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HomeMy WebLinkAbout2482DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 51. -1 -48 BOX 21 Mhi� i ly i ' J6.1 '; 02482 OWNEI SITE MATT; DATE PCHD Complaint # Name & Relationship (i.e, owner,tenant, etc.) TYPE FACILITY �n gA6—e z_� PHA i,9 a2 Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system. Different location may require submittal of proposal from licensed professional engineer or registered architect. ''? Proposal approved _ Inspector's Signature & V, I Proposal Disapproved roDosal amroved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name. b. Site Street Name, Town and Tax Map number. c. Location of installed carp onents tied. to two fixed points de System description (e.g., 1250 gal. concrete septic tank, drywells surrounded by one foot + gravel). e. Installer's name and number. FICLOc o9,PEAS .A tin. 14CA'Tra (e.g.,house corners). three precast 6' diam. x 6' deep 3. System repair to be performed in accordance with the above proposal and conditions. A a I, as owner, or reported agent of owner agree to the above conditions. SIGI�TURE TI'T'LE . - :.: 6:.em 'r--_ .... CC 'S: *Abe (PAID); YeUc w (jai HI); Pink (A TUMIt) 16 a S C44/_4 .. MO P V_". V4 U4 Y ti 10 5-7� PETER C. ALEXANDERSON County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225-0310 July 27, 1988 ENID L. CARRUTH, M.P.H. Public Health Director JOHN SIMMONS, M.D. Deputy Commissioner JOHN KARELL Jr., P.E. Director Stanley Peterson 0scawana Heights Road Putnam Valley, New York 10579 RE: Proposed Reconstruction- Peterson 0scawana Heights Rd. Putnam Y - - _ -- ...... _.._�_�.._ __�.... (T) Town No. 3~4 -1 -8 Dear Mr. Peterson: This Department approved the reconstruction of the partially burned above- captioned residence providing that the number of bedrooms and square footage of the original res- idence is maintained or reduced. If you have any questions,!please contact this writer at extension 317. Very truly yours, LCW:jb Lawrence C. Werper Assistant Public Health Engineer --------- -'--'- --------------'—�—v----- ' --------'-`------'--'~----�'---�°`---------------'---'—'�--------------------''------------------�--- - | -----``----`--------'-------`---------------- -- ----- ~ce t --- | re P _ - --------------------- -| , �| '-----' --l--------------~-------'----------------------------------'-----------------'-------' / �� w~ .-Rev'; 7' CO 9, PEl 0*neT/,A "p',4i"t Nait Mailing Aiddress Nambe of Bedrooms. paratel"YOMP y Io con WOF Ir. 0, Oihieu. _eq. en Al're .. Rre�riq t tjha t fam`; "above= descnbetl Viii it ' County Department. be sutim�tted Ito the place )in, 4 ' ^` will °be?locatetl "asshOa County. 'as a ,.Do P Date APPROVED FOR CC , revocable', fdi-,' 6`0 Date'- n. U I -sysiiern DIVISICU OF ENVIPLNKENT,AL HEALTH SERVICES DESIGN MTA Si=- SUBSUFACE=SEWAGE'DISPOSAL SYSTEM,.. FILE NJ. Owner E Q 7E ,e.fa v Address Located at ( Street) /%f . A P Sec. Block / Lot 8 (indicate nearest cross street) Municipality Watershed CG ewl -fl✓10 TO BE SUBMITTID.WITH APPLICATIONS Date of Pre - Soaking 2v _ Date of Percolation Test HOLE NCBIHER ' CL,OCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water From' Water Level No. Time Ground Surface In Inches Soil Rate Start-Stop Min. Start Stop Drop In Min/In Drop Inches Inches Inches �1p 7 .i 3 4 G•i3 - 7 �/ ski .2/ " .23 5 3 Of 4 5 2 y` ' o G - y�• ;<.zlv -�;/ '' ezy " 3 ,� /02 ter, /,s,� 5 • NOTES i ` =.,; ;1:` ; .Tests;: to be repeated at same depth until approximately equal . soil rates "" "'are obtained at each percolation test hole,, All data to' be sutmittbd for review. 2. Depth measurements to, be made, fran top of hole. rev. 9/85 TEST PIT DATA REQUIRED M BE SUBMITTED WITH OF SOILS 31 i► 41 /r 5° i► 60 g° 9° 10° 11° 12° 13° 14° /► P /r rr � ~ b I/ INDICATE LEVEL AT WHICH GROUNDMM IS ENCOUNTERED ;We , Jo i E ,veooNZciee-� /N / P INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED /r1or e joti e,60,ov 7'4 rt,!�� DEEP HOLE OBSERVATIONS MADE BY: ���J�n ��c .G 'o DATE: i9 DESIGN Soil Rate Used _ 3/ Min/1" Drop: S.D. Usable Area Provided /p o f Noe of Bedrooms Septic Tank Capacity 1 Soo gals. Type Absorption Area Provided By 00 L.F. x Other, //I C 4�- f u� ,o X'17L wl - /O IN 411 NO Signature 5 Name -Address _Ize�5— SEAL THIS SPACE FOR USE BY HEALTH DEPART ONLY: Soil Rate Approved sgaft /gal. Checked by Date DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 .... .... ... .... PCHD PERMIT WELL LOCATION Street Address O .9Wf Town/Village/City Tax Grid Number �l _y Ap. WELL OWNER Name T i✓LE Mailing Add ess Private E on! . . 3 � w �e O Public USE OF WELL 1 - primary 2- secondary 1 tESIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP O ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify 0 INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT _J�_ gpm /# PEOPLE SERVED /EST. OF DAILY USAGE 000gal REASON FOR DRILLING )MEW SUPPLY O PROVIDE ADDITIONAL SUPPLY O TEST OBSERVATION OREPLACE EXISTING SUPPLY ODEEPEN EXISTING WELL .DETAILED REASON FOR DRILLING W S W 41 „�o,✓s9� WELL TYPE DRILLED DRIVEN EIDUG � GRAVEL � OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: `,.g,FE aSsd�¢st�if Lot No. WATER WELL CONTRACTOR: Name Address:— 8oe6hfSTEe IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: I✓ //� TOWN /VIL /CITY DISTANCE TO PROPERTY 'FROM NEAREST WATER -MAIN'i LOCATION SKETCH & SOURCES OF.CONTAMINATION PROVIDED ON REAR OF THIS APPLICATION (date) PERMIT [ L 4rs, !eo '0 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 provided by the Putnam County Health Departmeen't. Date of Issue: :-,/ --3 19 �g -/���� Permit ssui ffic Date of Expiration: 194 Permit is Non - Transferrable White copy: H.D. File Yellow copy: Building Inspector 2/87 Pink Copy: Owner Orange copy: Well Driller , PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH.SERVICES Date Re: Property of "5-, Located at ��Sn �¢�/,�id� /Gh%�s FcY• Section Block Lot �.. Subdivision of �.Se ;4'('y4W1f_ /Vo. L Subdv. Lot # 75-- Filed Map # Date 4�1a -z /. .2% Gentlemen: This letter is to authorize,J��.i/J�� a duly licensed professional engineer ✓ or registered architect (Indicat.e ). to apply for a Construction Permit for a. separate sewage system, to serve the above noted property in accordance with the.standards, rules or regulations.as promulagated by the Commissioner of the Putnam County Department.of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in ^conformity with the provisions of Article 145 or. 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Countersigned PoEe , R°Ae , # Very truly yours, Signed Gll ,^ Owner Property Address Address '� —C/ / 0 -rp p Telephone Telephone APPENDIX B PUTNAM COUNTY DEPARMM OF HEALTH - DIVISION OF ENVIROIM71AL HEALTH L7R INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS .x »r. .a .' ..: �. . - r.- ..........W.... ..`i- y- ...: ->: _ v.,., -,u .x.:.. .... - .-...n .rr.:,.�i w,:. <....�.,.., . .. U.. �. ., - ,._. .... ........ ....._ ..• ..�. o �.,.:.� .�• <..�:,».':a,.. ,...:.a.' •.u..;,,t uREVIEW SHEET - CONSTRUCTION PERMIT DATE REUI-3VED : BY: h% tion) DOCUMENTS Permit Application Corporate Resolution Plans - Three sets s/s I Engineers Authorization Design Data Sheet (DDS) SUBDIVISION Deep Hole Log Perc Consistent Perc Res,il.ts (3 ) Fill Perc Hole Depth cd House Plans - Two sets Well permit; PWS letter Vari ce Request GENERAL, Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS. Plans & Permit Sarre REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) Sewage System Hydraulic Profile - Gravity Flcw Fill Profile & Dimensions - Volume D or J Box;Trench /Gales ; PZL2,it details Septic ank - Size, Detail Well Detail,'Service Line if over ConStructQri Design Data: Perc and deep results - Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing/Gutter,Curtain Drains (discharge OK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area; shown; gravity flow,suff. size If Paumped Pit & D Box Shown & Detailed House l'No. of Bedrooms Wells& SSDS's w /in 200 ft. of Proposed Systems Property Metes & Bounds House Setback Necessary (Tight lot) House Steer - 1 /4" /ft. 4 "0; Type pipe No Bends; Max. Bends 45" w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 101.to P.L., Driveway, Large Trees,Top of fill 20' to Foundaftii=b 100' to Well;150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains - Curtain, Leader, Footing 351to catch basin, stormdrain, piped watercourse 10' to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' from Foundation; 50' to well 15' Well to PL 9 �w. E� NO 2— ON MON MM =' EM NER M • provided 5 required -, Parellel to contours !?. 00% e-xp. OHM MM F ROB AM .. - MON .- HIM �0 100 yr. flood - ev. MM no 200 ft. - - etc. 5IRM 150 ft. .. .. MM wam tion) DOCUMENTS Permit Application Corporate Resolution Plans - Three sets s/s I Engineers Authorization Design Data Sheet (DDS) SUBDIVISION Deep Hole Log Perc Consistent Perc Res,il.ts (3 ) Fill Perc Hole Depth cd House Plans - Two sets Well permit; PWS letter Vari ce Request GENERAL, Legal Subdivision Subdivision Approval Checked Ex- approval SSDS Adj. Lots Checked Wetland (Town /DEC Permit R & D) Data On DDS. Plans & Permit Sarre REQUIRED DETAILS ON PLANS Sewage System Plan - (north arrow) Sewage System Hydraulic Profile - Gravity Flcw Fill Profile & Dimensions - Volume D or J Box;Trench /Gales ; PZL2,it details Septic ank - Size, Detail Well Detail,'Service Line if over ConStructQri Design Data: Perc and deep results - Two -Foot Contours Existing & Proposed Driveway & Slopes Cut Footing/Gutter,Curtain Drains (discharge OK) Perc & Deep Holes Located Representative of primary and expansion Expansion Area; shown; gravity flow,suff. size If Paumped Pit & D Box Shown & Detailed House l'No. of Bedrooms Wells& SSDS's w /in 200 ft. of Proposed Systems Property Metes & Bounds House Setback Necessary (Tight lot) House Steer - 1 /4" /ft. 4 "0; Type pipe No Bends; Max. Bends 45" w /cleanout SEPARATION DISTANCES SPECIFIED ON PLAN Fields 101.to P.L., Driveway, Large Trees,Top of fill 20' to Foundaftii=b 100' to Well;150' pits 100' to Stream, Watercourse, Lake (inc. expan) 15' to Drains - Curtain, Leader, Footing 351to catch basin, stormdrain, piped watercourse 10' to Water Line (pits -201) 50' intermittent drainage course Septic Tanks 10' from Foundation; 50' to well 15' Well to PL 9 O . C C b d; M m �J�� 4 ftl n. PC, z a° to Q 0 O 0 to a W �Q °I .5 a 0 BEDRM. 7 . REDRM. 2 IDEN /REDRM. 4 ,vonvo ,EORM.o 1414.10/0 BED RECREATION RM. BATH STORAGE C vienao :V .,.<:svr Ran FM E.-7637-2D Home for a S�1 {� .� .z Designed to gain full advantage. from a sloping site with a view, this four - bedroom contemporary home gains extra curb appeal with a series of stepped gable . roofs, including "eyebrow" clerestory windows that wash the vaulted- ceiling entry with natural light. Strong horizontal lines of western wood siding, plus an angled wood walkway leading to the front door, add to the custom -home look. This 3,714 sq. ft. house also is carefully detailed for full energy efficiency. The living areas and the master bedroom suite are on the 1,691 sq. ft. main floor, and the 2,023 sq. ft. daylight • basement includes three bedrooms with view windows, large bathroom with double vanities, a recreation 'room with fireplace, and two storage areas. One bedroom could double as a den or sewing/crafts room and the smaller storage area could be a home workshop. The larger area has direct access to outside, for garden storage. Sliding glass doors in the recreation room lead to a spacious wood deck, for outdoor activities. Off the vaulted entry on the main floor is a three- quarter guest bathroom and the master bedroom, which has a walk -in wardrobe and a skylit bathroom with sunken tub, twin vanities and a separate shower. Straight ahead from the entry is the vaulted living room and dining area, with a full window wall facing the view. The island kitchen, nook and family room flow together for an informal living space, brightened by a fireplace and skylights in the vaulted ceiling. Doors lead out to the' raised wood deck, connected by stairs to the deck below, off the recreation room. A THERMAL CRAFTED'" Home computer readout of Plan FME- 7637 -2D 'shows estimated annual heating costs of $328 and cooling costs of $77 (if built in Portland, Oregon — see page 18 for explanation of THERMAL CRAFTED'" Home Program). 37 is STORAGE 10 DA 22/8.:,/, ARAGEA .....s M'H�T ' BN.2,/8 Ran FM E.-7637-2D Home for a S�1 {� .� .z Designed to gain full advantage. from a sloping site with a view, this four - bedroom contemporary home gains extra curb appeal with a series of stepped gable . roofs, including "eyebrow" clerestory windows that wash the vaulted- ceiling entry with natural light. Strong horizontal lines of western wood siding, plus an angled wood walkway leading to the front door, add to the custom -home look. This 3,714 sq. ft. house also is carefully detailed for full energy efficiency. The living areas and the master bedroom suite are on the 1,691 sq. ft. main floor, and the 2,023 sq. ft. daylight • basement includes three bedrooms with view windows, large bathroom with double vanities, a recreation 'room with fireplace, and two storage areas. One bedroom could double as a den or sewing/crafts room and the smaller storage area could be a home workshop. The larger area has direct access to outside, for garden storage. Sliding glass doors in the recreation room lead to a spacious wood deck, for outdoor activities. Off the vaulted entry on the main floor is a three- quarter guest bathroom and the master bedroom, which has a walk -in wardrobe and a skylit bathroom with sunken tub, twin vanities and a separate shower. Straight ahead from the entry is the vaulted living room and dining area, with a full window wall facing the view. The island kitchen, nook and family room flow together for an informal living space, brightened by a fireplace and skylights in the vaulted ceiling. Doors lead out to the' raised wood deck, connected by stairs to the deck below, off the recreation room. A THERMAL CRAFTED'" Home computer readout of Plan FME- 7637 -2D 'shows estimated annual heating costs of $328 and cooling costs of $77 (if built in Portland, Oregon — see page 18 for explanation of THERMAL CRAFTED'" Home Program). 37 is 10 DA ARAGEA .....s M'H�T ' BN.2,/8 VAULTED VAULTED ' LIVING RK I 3 +/ u ..6 ii• A . ... FAAAHV RU cunno,nln.B�ru■ PLAN FME- 7637 -2D, lose 13/0.10/3 AAAIN FLOOR 1691 SEIM. ■■■ uouc�- ■■u LOWER FLOOR 2023 sq.ft. `� . c:. 160 n�rn� Ran FM E.-7637-2D Home for a S�1 {� .� .z Designed to gain full advantage. from a sloping site with a view, this four - bedroom contemporary home gains extra curb appeal with a series of stepped gable . roofs, including "eyebrow" clerestory windows that wash the vaulted- ceiling entry with natural light. Strong horizontal lines of western wood siding, plus an angled wood walkway leading to the front door, add to the custom -home look. This 3,714 sq. ft. house also is carefully detailed for full energy efficiency. The living areas and the master bedroom suite are on the 1,691 sq. ft. main floor, and the 2,023 sq. ft. daylight • basement includes three bedrooms with view windows, large bathroom with double vanities, a recreation 'room with fireplace, and two storage areas. One bedroom could double as a den or sewing/crafts room and the smaller storage area could be a home workshop. The larger area has direct access to outside, for garden storage. Sliding glass doors in the recreation room lead to a spacious wood deck, for outdoor activities. Off the vaulted entry on the main floor is a three- quarter guest bathroom and the master bedroom, which has a walk -in wardrobe and a skylit bathroom with sunken tub, twin vanities and a separate shower. Straight ahead from the entry is the vaulted living room and dining area, with a full window wall facing the view. The island kitchen, nook and family room flow together for an informal living space, brightened by a fireplace and skylights in the vaulted ceiling. Doors lead out to the' raised wood deck, connected by stairs to the deck below, off the recreation room. A THERMAL CRAFTED'" Home computer readout of Plan FME- 7637 -2D 'shows estimated annual heating costs of $328 and cooling costs of $77 (if built in Portland, Oregon — see page 18 for explanation of THERMAL CRAFTED'" Home Program). 37 is 10 DA ARAGEA .....s M'H�T ' BN.2,/8 - -- '�, ii• A . ... PLAN FME- 7637 -2D, WITH DAYLIGHT BASEMENT `r AAAIN FLOOR 1691 SEIM. LOWER FLOOR 2023 sq.ft. `� . Ran FM E.-7637-2D Home for a S�1 {� .� .z Designed to gain full advantage. from a sloping site with a view, this four - bedroom contemporary home gains extra curb appeal with a series of stepped gable . roofs, including "eyebrow" clerestory windows that wash the vaulted- ceiling entry with natural light. Strong horizontal lines of western wood siding, plus an angled wood walkway leading to the front door, add to the custom -home look. This 3,714 sq. ft. house also is carefully detailed for full energy efficiency. The living areas and the master bedroom suite are on the 1,691 sq. ft. main floor, and the 2,023 sq. ft. daylight • basement includes three bedrooms with view windows, large bathroom with double vanities, a recreation 'room with fireplace, and two storage areas. One bedroom could double as a den or sewing/crafts room and the smaller storage area could be a home workshop. The larger area has direct access to outside, for garden storage. Sliding glass doors in the recreation room lead to a spacious wood deck, for outdoor activities. Off the vaulted entry on the main floor is a three- quarter guest bathroom and the master bedroom, which has a walk -in wardrobe and a skylit bathroom with sunken tub, twin vanities and a separate shower. Straight ahead from the entry is the vaulted living room and dining area, with a full window wall facing the view. The island kitchen, nook and family room flow together for an informal living space, brightened by a fireplace and skylights in the vaulted ceiling. Doors lead out to the' raised wood deck, connected by stairs to the deck below, off the recreation room. A THERMAL CRAFTED'" Home computer readout of Plan FME- 7637 -2D 'shows estimated annual heating costs of $328 and cooling costs of $77 (if built in Portland, Oregon — see page 18 for explanation of THERMAL CRAFTED'" Home Program). 37 is SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LOTkETTA MOtNXRI,ARIV, IVISN Associate Commissioner of Health ROBERT J. BONDI . County Executive ROBERT MORRIS. PE Director of Eriviron'mental Health DEPARTMENT OF HEALTH DRINKING AND RECREATIONAL WATER Norman Anderson, Inc. 152 Barger Street Putnam Valley, NY 10579 Re: Proposed Well Peterson 19 Oscawana Heights Rd (T) Putnam Valley June 1, 2009 Dear Mr. Anderson: 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.. No future water wells will be drilled in Putnam County without an approved copy of "Application to Construct a Water Well" Form WP -97 available at the well Well drillers should retain- the.Orarrge copy of the fornrfor plus" purpose. 2. , A Well Completion Report (WC -97) shall be submitted no later than 30 days after the wells' completion by the permittee'. Please contact me at (845) 225 -5186 ext.2233 if you have any questions. S' cerely, Mitchell D. Lee Public Health Technician celfilF 110 OLD ROUTE 6, BUILDING 3 - CARMEL MY 10512 (845) 225 -5186 FAX (845) 225 -5418 Oil PC,'--',F,) Drinking V' 16(45GI06t R e f I- e r S " "n "I � PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES -..... .. .._.a -:: r-s�..w< �.��en- .� =:.y rC +...:.ge•i*T -:v �.rae�s._'- .e..v. sr. .a - ...�.:...�.: �._. ...dr. ._�. .,.a -�, ... a_.... ::... +...w-- ':_.c- :�r_.cu�w.... ..... -, ro %s•va >n w:�..n-. vs. . I PIN 12: "r18 APPLICATION TO CONSTRUCT A !MATER WELL t Diease Drint or Woe NCH.D Permit ., t � a. • !Nell Location Street Address: Town/Village: Tax Map # f ,¢ ��u• um .j / / 9 �S ca W'G I'm a ///6 P UA 1 /B Map Block Lot(s) Well Owner: Name: Address: Phone #: ,.- 31h�t WC, N-JN (A) C11 P14�11PA Vailet Use of Well: 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 Est. of Daily usage gal. Replace Existing Supply Test/Observation Additional Supply Reason for Drillin New Supply (new dwelling) Deepen Existing Well Detailed Reason C Lot rr, ,,4 1cle I( - 0so' dvS we,(l " i Ad v4 rP W14 for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ....................................................... ............................... Yes _ No Is well located in a realty subdivision? ........................................... ............................... Yes _ No Name of subdivision F //�� Lot No. Water Well Contractor: O.4 VAu � er sd Al Address:' S A U r, 0-1 S � h�J, Is Public Water Supply available on site? ....................................... ............................... Yes _ No Name of Public Water Supply: Town/Village to property from nearest water main: ,Distance Proposed well location & sources of contamination to be provided on separate sheet/plan. da L. -t7 ,...., ....Apkr1cant ;signatureDater _ .. _ 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 Departmei 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 alt ration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam C unty. 1 Date of Issue Jr �% �© 9 Permit Issuin Official: Date of Expiration - ( Title: Permit is Non - Transferable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner;( Orange copy - Well driller Form WP -97 Rev. 3/06 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO ABANDON A WATER WELL please print or type PCHD PERMIT # A l %') -U Location: Street Address: n illag�e ( , 51 x Grid '4s' 1To Map Block Lot(s) Well Owner: Name: �'�'rx h (��.rQ. rsoh Address: �. �1 �.I c� � d'"'`.� Lc: n i �,�or,�..v �. %• (�- Well Type: Drilled Driven Dug Gravel Other Depth Data: Well Depth ft Static Water Level ft Date Measured .� 1 Use of Well: V/-Residential Public Supply Air /Cond/Heat Pump Abandoned 1- primary Business Farm Test/Observation Other (specify) 2- secondary Industrial Institutional Standby Water Well Contractor: Nam : Address:: 1 H'7h a 1% d o L` �fi� 4 S !c7 [x r Y hR 0.H Reason For Abandonment: fit y Description of Work To Be Performed: 8F'v '3> "' ate C) �� t.�..a j s`'4• 7 P Date: y ('"° c 1 Applicant Signature: J�d-Lm." to .iYlrvl� ;i' PERMIT 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 White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -97 .1 wag i B <6®' cam.. . dicht 34'71' zoo pea 44 I'LL t4 AREA MR Kh, j4­ 5K ...... ... ..... 'I've k4� I - ry r PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type Well Location Street Address: Town/Village: Tax Map # V MapI Bloc lt Lots) Well Owner: Name: Address: Phone #: Use of Well: esidential Supply Air /cond /heat pump_ Irrigation 1- Primary � ' _Public Business Farm Test/monitoring —Other(specify) 2- Secondary Industrial Institutional Standby Amount of Use d Yield Sought gpm # People Served Est. of Daily usage gal. replace Existing Supply Test/Observation Additional Supply Reason for Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ........................................................ .............................. Yes — N o Is well located in a realty subdivision? ........................................... ............................... Yes _ No Name of subdivision Lot No. Water Well Contractor: Z&2 Ej v AZI Z)/--- SGT Address: Is Public Water Supply available on site? ....................................... ............................... Yes _ No R Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separ sheet/plan. D:aEe:: Applicant Signature: _ 6 s <• PERMIT TO CONSTRUCT ER 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. 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 County. Date of Issue Date of Expiration Permit is Non - Transferable Permit.lssuing Official: Title: White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Rev. 3/06 ' Tajy Sao •16'43 •p° °' �• —� Sao '0710•E o1>�ps O.Q OO • c 200, 00' deed ' OSCAWANA HE/GHS 4X& ROAD M ova T ROAD L RATA W H G'QK /M /87 sr .ho male At MW r.11ry Mal T rrey SAO" ow wax conphad by ma S 9 end h M d by 7. o. 2'/9 87 nd /A nh1.1.m1oOCTaa with 1M l ,4 n bAael/. f6r Ldnd,Sir= .at�phl 6/ IM N.w York $1.1. Assocla /hn or /'Yo- I.s,Am1 L and Sr:gon. RW7ERD HP 14 1A'S MA/A?a4C. A(r.M5 / SURVEY OF PROPERTY PREP4WD FOR STANLEY PETERSON SITL/4 TE AV TOWN OF PUTNAM VALLEY PUTNAM COUNTY NEW YORK scale / 50' �a� Raa,�b pev.., H87 CERTIFE'D TO: 5TANLEY PETERSOV COMWOMWE4L TH L4AV TITLE AVTW4NCE CQ NOTES : L All cerliticelions are v.bd for this mqp an0 ccp4i' /hereof. onl•• if said map or egeiea beer /he lmpres »d real of lht surveyor whose signature oppeers hereon 2. A/laralion of His docamen /, except by a Mcensed land sr- veyor, l} Nara( a Ttis mop end copies thereof are certified to lhs .'/tore named owner,hYle company and leneing MphYiHai(s named hereogend to those parties o dy. e•-Surveyed in accordance wllh deeds as nole4 • � rlaaa wdt • Y ��' �u _ N I� � I I .1 SOW o I 4N Z ;N �~ N h N Ilk ++ 0 0 zt J I AREA , a79ACRES '. . I I � is rona are• new .rw ;.er ' Tajy Sao •16'43 •p° °' �• —� Sao '0710•E o1>�ps O.Q OO • c 200, 00' deed ' OSCAWANA HE/GHS 4X& ROAD M ova T ROAD L RATA W H G'QK /M /87 sr .ho male At MW r.11ry Mal T rrey SAO" ow wax conphad by ma S 9 end h M d by 7. o. 2'/9 87 nd /A nh1.1.m1oOCTaa with 1M l ,4 n bAael/. f6r Ldnd,Sir= .at�phl 6/ IM N.w York $1.1. Assocla /hn or /'Yo- I.s,Am1 L and Sr:gon. RW7ERD HP 14 1A'S MA/A?a4C. A(r.M5 / SURVEY OF PROPERTY PREP4WD FOR STANLEY PETERSON SITL/4 TE AV TOWN OF PUTNAM VALLEY PUTNAM COUNTY NEW YORK scale / 50' �a� Raa,�b pev.., H87 CERTIFE'D TO: 5TANLEY PETERSOV COMWOMWE4L TH L4AV TITLE AVTW4NCE CQ NOTES : L All cerliticelions are v.bd for this mqp an0 ccp4i' /hereof. onl•• if said map or egeiea beer /he lmpres »d real of lht surveyor whose signature oppeers hereon 2. A/laralion of His docamen /, except by a Mcensed land sr- veyor, l} Nara( a Ttis mop end copies thereof are certified to lhs .'/tore named owner,hYle company and leneing MphYiHai(s named hereogend to those parties o dy. e•-Surveyed in accordance wllh deeds as nole4 � I I rd Iat N �e . I ID / O O 14KES0WCA WANA AOW-1 T Alae Y7/961 ' Tajy Sao •16'43 •p° °' �• —� Sao '0710•E o1>�ps O.Q OO • c 200, 00' deed ' OSCAWANA HE/GHS 4X& ROAD M ova T ROAD L RATA W H G'QK /M /87 sr .ho male At MW r.11ry Mal T rrey SAO" ow wax conphad by ma S 9 end h M d by 7. o. 2'/9 87 nd /A nh1.1.m1oOCTaa with 1M l ,4 n bAael/. f6r Ldnd,Sir= .at�phl 6/ IM N.w York $1.1. Assocla /hn or /'Yo- I.s,Am1 L and Sr:gon. RW7ERD HP 14 1A'S MA/A?a4C. A(r.M5 / SURVEY OF PROPERTY PREP4WD FOR STANLEY PETERSON SITL/4 TE AV TOWN OF PUTNAM VALLEY PUTNAM COUNTY NEW YORK scale / 50' �a� Raa,�b pev.., H87 CERTIFE'D TO: 5TANLEY PETERSOV COMWOMWE4L TH L4AV TITLE AVTW4NCE CQ NOTES : L All cerliticelions are v.bd for this mqp an0 ccp4i' /hereof. onl•• if said map or egeiea beer /he lmpres »d real of lht surveyor whose signature oppeers hereon 2. A/laralion of His docamen /, except by a Mcensed land sr- veyor, l} Nara( a Ttis mop end copies thereof are certified to lhs .'/tore named owner,hYle company and leneing MphYiHai(s named hereogend to those parties o dy. e•-Surveyed in accordance wllh deeds as nole4 l.; t� a� i" i q N / F RAMMOMD/ 9 G/ZZf e 1 t siL /. tao �) - 504 51'20 "W 827.77' deed - 904 3636 "W 927.77' coats, 1t .4 1 Q s p i" y .... __ _ t is ... ... ....... • -• - -- 0 =s o 33292' ' - 7!04.03'45'?" /54.44' N04.43'051' 340.86' ; ' d P i AA 'LINE l#1YST • AS PER " FIL D FNTlTLED 367, E JECK m \ FAA" A 1 C,NlS 7AM CO/blfgS' FRED AJ M9P NR J6) , DEC 7, 916 N IF G/ZZ/ L 910 / cp 277 - � y 9 � ;�' <. i ^ ": �,,. I t `� � Q ', �. ' S ;: W � i �{ � °s �'� �; �, �z s � r a:6