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BRUCE R. FOLEY, R.S.
Acting Public Health Director
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
ADDITION APPLICATION - (RESIDENTIAL ONLY
STREET: TOWN
/0 MAP #.
rTX
NAME: "S/Z//.G -�-�;� J ��� PHONE 97 '�3�9 PCHD PERMIT #
MAILING ADDRESS
Description of Addition 1 �4) i /zz
'dle,
Number of existing bedrooms Proposed number of bedrooms
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 DEPARTMENT,
4 GENEVA ROAD, BREWSTER, NY 10509, Phone 278 -6130 with the following information.
1. Certified Check for $100.00.
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.
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.
OFFICE • USE
Comments and /or conditions
application
August 1995
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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
Re:
esidence
BRUCE R. FOLEY, P.S.
Acting Public Health Director
Tax Map
Town �,✓
Gentlemen:
According to records maintained by the ToNNrn, the above noted dwelling
IS
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:
ASSESSORS RECORD:
OTHER
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BRUCE R. FOLEY
Acting Public Health Director
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road
Brewster, New York 10509
Tel. (914) 278-6130 Fax (914) 278-7921.
June 23, 1997
Janet Cassidy Stroh
Crossroad r
Patterson, NY 12563
Re: Addition - Cassidy Stroh
Cross Road
No increase in number of
bedrooms (T) Patterson TM #1 -7 -16
Dear Mr. Stroh:
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
June 20, 1997 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 Patterson.
If you have any questions, please contact me at your convenience
Very. tnkryours
William Hedges
Sr. Public Health Sanitarian
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PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
W40 -0-7
APPLICATION TO CONSTRUCT A WATER WELL
please print or type P -GHD Pefmlt ,' r: s s
Well Location
Street Address: Town/Village: Tax Map #
74 Cross Road, Patterson, NY Map 13 • Block -3 Lot(s)
-2
Well Owner:
Name:
Address:
Phone #:
Janet Cassidy -Stroh
74 Cross Road, Patterson, NY 12563
845 - 878 -353
Use of Well:
X 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 5 gpm # People Served Est. of Daily usage
gal.
X Replace Existing Supply Test/Observation Additional Supply
Reason for Drilling
New Supply (new dwelling) Deepen Existing Well
Detailed Reason
Existing well is collapsing
for Drilling
Well Type
Drilled Driven Gravel Other
Is well site subject to flooding? ............................... Yes
No
....................................................... —
Is well located in a realty subdivision? ........................................... ............................... Yes _
No
Name of subdivision Lot No.
Water Well Contractor: P. F. Beal & Sons, Inc. Address:4 Putnam Ave., Brewster,
NY 10509
Is Public Water Supply available on 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 prov'ded on separat she plan.
Date: 4/26/07 Applicant Signature:
Adam L. Beal
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 Departmel
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 constrp, tion 62he
well has been completed and inspected by the PCHD and is revocable for cause or maybe amended or m-p ified ..
X-
when
when considered necessary by the Commissioner of Health. Any revision or alteration of the approved plan equires..a
new permit. Well to be constructed by a water well driller certified by Putnam C unty. N
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Date of Issue � � Permit Issuin fficial:
Date of Expiration
6=1 I -.c2q Title:
Permit is Non - Transferable
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner;
-.A. W
e copy - Well drillsor
Form WP -97
Rev. 3/06
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
APPLICATION TO ABANDON A WATER WELL
please print or type
PCHD PERMIT # AW t,7 -01
Well Location:
Street Address: TownNillage Tax Grid #
74 Cross Road, Patterson, NY Map 13. Block -3 Lot(s) -2
Well Owner:
Name:
Address:
Janet Cassidy -Stroh
74 Cross Road, Patterson, NY 12563
Well Type:
X Drilled Driven Dug Gravel Other
Depth Data:
Well Depth 125 ft
Static Water Level ft
Date Measured
Use of Well:
X Residential Public Supply Air /Cond/Heat Pump Abandoned
1- primary
Business Farm Test/Observation Other (specify)
2- secondary
Industrial Institutional Standby
Water Well
Name: Address:
Contractor:
P. F. Beal & Sons, Inc.,.4 Putnam Avenue, Brewster, NY 10509
Reason For
Abandonment:
Well is collapsing
Description of Work To Be Performed:
We will remove pipe, pump and electrical components from the'well and
then fill the well from bottom to top with concrete.
Date: 4/26/0:3
Applicant Signature:
Adam L. Beal
PERMIT
This permit, to abandon one water well as set forth above, is granted under provisions of Article 10 of the Putnam
County Sanitary Code, Subpart 5 -2 of Part 5 of the New York State Sanitary Code and/or Part 75 of 10 NYCRR
and provided that: Within 30 days of the completion of the abandonment of the water well, the applicant shall
submit to the Department a certified statement that the information delineated on the application for this
permit has been completed.
5j((�Q�
Date. of Issue
White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WA -97
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SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health.
P.F. Beal & Sons, Inc.
c/o Adam L. Beal
4 Putnam Avenue
Brewster, NY 10509
May-4,2007
Dear Mr. Beal,
DEPARTMENT OF HEALTH
1 Geneva Road,. Brewster, New. York 10509
ROBERT J. BONDI
County Executive
ROBERT MORRIS, PE
Director of Environmental Health
Re: Proposed Well: Cassidy -Stroh
74 Cross Road
(T) Patterson
I have received a well permit application (WP -97) and a certified check in the amount of
$200.00. for the above teferenced.proposed well. Comments are offered as follows:
A survey plan or tax map of the property is to be submitted showing the locations
of the following:
• The proposed well (measured from two fixed points).
• The existing well (and all connections if the existing well is shared).
• The house and septic system.
2. The site plan is to also include location of all existing septic systems and wells
within 200 feet of the proposed well as well as all possible sources of
contamination within 200 feet (i.e., salt storage, oil tanks, land fills, etc). If there
are no additional septic systems within 200 feet of the proposed well, print on the
plan "No additional septic systems within 200 feet."
Upon receipt of a submission revised to reflect the above comments, this application will
be considered further. If there are any questions please contact me at (845) 225 -5.186 ext.
2233.
Very truly yours
Mitchell D. Lee
Public Health Technician
cc: MJB, W
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
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
Adam L. Beal
P.F. Beal & Sons, Inc.
4 Putnam Avenue
Brewster, NY 10509
May 11, 2007
Dear Mr. Beal:
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
ROBERT J. BONDI
County Executive
ROBERT MORRIS, PE
Director of Environmental Health
Re: Proposed Well Cassidy -Stroh
74 Cross Road
(T) Patterson
A field inspection was conducted at the above referenced lot by Mitchell Lee, Public
Health Technician. The application to drill a new well is approved with the following
stipulations:
1. A Well Completion Report (WC -97) shall be submitted no later than 30 days after
the well completion by the permittee.
2. The existing well is to be abandoned once the new well construction is complete.
Please provide notice to this Department two days prior to abandoning the
existing well so that this Department may witness it. A well abandonment report
form (WAR -97) is included for your use, and must be submitted within thirty
days of the abandonment of the old well.
Please contact me at (845) 225 -5186 ext.2233 if you have any questions.
cclile
z
Sincerely,
AW 6. L
Mitchell D. Lee
Public Health Technician
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
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