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HomeMy WebLinkAbout0668DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23.10 -1 -16 I rs Lid"Iml me j,", i� In �' - ' 1'6 rr ' I Jim A. Am do DEPARTMENT OF HEALTH q a ` Division of Environmental Health Services TWO CO Y CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT WELL LOCATION Street Address T; , 31 I w- W1c.- Town/Village/City Tax Grid Number S WELL OWNER N je MailingAddress �7v 2• 1r �d -31 'r"C. 1�'lti • �a PPrivate O Public USE OF WELL 1 - primary 2- secondary ❑ RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION U INSTITUTIONAL O STAND -BY 0 ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED S /EST. OF DAILY USAGE COO gal REASON FOR DRILLING 10NEW SUPPLY OPROVIDE ADDITIONAL SUPPLY 19REPLACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL OTEST OBSERVATION DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN []DUG GRAVEL C] OTHER IS WELL SITE SUBJECT TO FLOODING? YES 8C NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Nam;80�j d (4 k- *6 Lcui-A,0 ttt Co rk - Address : 'kAs R �S� CGcArlvt IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED O ON REAR OF•THIS APPLICATION O ON SEPARATE SHEET R (date) (sign ure) 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 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 P tnam County Health Department. Date of Issue: 19 �'� Date of Expiration:. 19 erm t ssu ng c Permit is Non - Transferrable 2/87 White copy: H.D. File Yellow copy: Building Inspector Pink Copy: Owner Orange copy: Well Driller Boyd Artesian Well, Co., - Inc. R. D * - No - 2. .5 Rte. 5 Carmel, N.Y. 10512 (914) 225-3196 —w—x / / c—'1121V If ej fA v Tc; I h Ll g�6 Army PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES John M. Simmons, -M.D'. Deputy Commissioner of Health - FIELD ACTIVITY REPORT - Sheet of C INSPECTION NAME / r12 A- _ Orig. Routine ADDRESS 3 �� �. /?%G� v Orig. plain Orig. g. equest No. Street Town TM No. _ . Compliance _ MAILING ADDRESS' Canplaint Camp Final P.O. Box Post Office Zip Code _ Group Illness _ Construction TELEPHONE PERSON IN CHARGE OR INTERVIEWED Name and Title DATE �� �� TYPE FACILITY TIME ARRIVED zz, % TIME LEFT FINDINGS: Reinspection Field, Sampling Only Field Conference Other Explain 1N5PB=R: TELEPHONE: Signature and Title PERSON IN CHARGE OR INTERVIEWED: I acknowledge this Field Activity Report. SIGNATURE: . :. TITLE: LORETTA MOLINARI R.N., M.S.N. Acting 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/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 June 4, 2003 Caravetta P.O. Box 111 Patterson, NY 12563 Re: Addition - Caravetta, 307 McManus Rd. N. No Increases in Number of Bedrooms (T)Patterson, TM #23.10 -1 -16 Dear Mr. Caravetta: ROBERT J. BONDI County Executive 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 June 3, 2003 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. 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 truly yours, Michael Luke MLAM Public Health Technician cc:BI 0 yY a BRUCE R. FOLEY Public Health Director DEPARTMENT - OF HEALTH 1 Geneva Road Brewster, New York 10509' LORETTA 'MOLINARI RN.; M.S.N. 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)278-6095 Early Intervention (845)278-6014' Preschool (845) 278 -6082 . Fax(845)278-6648,' ADDITION APPLICATION (RESIDENTIAL ONLY o STREET p°7 mcryaV�,IIS CAL W. TOWN :: TX MAPS NAME PHONE OR �jll��PCFID# i DESCRIPTION OF ADDITION O ✓i t 0 �" ( S Ltp S furs (L� den 1 o NUMBER OF EXISTING BEDROOMSPROPOSED # OF BEDROOMS ��- � (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) ' *Any addition which is considered a bedroom requires formal approval�of D* lafz (Construction 'Permit) prepared by a Professional Engineer or Registered Architect in accordance ith 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 9) *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. Contasct this office with any questions. 5. Copy of Cert. Of Occupancy from Town or Certification from Building Dept. with legal bedroom ' IVO.r oty count of dwelling. FFTCE USE .-. • Comments Feb98 BFhouseguidelines jP j Y 2 R FOLEY Health Director b LORETTA MOLINAM R.N., M.S.N. "a"�►4� Associate Public Health Director Director of Patient Services DEPARTMENT OF -HEALTH 1 Geneva Road. Brewster, New York 10509 Environmental Health (945)278-613o Fax(845)279-7921 Nursing Services (845)279-6359. WIC (845) 278.6678 Fox(945)278-6095 Early Intervention (845) 278.6014 Preschool (845) 278.6082 • Fax(845)21i-6648 O Putnam County Dept. of Health _ 4 Geneva Road Brewster, NY 10509 Re: $ *2 A6 Ab Residence Tax Map 3 ZP Town s � A) Gentlemen: According to records maintained by the Town, the above noted dwelling ' 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 Building Inspector BFhouseguidelines J will sk�N / si Pew/ ,oN fl 4Q ej L ►v C3 19 —7 � lQ� � E x.►S ++,.j c. J Qom' z � 30 -r-r v n .10 rr a �d �lo� PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY; BEDROOMS ignature & Title pad is b T l S4 1� O ° a s o )v ri S hh 0 NEW F._ 3o rT � ---cj � y, a� ,.xo 0/ � r ty � QtyC C r(I LCL faun 0 o � Elso Q. ) x 3 = 0 --c WA ,A*n / f f S- / ICU � �j I W-0✓ ni % el I p m --a- 4 fig x 20 0 9 raam' m 30 Elo ,4 .mss ---- . �4 M1�r S MY'1 ?!d...`'�'.F".�Sc '�4. _ .. .f 1 '1�� �A�1''• f o I 4Zs �uxl3 0 o �'� s ❑ 7 a ^ � ., on son MEN MEN! m mmo m immm: I '- lu e� co CU jd�,�nmJ Fit V/0 W.A IX n Vyv Ll R, 0 h V )-:� , 4rh t 11 c. x � Y� IZ Q �J ry ej __ __. � _,.�. �......� � � ._ .., �... � ... _,- -.r__. .. � -- _._.�_._.v__�.._._. ... _ ., ._ ,. _. _ ...... .. .- ..... � ........ ......�...__.._.,..._..,...__�, .........___-._ -- �----- .......... _. _�._.....�� :. ._._-- ��M._.:......._._.._.._.. _ _. ... _ ._.. ...... . . .._.�r..,_7... r. ._..�rv.. .� ...ye._.....___._ ......_-- _- •,r_- .._.`.w.. -- ___..___.._.__._....___ten ....__._._r.._.___ _. ...._ —, `— ,�v_�____ _ ..w _.:._. .. . _ TV Hill ,:ca.:umras;±• opt'° -" '.^.`•"":"'^.` -^ ^...se.�z...y.- s.^,- _- ..t.... _ .t..r�.......�.- ++m'cr'. - ,.a:....- .s.:,= ?Hr.:r >;^. %' r.�` ;v 1 i C A. f i t e X ol T 7. .5 Ibw Qu -00 CJ M,4P SLAVE-,- PkEPAREb Fok BATTY CARAVE7rA. E, jZS o Q, -FLT--""--IcOUAjry. N y SC.AL.E I,-= 50. DEcemp,,912 2,G. 20,z7 ©- sww. 0 k)A LCVrr All �of~,%m .*I.k 4e AN'K ew:)p jrj a I IS .4? C-a'd 0,t( P" n?"15 ,E;�e ,,,,P rem bra I of Or o✓ L4vv T�vbwp jpC -% b*t,•vm• UCC-Kj<ZE W 415!" (-AV-� C4Q.,MP/-, ukv yoRk 845 -225, love 14 1 a 7���036 ,piLC -ss PHONE 1 SITE LOCATION %" ti TM ok 3- I U- I" 1 b MAILING ADDRESS PERSON INTERVIEWED PCHD Complaint # Name & Relationship (i.e, owner,tenant, etc.) DATE �-� ` TYPE FACILITY PROPOSED IlSST Abp L � C� JI(' i J�-�� t C SL. tI i/K SOME q 1 L Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system. Different location may require submittal of proposal from licensed professional engineer or registered architect. �t eta l 'nn `, ' i� 1� y Yl Proposal approved �--- y-- Inspectoe s T4,01i Proposal Disapproved roposal approved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submisgion of as built repair sketch --in duplicate showing: a. Owner's name. b. Site Street Name, Town and Tax Map number. c. Location of installed components tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diem. x 6' deep drywells surrounded by one foot + gravel). e. Installer's name and number. 3.— System repair to be performed in accordance with the above proposal and conditions. I, as owner, or reported agent of er agree to the above conditions. S� SIG TITLE C W DATE TP1ES: -V&te MV; Yellow (2n HE); Pink (Applicant) 4 y rI J • It t ! � 5 �"F a f IN f c-Awrt,,x.; RO CL C 41 ap /9 O�k 3� ht-imLZ-Plu- iz Miantovi septic Tank Services Septic Tanks Cleaned - Installed MA 8-2329 or MA 8.4441 Date Cleaned J, NexM1, ning to I 95