c) J(&X\a-tfovi la � y (so, to it kr?T PutlL is "all Z4' MEN! IN A C) 3c) J(&X\a-tfovi la � y (so, to it kr?T PutlL �� ������ ���L��� i 34-L 0' I� i I � I 6• is ,¢ � �4„ 7 =10' g' Z �� 6„ i S,o 9 X egZ4 4 —LC ! ' ' -w • II.I, I � - _� i �• I c o " I m Ac 7 o I' UZ t 2 it I � � � v � '� = C��'_'� "•� " � _�' .. . e , . , •. ^irk Y;� tv b \ J \V \ 1 �Q • ( 1 # 114 t i c I 4" -' /1-' 4 6 n � s �. PUTNAM COUNTY DEPARTMENT OF HEALTH - ...... �. c �" HOUSE PLANS APPP,OVED FOR BEDROOM COUNT ONLY, ITEDZOnIHS 33 L � - 1L ; :N 1 1 ti TG' \IA TF.? ATIOF S 1A TIME HOUSE pI IiE H S .. . -.._. _ .• .._ , ... j �' P N � DL IGNATURE & TITLE DnTF y C0� 3G� h�3lSJc�d � � -a.Srp,� �p �� c } �. � to - ► NMAP VI cv, ��� r� I D I . r � 3� , . ^':' ': rala�s rw:.�iYrscp -s3. �f,^ --•.� z n • - ' CRRTIFRCATE.. 01? OCCUPAKCY Addition /Alteration Gertifica>*e of-- OccuQancy.Io. 42 ®279 4�pplic�tion 'RTo. 92 °836 X {`cat>on; -of Premises 55.Tan lew lde Road o'M,#83073m1-33 :;: 4 ' Ta la�& i� e. Petri .' ®�61. Teti le ylde. Rdo Lake PeekskiU.NX , ham .. .. ........ ..... ............:... ... ........... heretofore filed ,an a plication, fora buildin& p0mit pursuant to the Zoning Ordinance, Sanitary �f - C6d'e and the Yaws., effect i><i -the To*n of Putnam 'Valley, Putnam County, l�Tew: York," having r rA " paid the required. therefor and the undersigned having by personal inspection ascertained that �. "thekepplicant has subsequently proceeded with the erection or improvement of the ,,proposed struc- . tui aa,_ compliance with, the requirements of .the laws as aforeriientioned and , that, the.. said work and: materials met every requirement of the laws as aforementioned 'aad iliat' the premises have now been fully completed and are read for occupancy pursuant to the, provisions, of law, Now, therefore, this certificate of. occupancy as hereby issued under the seal of the Town of Putnam. Valley this ..... ...... day of ....... JNiy ...................... ip.. 92 Not valid unless signed in. ink )y a duly au ore agent I DWK ® NEW , RK �BEY of 6 d under the seal of the . Town of Putnam Valley. By......................................... ®: DRUMS DSTSCTOR:. -2 CARLOS E.L$C -INC. 3 HUDSON STREET 1ARRYTOWN, NY, 10591 _.._ <... 1 �P" ��� LTC. @.33635 GENERAL MANAGER certificate must not,b.e_oltered_ n ony.monner; return to,_the, office, oftthe Board -if, 196 Per Inspectors- moy be. identified by •their - credentiols.- COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.. TOTAL Rev. 1 /a5 uzs y �P 2. 40 G E . or 1 rE } e 3' Q 1 5. 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