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Home My WebLink About2476DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 51. -1 -41 BOX 21 .., L �. 4.. Z I A.L. 1, � A ., ..# �. . : r 6 L1' J� �, � dn OdL.i M, 02476 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION T ONS' I i C'T A WATER WELL., �Yplease print or type f PCHD Permit # Well Location: Street Address: To illage Tax Grid # 11644 fbu G�.i�f ✓t 4 A( �y�d g. v /le ap I Block I Lot(s) / Well Owner: Name: A#�iJ'dy ¢ V Address: G1�s�c a ox" W 4, ee p�, A , Ae of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1 rimary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily Usage3L _gal. Replace Existing Supply Test/Observation Additional Supply Reason for Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason a r 6 /aG.c S4.4 t 0 4u 1We/ am d R. Me w• e�c � A��;, for Drilling o a 4.,0 Well TypeDrilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ......... ..............................: Yes NoL/ Name of subdivision Lot No. Water Well Contractor: Address: Is Public Water Supply available to site? ................ .................. ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: /lillf' Proposed well location & sources of contamination to b kovidedd on parate sheet/plan. Date: 6 .Applicant, Signature... - Li 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 theryapproved plan requires a new permit. Well to be constructed by a at well driller certified by Putnam Date of Issue —�( Date of Expiration Permit is Non-Trahsfi-rpfible Penmi Title: White copy - HD file; Yellow copy - Building Inspector; Form WP -97 0 ?UTNAM COUNTY DEPARTMENT OF HEALTH DWISI N OF ENVERONMENTAL HEALTH SERVICES APPLICATION TO ABANDON A WATER WELL please print or type PCHD PERMIT # \J: Svo z Well Location: Street Address: o illage Tax Grid # SG 4 f/v d lk Maps' / Block Lot(s) if Well Owner: Name: Address: .- n Well Type: Drilled Driven Dug Gravel Other Depth Data: Well Depth ft Static Water Level ft Date Measured Use of Well: &-o' Residential Public Supply Air /Cond/Heat Pump Abandoned plriimnairyv Business Farm Test/Observation Other (specify) 2-secondary Industrial Institutional Standby Water Well Contractor: Name: Address: kS j jV f s/. 141V()e Reason Foir rr Abandonment: Description of Work To Be Peaf ®rnel: lyjk, / f-7- ' 4f Date: <-Ile) Z Applicant Signature: 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 ssue White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -97 c tTfNG_ ENGtN RS ❑ Daniel 1. Donahue, P.E. 200 Breckenridge Road Mahopac, N.Y. 10541 — — -- - - -• -- 914- 628 -7576 TO WE ARE SENDING YOU ^ Attached ❑ Under separate cover via LIEVVIEM ® �c a ►��o� � _.,.the following items: O Shop drawings O Prints 0 Plans O Samplos ❑ Specifications G Copy of letter 0 Change order G COPIES DATE NO. DESCRIPTION C /C yG9 rf" THESE ARE TRANSMITTED as checked below: C For approval O Approved as submitted O Resubmit copies for approval Ei For your use i7 Approved as noted O Submit copies for distribution C As requested C Returned for corrections O Return corrected prints Q For review and comment Cl — _ --- ❑ FOR SIDS DUE 19 l7 PRINTS RETURNED AFTER LOAN TO US REMARKS - -�--�– r `� 10 .. J, COPY TO �... - SIGNED: ..a_11 -. to. us .t once. orney RE taw Admitted In Now York and Florida July 11, 2002 Karen Clark P.O. Box 2971 Carterville, Georgia 30120 Dear Ms. Clark: Please be advised that I am the attorney for Richard, John and Raymond Gizzi, owners of certain vacant land on Oscawana Heights Road, Putnam Valley, New York. Said property is across from land owned by your family on Oscawana Heights Road. My clients are developing their lot and their proposed septic field is too close to the well servicing the above - referenced .Anderson property. In conversing with a member of your family, and I presume same to be Richard Anderson, my clients agreed to have a new well drilled on the .Anderson property and pipe same to the house so that their construction is not inhibited and same was accepted. In that you.are the Executrix of the Anderson Estate, it is necessary that formal consent to same be obtained. Towards said end, the request is made that you acknowledge below that my clients, their agents, contractors, etc. are permitted to traverse upon the Anderson property on Oscawana Heights Road, Putnam Valley, New York for the purpose of drilling a new /replacement well thereupon and piping same to the house thereupon. A return envelope is "ericlosed for your convenience-. Should you have any questions regarding this matter, do not hesitate to call. Thanking you in advance, I am Very tnily yours, Paul W. Meyer, Jr. Consent Given to Entry Upon Property and Drilling of New /Replacement Well: By: 44"44 Karen Clark, Executrix 35 Bast Grassy Sprain Road Tel. 914 -961 -3000 Suite 508 Pax. 914- 961 -4993 Yonkers, Now York 10710 (Pax not for servlae purposes) m iRZ: Pmpwty of r „I� 44 v l w -W ii i-1 v, iv f rC zv�1 Cti � Located / 00 ' Tax Map # � � Block Lot � l C7 s- 7 c� $ubdiviaion Subdivlaioa ' t# Filed Map This louse is to authi dmv L a duly licensed Pm ionnt Engineer ✓ or Registered Architect to apply fbr the rogniW wastewater F=1 and/or water supply pa rmit(9) to serve tho above noted ropm in acoordm with the sta, es or regulations as promulgated by the Public Health hector of the Putaent County IRW art, and to sign all necessary papers on My behalf' connection with this auder and to su the constriction of said wastewater tretnnent and/or ter supply system in confbtmity with thq visions of Ardele 14S and/or 147 of the Educatlon I.Aw, the Public Health Law, and the County Sanitary Code. V trot ours A CAS Countersigned: P.E., LA., # Mailing Address Ta !®phone; aY YY S L l) � (owns of Pro®ot�) ✓ �/ i '�E�9 /�`�t`.a,�G(aalin�Addrsgg! �b S�aL�Jor Zip --Z!! � State C- 7rf 4- Talephoae: 91S � Z 9 r r s'ona LAM 'ts. R V z •saes . 5ti 6{ (an.L) ZO. fiZ "Inr CONSUMNG ENGINEERS—* LIE77[EM El Daniel J. Donahue, 200 Breckenridge Road Mahopac. N.Y. 10541 914-628-7576 TO fiz WE ARE SENDING YOU 0 Attached ❑ Under separate cover via • Shop drawings ❑ Prints ❑ Copy of letter ❑ Change order GATE Joe NO. � ATTENTION /V 01' r AV1_ _74 ❑ Plans ❑ Samples Fl COPIES DATE NO. DESCRIPTION 9FI 7 THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ Approved as submitted ❑ For your use C-1 Approved as noted 0 As requested ❑ Returned for corrections ❑ For review and comment Cl ❑ FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS the following items: ❑ Specifications ❑ Resubmit-copies for approval ❑ Submit copies for distribution C3 Return- corrected prints COPY TO-- SIGNED:--?- of At once. rr DEPARTMENT OF HEALTH Division of Environmental Health Services 1 10 COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 r:ei..K_ - i"]e. KC ..r !!:¢�. +a .i.-w . �. �_... s_. a. 4._... �a- �lK.e�xtt- >fwt-.•. >A':x:..�.[Mti -mss. .eY./sray a4'.: -a. r. V "TTa ^.n -. APPLICATION TO CONSTRUCT A WATER WELL t� PCHD PERMIT WELL LOCATION Street Address 'J S e- tn' pv Jv�fa Town/Village/City / Tax Grid Number " / / '%�A u r - - . WELL OWNER Name Mailing Address _ Pr iv ate O Public USE OF WELL 1 primary 2 - secondary RESIDENTIAL ®BUSINESS ® INDUSTRIAL O PUBLIC SUPPLY O FARM O INSTITUTIONAL O AIR /COND /HEAT PUMP O TEST /OBSERVATION O STAND -BY O ABANDONED O OTHER (specify, AMOUNT OF USE YIELD SOUGHT ___.gpm /# PEOPLE SERVED /EST. OF DAILY USAGE_, 00 gal REASON FOR DRILLING ONEW SUPPLY O PROVIDE ADDITIONAL SUPPLY REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL O TEST /OBSERVATION DETAILED REASON FOR DRILLING c —. f CJ , z' T Cj or FF g WELL TYPE ODRILLED DRIVEN ODUG O GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: A(o Lot No. WATER WELL CONTRACTOR: Name lJi� / / -liN Address: IS PUBLIO WATER SUPPLY AVAILABLE TO SITE: NAME OF PUBLIC WATER SUPPLY: dJ DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: -j1A YES NO TOWN /VIL /CITY LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED []ON REAR OF THIS APPLICATION 0 PARATE SHE TY'Lj (date) (signature) PERMIT TO CONSTRUCT A WATER WELL dZhk' /U 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. 2. 3. Date of Date of Permit 2/87 Pump the well until the water is clear. Disinfect the well in accordance with the County Health Department attached to this Submit a Well Completion Report on a form Health Department. Issue: Z 19 Expiration: I 51z-f 19�C� requirements of the Putnam per it. pr ided by th Putnam County Permit Iss 'ng f icia is Non - Transferrable White copy: Yellow copy: Pink Copy: Orange copy: H. D. File Building Inspector Owner Well Driller / �7,7/ J P ro O — , If) For ?' _.� O wE, N If) privy �a� TO l� • / privy ` O Pr-/ vie 9 fo O we// REMAIN Cr) r 4i7dor7�/ deco +\ ^ O:(� O,r� O ✓ed /rome -x c P FD - garage post' N G o � J 9 � - -- - - - -- 102.x' � - -- � � r�r• te9ta�a,� j 'o � of CVq r Potob x -- - r/, D P ip� ►+ Pur- Po �� fence � j i �- `� -- ;02.3'x- �� bane RARCEL I f AREA= 2.00 - SF E `� 640 8 7,12 �- Co 0 to n). ��Y •._'"'\ If) ` L� \ `� _ -c't. cam\ _, —� �'� i c��' �� ®P� , s R' /�f{ 63 ' = U os CA WA N r 0 - G, po _ !7 !n 7 rlO 771 -77 tR �, n G;rfl 44t y , wti t °�';.J �r5 ' -17 7 Ir Ff i \if N— �Y1 " r� N1 V 1 ^ ii U1 i t� Q `le, vim r .y 1�\ I d4 v �rjRA .a a y nl a p� ,y ` J r lz LUD l� R � F � i :. ' . 4 SC ,¢ wANAf_w /G�S��I,Q��3`r9lj, ` 5h • [., .r. _ , fit}„• ,M. wr. o � .,i S Pka posEo N'G Z� , �b ny a, r i .. � •r i o � r a V " ed �, i� . :,. � i� ,�°' r q{'•U l x � , t, 1�', �]�� , _ �,,• P '.+,w�h n r � ,,�•! � y- 4t'��r.d '� 't• v' Z }� .,r � � { � V i_,�j .pWuir ��. q d,t 1 �� rt �� I 5_„�,,,r•, : 5' a � 7 �`" r.f n F 4n � P �� .�1 >i x. "G - z a: cSSTS PROP /cd jf V REVISIONS e . V y DATE � / 0