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HomeMy WebLinkAbout2481DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 51. -1 -47 BOX 21 02481 - -:o ; T - ; r , , � mk+L i m 02481 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION -TO CONSTRDCrA WATER WE'LL-- -: u please print or type Well Location Street Address: Town/Village: Tax Map # Putnam 23 Cscawana Heights Rd: Valley Map 51 Block Lot(s) 47 Well Owner: Name: Address: Phone #: 201 Saw `4'i1l River Road Richard- u^izzi Yonkers, New York 10701 Use of Well: x Residential '_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 5 gpm # People Served 'ti Est. of Daily usage 6 0 ti gal. Replace Existing Supply Test/Observation Additional Supply Reason for Drilling x New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Tye x Drilled Driven Gravel Other Is well site subject to flooding? ....................................................... ............................... Yes —No x Is well located in a realty subdivision? ........................................... ............................... Yes x No Name of subdivision':,innr Syhiliui Ginn' fnr r;i z'7.i rT Ravin n °' H­. Lot No. 2 r R. Add Water Well Contractor: T.B.D. P L ,V Is Public Water Supply available on site? .................................................. .�:a...k�'......: N. es No x Name of Public Water Supply: IN/ A T "wn a -^ Distance to property from nearest water main: ii / A Proposed well location & sources of contami nation, to be p id o s arat Ian. w Date: �� � Applicant.Signature ~KUFESS���: 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 Departmel 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 Commissioner of Health. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam get.lnty. ^ Date of Issue Permit,lssu' g Offici k �r Date of Expiration t 014 Title: - lr Permit is Non White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Rev. 3/06 DEPARTMENT OF HEALTH Division of Environmental Health Services TWO CO Y CENTER - CARMEL, N.Y. 10512 (910) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL 14 1 PCHD PERMIT �,� WELL LOCATION Street a Add Tess Town /Villag City / Tax Grid Number WELL OWNER Name Mailing G /2Z/ Address ,,,e AV c• /.� Private p O Public USE OF WELL (D- primary 2 - secondary j7RE9IDENTIAL ® PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP ® BUSINESS 13 FARM O TEST /OBSERVATION ® INDUSTRIAL O INSTITUTIONAL O STAND -BY O ABANDONED 0 OTHER (specify AMOUNT OF USE YIELD SOUGHT _gpm /�� PEOPLE SERVED /EST. OF DAILY USAGE 5" gal REASON FOR DRILLING WEW SUPPLY ® REPLACE EXISTING SUPPLY ❑PROVIDE ADDITIONAL SUPPLY ® DEEPEN EXISTING WELL ®TEST /OBSERVATION DETAILED REASON FOR DRILLING -1' (J ® 9 A a d4 AA Di WELL TYPE DRILLED 13DRIVEN ®DUG ®GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES _ -NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: G /Za Lot No. WATER WELL CONTRACTOR: Name ©e?fD &tk,44 04- 1-4/16 Address Ai 01'2 - 6.49&41, Al tY, IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO NAME OF PUBLIC WATER SUPPLY: yV �� TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: /� LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ®ON REAR OF THIS APPLICATION N SE SHEE (date) (signatu e) 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 pro ded by the Putnam Counter Health Department. Date of Issue: — 19 Date of Expiration: " Z2 19 ermit Issuing Permit is Non - Transferrable White copy: H.D. Tile '1 2/87 Ye11oW copy. Btu cisng Inspector Pink Copy: Owner Orange copy: Well Driller 700 �o 0a,�_ 690 690 PARCEL 1 //" N �1 680 / AREA= 3.4275 ACRES !49,304 SF�� 3 f- 680 Ld / O 670 ri W i m erm vnl m E r 660 h w Privy bard? 1 Pri vice to IleO O well �on6d deck \ 4 - L Z wall 650 -102.5' iAr r`e � 3 � x3 � Potab `- Purpe 0 +\ h m` W 640 U 102.3' `\QD Xl G 0 p _ lz h 620 � o MONUMFCIS MF N 42' ,j3• /3• �" sEr N 4SW N 4: 44 o° �o ®SCA W, - 4T. 670 Z Op O 660 6 p�a5 °d 0 061 l � N� �o ^ h N -� Bcm PARCEL I AREA, 8 120 SF.\ 0 � I 05E 4 or P� 0 V0 ` _yiLl 09 P�;n 640 W / Lu a CO ' 14.29' F--mr1 , , /.. 407.00' PrapOSed / , oQ, � ti do 1.0. °° Q ° P a0 ti 0° � a o � a co r pn.,b A P 9 oti 7/ o0 9x05 �° 5 t2o' Pp�e. 0 3• I IV cl 'X' — C IN LED( S 45° 12'2, 14.29' v M HEI GH cup' EDGE OAS TS . P... Q) Z IU Cb c 'X' — C IN LED( S 45° 12'2, 14.29' v M HEI GH cup' EDGE OAS TS . P...