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HomeMy WebLinkAbout2319DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 41.10 -2 -34 BOX 20 ,. , 1. -2 1 14 ■ ' ;� ;�., L iE', ��t I� , lf ! ` r1 or 02319 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Norman Anderson, Inc. 152 Barger Street . Putnam Valley, NY 10579 August 3, 2007 Dear Mr. Anderson: ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Proposed Well Ryan 577 Lake Shore Rd (T) Putnam Valley A field inspection was conducted on the above referenced lot by Mitchell Lee, Public Health Technician. The application to drill a new well is approved with the following stipulations: 1. The well pump and all electrical components are to be removed from the existing well once it is abandoned. -2. A'Well- Completion. Report (WC -97) shallbe'submitted no later than 30 days after the well completion by the permittee. 3. 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. cc: file,, Sincerely, 4� b. 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 PUTNAM COUNTY DEPARTMENT OF HEALTH DWISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO ABANDON A WATER WELL please print or type PCHD PERMIT # A)-)-o---) Well Location: • " " ° °` "" " "" // 4C� EL�k i own/ v mage 1 ax thin # J7 �t kr Y(o V � �P Map�� Block � Lot(s) 3 J i e t/ a Well Owner: ame: Address: ur, lIP Well Type: rifled Driven Dug Gravel Other Depth Data: Well Depth . v ft Static Water Level ft Date Measured Use of Well: ✓ 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: Reason or C' Abandonment: Description of Work To Be Performed: 6 4t&Lt '� � 1 -1 [C) � Applicant Signature: /� av C�4�� 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. , Date of Issue Permit Issuing 0 ici White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well dr. tle Form WA -97 P i UTNAM COUNTY DEPARTMENT OF HEALTH 16W DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print of type .. Permit #" Vi1 3-0--7 Well Location: Street Address: `/ TownNilllage tt JJ // Tax Grid # 3 n? 1�r �ltdfc 4 (4 & LR A k✓ #4, Map Block Lot(s) Well Owner: Name: / Q � Address: / -97 4 4 S XJre 4J � AaA f \ (�Kl�� ' \ �M s5 Use of Well: G- 1�esidential 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 ---K gpm # People Served Est. of Daily Usage gal. Reason for ✓ Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason r e.lk'4 ( o . ► �►� /� c� s d W J, for Drilling Well Type Drilled V Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No t/ Is well located in a realty subdivision? ...................................... ............................... Yes No 1/ Name of subdivision Lot No. A Water Well Contractor: Address: 5-f-A�J & tv, UA %, Is Public Water Supply, available to site? .................................. ............................... Yes No .� Name of Public Water Supply: TownNillage Distance to: property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: -7 (1 ° i Applicant Signature://'- M4y U ...... � -� n. :.a -. • - .G s ..t. �... .♦ s- .—.-. ... t ...... � _..._ .. ._a . -..... .. .. .... . —. -.. .. ..n —... —. n_ .R .. � _ ... �.... .�.�.• w... --. ._. ... 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 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 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 Public Health Director. Any revision or alteration of happroved plan requires a new permit. Well to be constructed by a waterwell driller certified by Putnam County. I Date of Issue C I —E�l Permit Issuing Date of Expiration Title: Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; f,,Orange copy - Well driller e ` Form WP -97 n snow fence Mae r 1 o!s 0.9 o/s 4.9' J N40a -4 ' -30 "E - 1 •R =275.00' /4 S' 14.2 It �° I 0 N +I Lz Z9.20 tl= 06405 =00" 'REWIRE) IN ACCORDANCE WITH THE EXISTING CODE OF PRACTICE 1 Do LAND SURVFYS ATIOPTEP BY THL NEW YORK STATE ASSOCIATION f ;IK*ESSIONAL LAND SURVEYORS. SAID CERTIFICATIONS SHALL RUN •� HI Y to IMF PERSON^ FOR WIL7tA TH c RYEY iS PREPARED AND ON SINGLE ao O 3` °�e;. , FEE rn of .+ s� °��• let overhead i DWELLING ?PIES FROM THE ORIGINAL f)F THIS SURVEY MAP NOT MMEDWITH to I ORIGINAL OF THE LAND SUHVEtM S INKED OR HIS EMBOSSED * { -'' � N V, � . tee-✓• .� �E sr.,;� porn IAUTHORIZEU ALTERAiIUN OR ACD'T ION TO A SURVEY MAP BEARING A a� � • fr. • aoodtn 34.B' STATE OF •'PiEW 09, SUB- OIVISION 2, OF THE NEW YORK STATE EDUCATION LAW, bin w4t ` DERGROUNO STRUCTURES, IF ANY, NOT SHOWN. =� SCALE 1 "830' LED MAP REFERENCE: "ROARING BROOK LAKE,MAP 1, SECTION 8 ", LED JULY 28,1949, AS MAP He 308 B, also see amended mop, filed inop'no.308 J. t. 18JECT LAT:59 �U -pole Iron tin Ind. NO. 24' 1 WO.G2' 0B-' OrorN zY ; , ' clear Arort rWA . S LOLO ---�B 292.06(comp) stk w /tack ind S O.OG .67 '0.92. It tilledmup) W0.6T 1' V)/ to wood fence m an line O7 07 ; O w � cross cutfnd online 0.7' LOT 66• 7 3'hiph iron pipe fud S0.61' WO.59' �i SURVEY OF PROPERTY :1 1.0 It AIIUN'; INDICATED HEREON SIGNIFY THAT THIS SURVEY WAS PREPARED FOR 'REWIRE) IN ACCORDANCE WITH THE EXISTING CODE OF PRACTICE Do LAND SURVFYS ATIOPTEP BY THL NEW YORK STATE ASSOCIATION f ;IK*ESSIONAL LAND SURVEYORS. SAID CERTIFICATIONS SHALL RUN j� •. jj�� �• N ! C H O L �S R• Ek L HV E R N 10 HI Y to IMF PERSON^ FOR WIL7tA TH c RYEY iS PREPARED AND ON I HEIR BEHALF TO THE TITLE COMPANY; GOVERNMENTAL AGENCY AND/OR. ` ENDING INSTITUTION LISTEO HEREON,ANO TO THE ASSIGNEES Or THE ENDING INSTITUTION. CERTIFICATIONS ARE NOT TRANSFERABLE TO P '• WOOD' LOCK 1S. ®dAD DDITIONAL INSTITUTIONS OR SURSFOUENT OWNERS, t ' ?PIES FROM THE ORIGINAL f)F THIS SURVEY MAP NOT MMEDWITH l -SITUATE IN I ORIGINAL OF THE LAND SUHVEtM S INKED OR HIS EMBOSSED * { :AL S IAI I HOT BE CONSIDERED TO BF A VALID TRUE COPY. TO dVN OF PUTNAFA VALLEY COUNTY, OF PU TN AN IAUTHORIZEU ALTERAiIUN OR ACD'T ION TO A SURVEY MAP BEARING A CEHSEO LAND SURVEYORS SEAL IS A VIOLATION OF SECTInN STATE OF •'PiEW 09, SUB- OIVISION 2, OF THE NEW YORK STATE EDUCATION LAW, YORK. DERGROUNO STRUCTURES, IF ANY, NOT SHOWN. =� SCALE 1 "830' LED MAP REFERENCE: "ROARING BROOK LAKE,MAP 1, SECTION 8 ", LED JULY 28,1949, AS MAP He 308 B, also see amended mop, filed inop'no.308 J. t. 18JECT LAT:59 D7 REFERENCE' USER 771,CPOI1, RECORDED JULY 16, 1980, .. ANTEE: KENNETH J. 01 PRIMA pTIpiEp 70, OGLE FUNDING CORPORATION LD WORK COMPLETED MARCH 18, 1981 1UG14770 AUGUST 13, 1994 KENNETH PREGNO AGENCY,LTD.IKPPr0750329) NICHOLAS R. 81 LAVERN T. LOCKWOQO DATE P PREPARED M•ARC420, 1981 COMMONWEALTH LAND TIRE INSURA6LCE'COMPANY TSED AUGUST 1,1994 HOLAS G. CHAPIS, P. L.S. I OF LAND T OFFICE BOX 897 T OFFICE MEL, NEW YORK I0512 AS G. CHAPIS NEW YOR STATE LICENSE Ng049330 NICHO ' 2 29 2221 L) 2 - { - -- 610110 , 4 O 31 n � o �u aL 1 , o� 00 U. � ,.a ♦ I snow lento near edge macadam drive wirc tense i i /s4,9' clear X N d `Q LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES Or THE TRANSFERABLE TO �75.00' J h. Nn., wit, i � � S ITUATE IN blk. walk Yrre/ sn�e SEA�;SHAI.I NOT BE CONSIDERED TO BF A VALID TRUE COPY, N o o N home shed 9.20 „ 64 65 =00 Fwd of :o• LICENSED LANG SURVEYOR'S SEAL IS A VIOLATION OF SECTION TZO9, SUS- DIVISION 2, OF THE NEW YORK STATE EDUCATICN LAW. LdT 59 D -• r4• O 31 n � o �u aL 1 , o� 00 U. � ,.a ♦ that PREPARED FOR wirc tense I N I C H O I. AS R. 8c L A V E R N T. 0 outlet overheoJ ou wEes THEIR BEHALF TO THE TITLE COMPANY. GOVERNMENTAL AGENCY AND/OR N d `Q LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES Or THE TRANSFERABLE TO t' 0 ^ �� O OD 1r J h. Nn., wit, iron -fipe 1v 0, 14,2 wa M I SINGLE STORY FRAME I DWELLING 1 _. a/ed vole i r '26{.81' os' erwri aorr NO.2 4' °a /t WO. G2' 1 Ilk w /tack 'Ind S 0.00' W 0'. 617' wood fence , on line cross cut fnd online 0.7' Lot 66_• 3'high iron pipe fod S0.6t' W0.59' LOT 60 SURVEY OF PROPERTY ClHl,Flf AIWW; INUICATEV HEREON SIGNIFY THAT THIS SURVEYWS LOLO --T—�Q PREHAREN IN AI:CMANCE WITH THE EXISTING CODE OF PRACTICE PREPARED FOR wirc tense I N I C H O I. AS R. 8c L A V E R N T. am TU IN( PERSON^ FOR WHOM THE SURYELIS PREPARED AND ON 1 THEIR BEHALF TO THE TITLE COMPANY. GOVERNMENTAL AGENCY AND/OR . LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES Or THE TRANSFERABLE TO t' 0 ^ �� O OD 1r 16.C+ ell /o.s' 292.11 (fi{edmup) ' Fro.° Surd i � � S ITUATE IN blk. walk Yrre/ sn�e SEA�;SHAI.I NOT BE CONSIDERED TO BF A VALID TRUE COPY, N o home shed :PP m O LICENSED LANG SURVEYOR'S SEAL IS A VIOLATION OF SECTION TZO9, SUS- DIVISION 2, OF THE NEW YORK STATE EDUCATICN LAW. LdT 59 80 N '0- FILED MAP REFERENCE: "ROARING BROOK LAKE,MAP I, SECTION B ", FILED JULY 28,1945, AS MAP Ns 308 B, oleo site amended mop, filed map no.308 J. f• SUBJECT LOT: 59 wire fence a 3 m 56.9' CERTIFIED 'TO DALE FUNDING CORPORATION I 9 KENNETH PREONO AGENCY,LTD.(KPP G750329) NICHOLAS R. Bt LAVERN T. LOCKWO90 �cwu. aid so o 1EVISED AUGUST 14, 1984 1 Ilk w /tack 'Ind S 0.00' W 0'. 617' wood fence , on line cross cut fnd online 0.7' Lot 66_• 3'high iron pipe fod S0.6t' W0.59' LOT 60 SURVEY OF PROPERTY ClHl,Flf AIWW; INUICATEV HEREON SIGNIFY THAT THIS SURVEYWS PREHAREN IN AI:CMANCE WITH THE EXISTING CODE OF PRACTICE PREPARED FOR FOR 1.AN0 suhFYS At1UPTE0 BY THE NEW YORK STATE ASSOCIATION Of PRLIFESSIONAL LAND SURVEYORS. to CERTIFICATIONS SHALL RUN I N I C H O I. AS R. 8c L A V E R N T. am TU IN( PERSON^ FOR WHOM THE SURYELIS PREPARED AND ON 1 THEIR BEHALF TO THE TITLE COMPANY. GOVERNMENTAL AGENCY AND/OR . LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES Or THE TRANSFERABLE TO t' 0 ^ �� O OD 1r LENDING JHSTITtITION. CERTIFICATIONS ARE NOT ADDITIONAL INSTITUTIONS. OR SURSFOUENT O%NERS, "ES FROM THE ORIGINAL fIF THIS SURVEY MAP NOT MARKEDWITH � � S ITUATE IN AN ORIGINAL OF THE LAND SIANEKA'S INKED OR HIS EMBOSSED SEA�;SHAI.I NOT BE CONSIDERED TO BF A VALID TRUE COPY, TOWN OF QUTNAM VALLEY COUNTY: OF PU TN Ate IINAUT11ORIZED ALTERAFIUN OR ADDITION TO A SURVEY MAP BEARING A LICENSED LANG SURVEYOR'S SEAL IS A VIOLATION OF SECTION TZO9, SUS- DIVISION 2, OF THE NEW YORK STATE EDUCATICN LAW. STATE OF "NEW YORK UNDERGROUND STRUCTURES, IF ANY, NOT SHOWN: ` SCALE 1 "s30' 1 FILED MAP REFERENCE: "ROARING BROOK LAKE,MAP I, SECTION B ", FILED JULY 28,1945, AS MAP Ns 308 B, oleo site amended mop, filed map no.308 J. f• SUBJECT LOT: 59 ICED REFERENCE: LIBER 771,CPOII, RECORDED JULY 16, 1980, 69ANTEE: KENNETH J. 01 PRIMA CERTIFIED 'TO DALE FUNDING CORPORATION I %ELD WORK COMPLETED MARCH 18,1981 TO DATE AUGUST 13, 1984 KENNETH PREONO AGENCY,LTD.(KPP G750329) NICHOLAS R. Bt LAVERN T. LOCKWO90 BROUGHT LAP PREPARED M,ARC)+20, 1981 COMMONWEALTH LAND TITLE INSURANCE COMPANY 1EVISED AUGUST 14, 1984 IICHCLAS G. CHAPIS, R L.S. URVEYOR Of LAND /� n DST OFFICE 80X 397 %� 1 .,,,.,,z ARMEL, NEW YORK 10812 NICHO AS 8. CHAPIS NEW YORKSTATE LICENSE N :049330 t i14) 223 - 2221 I - 610110