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631- 589 -8100
91.27 -1 -22
BOX 36
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BRUCE R. FOLEY, R.S.
Acting Public Health D:,-e „_
DEPARTS E-IN T OF HEALTH
Division Oi Environ-mental Health Services
4 Geneva Road, 6rewster, New York 10509
(914) 278 -6130
P-R'*QPvS =D A-2DITION) APPLICAT ION _ (R_SIDENTIA!
STRHT 3 1''Inc"� TOW; [KQ 9e0- Tx r ,P T .
/
'AME: ®aq e I azy) it't t ��`�1� P� 0 \= �l �i 50"� ��� i PCHD PERMIT r yo
ADDRESS ► nchl,�he
Description of addition
P:uimber of existing bedrooms Proposed number of bedrooms
from Certificate of Occupancy or
Certification'frcn Buildin_ Inspector -
ny addition which is considered a bedj.rcc,,, 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 PUTWAN COUM Y hEA_TH.DEPA9TMcNT,.
^. G „��1� .ROAD; _�R'MSTER P:,:.:105 3:, P. oo ,_ 278 -5130 �r-itn - the 'TO I-lowing information.
1. Certified Check for $100.00.
a2. Sketch of existing fioo- plan (all living area including basement, if any)
Non- professional dravring is acceptable.
3. Sketch of proposed floor plan .i \\
Ron professional drawing is acceptable
4. 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 free Torn or Certification f rom Building
Department of legal bedroom count of dwelling.
OFFICE USE
Comments and /or conditions
application
August 1995
July 1996 (Revised)
1
BRUCE -,9. FOLEY,
' � `Public Health Dr'reclor
DEPARTMENT OF HEALTH
Division of Environmental. Health Services .
4 Geneva Road
;Brewster, New York 10509
Tel. 914) 27'8-6130 Fax (914) 278 - 7921
August 12, 1998
Dave and Karen Miller
3 Finch Lane
Lake Peekskill NY 10566
Re: Addition - Miller, Finch Lane
Increase in Number of Bedrooms
(T) Putnam Valley, TM# 91.27 -1 -22
Dear Mr. and Mrs. Miller:
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
August 11, 1998 and this Department's approval stamp.
Based on the information submitted, the above mentioned addition is approved with the following
conditions:
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.
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:tn .
cc: BI (T)
Very truly yours,
William Hedges
Sr. Public Health Sanitarian
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: 1,1,4
R sidence
Tax Map 10-7
Town
BRUCE R. FOLEY, R.S.
Acting Public Health Director
According to records maintained by the Town, the above noted dwelling
•.�._; .. ._.,. - -.. .. ._..<. -... _...•.. ..,.,, .. �. ..r,a ..... ,r, .::... .. .., .. .�� _ ....... .. .. � -.�._ .. .. .. ....... .. v ..fin.... ,.h
IS NOT
in compliance wit T \vn code and the total number of bedrooms on record
is —7� 0 2
This information has been obtained from:
CERTIFICATE OF OCCUPANCY:
a
ASSESSORS RECORD:
OTHER --
Buildin nspector
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PUTNAM COUNTY DEPARTMENT OF HEALTH
MUSE PLANS APPROVED FOR
BEDROOM COUNT ONLY;
49,BEDROOMS
Signature & Title //Ilaie
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PUTNAM COUNTY DEPAR J '
MENT OF HEALTH
ROUSE PLANS'APPROVED FOR
BEDROOM -COU14T ONLY;
,2s.3EDR
Signature &Title D e
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OF HEALTH
HOW- PLANS
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DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road
1,Brewster, New York 10509
Tel. 914) 278 - 6130 Fax (914) 278 - 7921
August 12, 1998
Dave and Karen Miller
3 Finch Lane
Lake Peekskill NY 10566
Re: Addition - Miller, Finch Lane
Increase in Number of Bedrooms
(T) Putnam Valley, TM# 91.27 -1 -22
Dear Mr. and Mrs. Miller:
BRUCE_R. FOLEY
Public Health Director
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
August 11, 1998 and this Department's approval stamp.
Based on the information submitted, the above mentioned addition is approved with the following
conditions:
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.
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.
Very truly yours,
William Hedges
Sr. Public Health Sanitarian
WHAn
cc: BI (T)
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PUTNAM COUNTY DEPARTMENT DF HEALTH
HOUSE PLANS APPROVED FOR
BEDROOM COUNT ONLY;
,2.-BEDROOMS "�o
Olr'iluUul "C a 111.1--
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PUTNAM COUNTY DEPARTMENT OF HEALTH
HOUSE PLANS APPROVED FOR
BEDROOM COUNT ONLY;
13EDROOMS7 ill
Signature &Title
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Certifications hereon are valid
for Bank,
SURVEY OF PROPERTY
SURVEYED: _pF
Title Co. B Owners for this
transaction
FOR
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Poach
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transferable to
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subsequent Bank, Title Co.jor
Owners.
BROUGHT TO DATE
HOWARD /���T
'
All certifications hereon are valid for this
map and copies thereof only if said map or
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copies bear the impressed Iseal of the sur-
/ STOeY f2usE�
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/OWN (fir RiiA/.iN.' YAClEi'
1 NORTHRIDGE ROAD
"It is hereby ertified thatjthis survey as
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PLl7 -NAM COUNTY
PEEKSKILL. N. Y.
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prepared in accordance with the existing
NEW YORK
4 ,/' , Ae. e ,
Code of Practice for Land Surveys adopted
by the New York State Association of Pro.
d F. E. & L. S. NYS LIC. NO. 027646
fessional Land Surveyors." }
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Certifications hereon are valid
for Bank,
SURVEY OF PROPERTY
SURVEYED: _pF
Title Co. B Owners for this
transaction
FOR
-
BROUGHT TO DATE
only. Certifications are notl
transferable to
..
subsequent Bank, Title Co.jor
Owners.
BROUGHT TO DATE
HOWARD /���T
'
All certifications hereon are valid for this
map and copies thereof only if said map or
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TM l-B-'7 - A - 3
JOHN SALVATORE ROMEO
copies bear the impressed Iseal of the sur-
SITUATE IN THE
l:oniulhng Eiigincn b' Land Surveyor
veyor wh'ose'signature appears 6reon:
" ,: •.� ... , .•
/OWN (fir RiiA/.iN.' YAClEi'
1 NORTHRIDGE ROAD
"It is hereby ertified thatjthis survey as
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PLl7 -NAM COUNTY
PEEKSKILL. N. Y.
,A /�
prepared in accordance with the existing
NEW YORK
4 ,/' , Ae. e ,
Code of Practice for Land Surveys adopted
by the New York State Association of Pro.
d F. E. & L. S. NYS LIC. NO. 027646
fessional Land Surveyors." }
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REVISIONS .. ,.:
SPECIAL IXSTRKT INFORIMT,ON ' ' � � � LEGEND
' FOR TA%PURPOSES ONLY -. ..
° ::I — = - -- ,,. �.[ —._ K� _ m PRELIMINARY
sEuxD 1oN fO YtrANC6 ln.,...... -- i •.c a =' TOWN ' OF PUTNPM VALIEX z
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.13
DIVISION :OF- 'ENVIRONMENTAL'HEALTH SERVICES_
John M. Simmons- M.D.:
,F
Deputy Caninissioner of Health -: FIELQ ACTIVITY, REPORT -Sheet l of-, . l
INSPBCTION
Orig: Routine
Orig.' •Complain:
ADDRESS Orig:;Request
TM ance
No. Street ° : Town CaVIi : No _
- F Ccmpiaint Camp
MAILING ADDRESS / 4: 7%`7 Final°
P O. Box Post Office Zip Code roup,Illness
:struction
- - .
TELEPFIC�IE
:> -
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Renspe_ction
y.PERSON IN CHARGE= Field, Samping'Only
v
OR=INTF.EtVIEWED Y , Field Conference
_ - Name and Title
Other
FACILITY
.DATE TYPE -'
TIME ARRIVED ; :Q TIME LEFT _ bcpl ain
FINDIAIGS: x.
>' � '` �✓��� ��1��`G-� %mom ``�" �_�.��� -
,� /�� _
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INSPECTOR: TELEPHCINE. rZ!
g - Tide 3 = F
Si a and
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PERSON IN CMRGE -OR INTERVIE�rVED:
>:I acknowledge this° Fiel Activity Report. °- SIGN,TtAZEs
6/86+ TITLE: x E
L)Cr?1RIIV►uvi . vi I ILr%LII I
: Division Of Environmental Huh Services
TWO COUNTY CENTER — CARMEL, N.Y.. 10512 (914) 225 -3641 _
_ �... �. APPLICATI.ON, TO_ CJNSTRUCT-:=A. WATER:;WEL•Ln = ; =:�::. �: .: s , .• r ....., �:
WELL LOCATION
A, 5
ioww VILLAGE /GIIY , . IAX GRiU NLIM8EA.
.�"r
r
WELL OWNER
N km R .
W
AOOR s:
�- �" l( ;,�,;�v
f, PSIVATI:
❑ EUSLIC
USE OF WELL
RESIDENTIAL
❑ PUBLIC SUPPLY ❑ AIR/CONO. /HEAT PUMP ❑ ABANDONED
1 -- primary
❑ BUSINESS
❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify)
2 - secondary
❑ INDUSTRIAL
❑ INSTITUTIONAL ❑ aTANO -BY ❑
MOUNT OF USE
YIELD SOUGHT — gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE T gal.
REASON FOR
❑ NEW SUPPLY
❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION
GRILLING
�kgEPLACE EXISTING SUPPLY DEEPEN EXISTING WELL
WELL TYPE
DRILLED.
DRIVEN E] DUG GRAVEL E] OTHER
IS WELL SITE SUBJECT TO.FLOODING? YES /i NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: 0
LOT NO -:
WATER WELL CONTRACTOR: Name
4t -ft%lP Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE:. — YES _ NO S *lce#� L
NAME OF PUBLIC-WATER SUPPLY. s1� TOWiN /V /C
DISTANCE TO PROPERTY FROM N-EAREST WATER..MAIN
LOCATION SKETCH & SOURCES OF CONTAMINATION
;v
dat) (signature)
PERMIT "
TO CONSTRUCT A WATER WELL
This permit to construct one water well asset 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: Gfll� 19
ermit I suing Official
Permit. is .Non - Transferrable
DAVID D. BRUEN
County Executive
c� /C
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
September 15, 1986
Howard B. Gragert
Box 11, RD #2
Putnam Valley, New York 10.579
Dear Mr. Gragert:
JOHN SIMMONS, M.D.
Deputy Commissioner
Re: Proposed Well Construction
Application #W -30 -86 -
Review of the above captioned application has been completed
Additional information or clarification is required as checked
below:
1. A detailed reason for drilling the well is required.
A short narrative is required. For what purpose will
the well be used, i.e., drinking, lawn watering, etc.
2e. Is.the site presently served by a well? Explain.
3. Is the site presently served by a sewage disposal system.)
Explain.
4. Is the present structure to be reconstructed: Expanded?
How?
5. A sketch showing the location of:
- the proposed well
- the existing sewage system on this parcel
- the existing house on this parcel
- existing sewage systems and wells on. adjacent parcels
within 200, feet of the proposed well
- all of the above is not provided
.Upon receipt of the above infl
considered further.
JK;pt
cc:Bldg. Inspector
TWO COUNTY CENTFR
Environmental Health Services
DAVID D. BRUEN
County Executive
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
September 15, 1986
Howard B. Gragert
Box 11, RD #2
Putnam Valley, New York 10579
Dear Mr. Gragert:
JOHN SIMMONS. M.D.
Deputy Commissioner
Re: Proposed Well Construction
Application #W -30 -86
Review of the above captioned application has been completed
Additional information or clarification is required as checked
below:
1. A detailed reason for drilling the well is required.
A short narrative is required. For what purpose will
the well be used, i.e., drinking, lawn watering, etc.
2.` Is the site' presently served by a well? Explain."'
3. Is the site presently served by a sewage disposal system?
Explain.
4. Is the present structure to be reconstructed: Expanded?
How?
5. A sketch showing the location of:
- the proposed well
- the existing sewage system on this parcel
- the existing house on this parcel
- existing sewage systems and wells on. adjacent parcels
within 200 feet of the proposed well
- all of the above is not provided
Upon receipt of the above informa io this application wil
considered further.
in tr 1 y u
Kar , .ector,
JK :pt Environmental Health Services
cc:Bldg. Inspector