The URL can be used to link to this page

Home My WebLink About2216DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.05 -1 -7 BOX 19 02216 �� 6 �� INS% oil 1 I INS Nor 1■ me I ,` r- IN i . Lr- 02216 1 —1 •1 1 — .11••:1 PUT , NAM COUNTY DEPARTMENT OF. HEALTH. DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION; REPORT Well Locatipn .2 Street Address wn/Vil dma fid :Tak:�O V P, q.1i, Lots). 7.. Ad:, J: T S U4d,WAI:6 zt 1-prmry, � 2�secondar i >fkesidentiw. PublicSupply C/ Air. cofid/hedt -punp h Ausiness Farm'. Test/monit6ring �Qthei(sp etifi*)_ industrial Institutional Standby fin Equ* ipm�nt 9 Rotary; 'Cable percussion Compressed�,air Oericimion Other (specify) Well Type Screened Open end casing. Open hole in bedrock Other Casing Detkilg Total'Iength A. ' Length below 4, VA - 'AiL Weight per foot 14 lb /ft. Mater i Is: < St6e Plas tic Othe r t. Joi P ts, . , Welded POO _ then Seal: t 6 _.Cement grout en. op ,e. MW DriveShoe: -,-e Ye S, No JL; e Screen Details Diameter (in) Slot Size- Length(ft), Depth, to rq '4 n eld�e d? First Yes ,. No %r & Second We. lF.. Y. ieI ld Test Bailed Pu mpe d e Coi ressed Air Hours"7� Yield S — gpm Depth Data Measure frqm- land' surface-static (specif- fty_�' y X During yield test(ft) Depth of completed well in. feet T1 Well Log; If'nore. detailed rma t ion descriptiofts-or' sieve analyses are available, please attach. �10.�O-th.froni Surfad"j. Water' B earing. Diameteron Formation:* t a ;- eschp ion, ft ... ft Land Surface' WL; If ield-'was tested� �y at different. depths during drilling, list. Fek Gallons Peri Minute Pump /Storage Tank* Itif6rmafion Pump Ty pe I q4PAq 5 y . . kt ...... Depth -Model 6.�i Voltage )..fQ HP Tank Type Volume A `. Date:Vell-lCothpleted.: ' N Putham' County -Certi Certification o;- Dq!e of eport WdILDrille 7N N NOTE:' : -k ct location"ot-well with distandes to'At, lejast. tWo-pprhialhel landrhatt�§ t be prdX.ided on a" 'e sheet7blan.- Well Driller's Name Address: 7 Signature: __711 Date: White copy: HD File; Yellow copy - Building Inspector; Pink.copy - Owner; Orange copy - Well driller Form WC-97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVffCES APPLICATRON TO CONSTRUCT A WATER WELL please print or type PCHD Per" it # 7 / D WeRl Location: Street Address: Town/Village Tax Grid # OAKRIDGE DRIVE PUTNAM VALLEY Map 41 , 5 Block 1 Lot(s) 7 Well Owner: Name 4 Address: o PUTNAM VALLEY; NXXX N.Y. Use of Well: x Residential Public Supply Air /Cond/Heat Pump Irrigation 9D rimary Business Farm Test/1Vlonitoring Other (specify) 2- secondtryy Industrial Institutional Standby Amount of Use Yield Sought 5 gpm # People Served 4 Est. of Daily Usage 3 0 0 gal. Reason for X Replace Existing Supply Test/Observation Additional Supply gDrnlfing New Supply (new dwelling) Deepen Existing Well DetaiiRed Reason REPLACE EXISTING WELL for 1(Dri ing WeH Type X Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes NoX Is well located in a realty subdivision? ...................................... ............................... Yes x No Name of subdivision 5TH MAP OF ROARING BROOK LAKE Lot No. 505 Water Well Contractor: p ST> Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: N/A Town/Vi ag Distance to property from nearest water main: N/A Proposed well location & sources of contaminatin be pro td on sep ate s eet/plan. Date: - - 7 /-5 / 0 0 Applicant Signature: J. - 1. i PERMIT TO C RUCT A WATER WELL This permit to construct one water well as set fo 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 .IFOR CONSTRUCTION: This approval expires s 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 driller certified by PAitnam County. Date of Issue 1 Permit Issuing Official: Date of Expirati, Title: Permit is Non White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller ,!!F- ��. D ,4 L.: _w.:.::... PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO ABANbO,N , WATER WELL; please print or type PCHD PERMIT # Well Location: Street'Address: TownNillage Tax Grid # PUTNAM VALLEY Map41 .93lock 1 Lots) 7 Well Owner: Name: Address: ,JOHN SHERRY 277 LAKE SHORE RD., PUTNAM VALLEY, N Well Type: X Drilled Driven Dug Gravel Other Depth Data: Well Depth 100 ft Static Water Level VN� ft Date Measured Use of Well: X Residential Public Supply Air /Cond/Heat Pump Abandoned rimary Business Farm Test/Observation Other (specify) 2- secondary Industrial Institutional Standby Water. Well Name: Address: Contractor: 3 Reason For Abandonment: NEW WELL TO BE DRILLED Description of Work To Be Performed: FILL IN EXISTING WELL WITH CONCRETE. DRILL NEW WELL IN .LOCATION SHOWN ON SITE PLAN. Date: 8/1112000 Applicant Signatur P RM P This permit, to abandon one water well as set fbrth\4Wve, is granted under provisions of Aiticle 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 informakn delineated on the application for this permit has een completed. Date f Is ue /NJJS.A&A. '- -- Permit Issuing Official White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -97 Y. DIVISION OF ENVIRONMENTAL HEALTH SERVICE RE: Property of LETTER OF AUTHORIZATION I OUN �s Located at 1-7-7 L Q kt ,.T/V earNpm Tax Ma p# ,. Ova Block Lot 06U.EY p � � Subdivision of ,'jT--N /Apf! 2 &AQ jN a 'S Igo,6 6e, L b6 Subdivision Lot # C) J Filed Map # Date Filed Gentlemen: This letter is to authorize --,) 6 EL, a duly licensed Professional Engineer or Registered Architect to apply for the required water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervis - ction of said wastewater tretment and/or water supply systems in conformity. with..t A icle 145 and /or 147 of the Education Law, the .Public Health Law, and the P bounty Code. �v Very truly yours, Counte 1 d: 0 t, o, ota �c Signed: P.E., A. ( r of Property) Mailing Address 2 �6T fZDb ti, Mailing Address: 177 kE .SBj,ER „ MA AuPA& ET�j �q k& On I j= U State d Zip State., Zip�� Telephone: (,-,-7 � � 6� Telephone: 1 } Form LA -97 M - 3 P1 Street Address 1T A OAK•DGEe ,Dp TV E P UVW -` VALLEY j 6t( Well r Address ON Use of Well _Y, 2!,-sec6nc"J1a:r-y'--:-:. _V X Residential Pubic .Su . .. ..... PMngation mess:,, us' `F arm er .. .... 777� 77-7 Indusfri Institutional A6"ni fUse"�,`.Ii.%; to Reason fo`r'--'-:, - - Yie:ld5, ple', 9 #.Pqo Serve '-16plke��fxi s Supply M� , - Test/Observation 41--, IM" .: W Supply - —I , e 'S ly,. (ii dwelling),' , D `�elF- Deepen Existing ,mj for.Drillin ' g U �RE t X -1 S T IN G WE tt:' ` � ! ..... ..... � ' .' '. Wetl-Type 'X ed" ............ es'.. Ri well site subject to flooding ?' ' "'I" - Is............ g, , 44. g, 'L V locateddn,a realty ivisionT�" ................. Y Is';,well subdivision ............... il 1A, Namelof subdivisions :! 5TH MAP DF' DAR INIG BROOK LA KE I d ....................................... -'69, '017 IsTublic',-N,�' S available .................... .... 5N6 y.av 11., �g : "Na�e"6f-Piblic.Water.$Vpp Town/Vi agM Distance to �Tom,nearest *.-water '-" main X ; Proposed well. lo.cktionl+& - sources,-of co i ati e.,. e: I .e P ....... Date 7: 5 `66 ". ., # We t Thus. permit to c t-.( e' E Putnam co ,:Code repr fil.f .6'ti:"th6::welli,,.,m`accori shall Pump Ahe--,wel �',up sh 7 jeqiurements gf the iPutnahi, CountyHealth `Npartment' , '77., ty,'�HealthTe- provid6d-b'Ahe'. 'all' ll*,'drilling",;,Qpprati6ris',.f',thi y. Putnam ouril partment. I g, r shall take: Rz well .and all ,-w' r. waste products qppTqpnat �,action:W.;a , assure u , x and, rWgn annei on thus welLdrilling+ operati'on's,b*e.'to''n'"ta-in"'e�"�lo.a' 66n groundwater 's or . PROVED FOR CONSTRUCTIOMA-1fis! onf-the ,4aWis; a construction of the well Ka s":Jbiee, been completed � , , CHD, c1ds,`revo&ble'j'.f� §SpV I_ ,..:",- -I amended or mod d w:h� en.cons,ider, ed necessary thePublic-Health`Dl* rector".,',:, A - ieAs 6 f the approved :plan requires 'a new -permi W e i ;to.+., e..c6fi*structed,�byi�a'�;k*iter.,,.we i er, County D ate o tI ssue Ternu I'ss Official, 0 '(9 lex, Date- of E iiati Title itle' , Perinit is.Non+-T ansferra6ie.,I White copy file- Yellowlcopy - 'Building Inspector; �Pink copy,L`.OWner-` Orange copy �',tC.,�f T•Lf =x" x`: T•x -rt a Yor' •'' . .. - � ., .. .. S . �`• + . < r PUTNAM COUNTY DEPARTMENT OF HEALTH DEV1,1SION OF ENVERONMENTAL HEALTH SERVICES APPLICATION TO ABAN DON A WATER WE. LL please print or type PCHD PERMIT. # Street Address::: Town/Village Tax Grid # Weflfl Location: OA 1D .PUTNAM -. VALLEY 41 1 .. 7 lock,, Lot(s) Weflfl Owner: Name: Address: . JOHN SHERRY 2.7 7 : TAKE SHORE RD o , PUTNAM VALLEY, N Y, �, WeRl Type: • Drilled ' Driven Dug :. . "Gravel � Other , DCF .. IlData ,r .. Well Depth 1(i 0 .ft Static Water Level � °��- ft Date Measured Use off W�flfl I.X Residential Public Supply: Air%Cond/Heat:Pump Abandoned u'nffinitq Business Farm Test/Observation Other (specify) 1-s eco ndan Industrial Institutional Standby' Name:. Address: t W�ite>r Weflfl .: C ®�tu•act ®�. til h R.r.: Ab naIlo iinn�tn$• NEW WELL TO BE DRILLED �Descrip>tio® off Work To Be.Perffo> meafl A. FILL.- IN, EXISTING WELL WITH CONCRETE. L.- DRILL NEW WELL IN LOCATION 'SHOWN ON -SITE PLAN; ref Date ;' 8 > 1.1 / 2000 Applicant Signature PE This permit, to abandon one water-well as set forth a ve, is granted under provisions of Article l0 of.the Putnam w x. 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 informati delineated on the application for this 2. perrmt has been completed. •'1 0 .. , Date of Issue Permit Issuing Official Tittle` ,r � 4• White copy: HD file; Yellow copy - Building Inspector;, Pink copy - Owner; Orange copy - Well driller, -97 Form WA s�rrA€eI W @LLC EL.Eo. "WPUi ��1aotil . SSE LL 69^06 d \Y �•clli �.? /� 9� ELL r91ofE slo�� —; hl LI cEMErJT 4ROUT ZO' lw-m SOt-Ip WATeg L.196' i� TroGK. r0 Hous p- N, .. - -- -. - - -- (set BfLotir F[o$1%, Pr 7 LE_..c; DP.PT E� L. L, Li C. AsIN4 5 L T LO' l7KoP PirE NTO Soop R.ocK 1 APPROX. LOC. OF EX. AD.IACENr 5575 L4T 503 ' DIA. CCVC LEACHING BASIN - RCPosED J BEDROOM ONELLING DATL ' FIRST F.F. ELEV. - 812' .74'. _ - - " "- - 7' CURTAIN DRAIN rO B£ CONNECTED rO £X. SWAL£ DRIVEWAY SOIL J00 t. F. OF LEACHING FIELDS rO BE REMOVED i--� - — - - n' - - - $ Rsr 2' r0 BE SOLID PIPE y - c . >- ----;. _ . vNC710N Box rrP - Aos ;u. - LOT 5 N / A S U R r""Iftm k;uu aly Ubpe r' "L ul ab" %;& pivision.o� Environ?i taI Re81th.Servic., (5 L lvpmved as notes for confo a with ayylloable Rules and Rehulations of Eu C°''aff D ento m, «,e�, SUR WDE LEACHING TRENCHES O 6 _ C -_ _ _- _ p' \..' a 268.25' , MIN. OF loo' FROM Ssrs '. "-, �WA7£RUN£ rO HOUSE —� 10' G c b C REN ANC PROPOSED If£LL WITI s, A C N SUE - HOUSE- I -� FILI 1/� �`{ toS79 Sllf i I LOT 505 4 i ! ; 97.59'. wEi LAYOUT �oGA•tet] (3y %1Vg i-gw,o SvµvC�(o� , j i. EROS APPROX. LOC. OF EX. AD.IACENr 5575 INSTE ' DIA. CCVC LEACHING BASIN - RCPosED J BEDROOM ONELLING DATL ' FIRST F.F. ELEV. - 812' SECOND F.F. EL£V. - 821' 7' CURTAIN DRAIN rO B£ CONNECTED rO £X. SWAL£ SOIL J00 t. F. OF LEACHING FIELDS rO BE REMOVED i--� - — - - n' - - - Rsr 2' r0 BE SOLID PIPE y -z_, ° ROAI _ . vNC710N Box rrP - - z - MIN. SLOPE - 114- PER FOOT 1250 GAL. CCVC. SEP77C TANK S U R r""Iftm k;uu aly Ubpe r' "L ul ab" %;& pivision.o� Environ?i taI Re81th.Servic., (5 L lvpmved as notes for confo a with ayylloable Rules and Rehulations of Eu C°''aff D ento m, «,e�, SUR WDE LEACHING TRENCHES O 6 _ C -_ _ _- _ 5D T EXPANSION .. - NYS . -.... X. HELL r0 BE RELOCATED MIN. OF loo' FROM Ssrs '. ALL 10' G c b C REN ANC ;. WITI s, A C N SUE Ow+� �a • OF -� FILI 1/� �`{ toS79 Sllf