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