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HomeMy WebLinkAbout2592DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 52. -2 -37 BOX 22 02592 . r ' kv . ._ 16 , L I IL F. L 02592 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL - - - - - - P P •_., .. -typ Well Location: Street Address: Town/Village Tax Grid # g k o os �, �,t e I'al wrIL! V,*Ille% Map 5 2. Block 2 Lot(s) 2 J� Well Owner: Name: Address: od ©re Loo 9' 4.00r i 4Ne Pv7�U ,e Use of Well: ,/ Residential Public Supply Air /Cond/Heat Pump Irrig tion 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary t-- Industrial Institutional Standby Amount of Use Yield Sought 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 ,e d U) 9"v b le- d V-0 tf S for Drilling Well Type ✓ Drilled I Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision Lot No. Water Well Contractor: lVo r M �l a AA2d yr_r o �tJ Address: � a rrc ,P, r S �"', eaLy -A► , Is Public Water Supply available to site? ...........................:...... ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Date:© _ 3 d v 2r Applicant Signature:_. N) PERMIT TO CONSTRUCT A- WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Artier l0 of tle; Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary r- ty terry p terry Cod�and;ir.�v�ed that within thirty (30) days of the completion of water well construction, the applicant or theiraesi 'a'r'ed representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordame v 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. y revision or alteration of the approved plan requires a new permit. Well to be constructed by a water ell 'ller certified by Putnam County. Date of Issue It o L— Permit Iss ' icial: Date of Expiration // 0 Title:_ Permit is Non- Transferra le White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 ENT POPOSES ONLY ED FOR CONVEYANCES OAIOM IE'WALL COMPANY IT. OLD TOWN, AOIINE ' .REVISIONS :SPECIAL "DISTRICT IAFORMATI S- rkaa', =' . . 41 �JaeunlA sca¢ain9avuaDa _ 1u.•a•1er. n .. vi rdm -1a. rnur I ••n wim sm QImIcT ,• met 1n1[ .uw 011101.11a. - IOVx UR - wl""KUW -___ IIODt 11mv - - - 1mm! uR alllxa u Nvlllm A11fA/ , MINiMI! wthrmlr Aa00.&V. 4IRm/IAmIlt i MIA Cloin Lin 1a&a /IWIV IN , 'rm a rAlm loam k wa«. lrimn u Y....d Y+.S...ar.. u Y NY 'a,a u.. vYUw tl �OMalnp nn na a- rata r ImRC1Im n1WIa P/0 41.2.1_- '� -'� _ -/0 2.14.-__ P 41. ,.El(EMP7 . /• _ '' CUR CL.FANNP.�ST00( MEMONI AU ST ATE. PAAX '; NCEL FAMN ,- NCE It TATE PAB6S*il'� . .� •�. i I Sl 1 �!•� 63.00 At 9 .ti" .63.88 At CAL. I � � r f ° 114.49 CAL, �..; At 61.82 AC. 1 ,: I. wxco� 54 454.13 At CAL � I e:eryc IpAU ' 2 AF2M W 4 4.10 rally' t •� 52 6 .35 AC. CAL N q I - C 24.04 At CAL. >+, a2a 0e. 71 .�.` ' .14•. \� • CI I \ �1• 0.1E /Gi.E 7D an �'4. &3611n. � .� � "'� rY 7.4 J `'•J � � I Yp'O \ e A6D An. y 8 I Hp�� 6.Dx 10.21 AC. AQ 10 4 m nee 9 A•m 9 . 3. / 535 AC. CAL • 8.621AC. }' C. 19' �Jr `•a°'I° 10 rti AIx 10 I^• 49 J 96 +�,� s tea` i 4 �f . N „N.ri 5.26 AC ° '4 IA4 I I t Faa J S. At: 7.03 AC. J ;'•II v_ J 10 a4 I\ 4O 4'r° / 12 1d I / 80.13 At. CAL 7.82 AC. 46. T.6B AG D!'L f J • / y u /�$ 1 1 �y y� $ J / �6 5.67 AC ' �' � °•' }. �,�r a jl 0 'dry'D 44• "fS & y A 0.23 AC. o I I mnm 39 1 41 ? 5 19 q Is AC.o 47 p 14 Qtl 8.50 AG •NV - f 4P .6 ,32 tl 79• t 37 �,I E�81` On! .101.0 r/ 22� Ilaf t`Dy �.J, Ilnol mqA tY 11.. I G 6.82 At CAL �.. • ty r la254.qu_ $ \; 488 At ,. fi IP 12 1 w ROAD t °. goal i� q 34.39 At CAL. i a .� a'4'J: 36 I.0 Qg 1 n `14J • 8 I • I6 IT 4 6.51 bC. SY 3250 At �0 .r AG � 1 N N•/ Y ,� na ioASSi..O n.. o �}Od� I653AG1C AG .40 A�C.a "'m AC ul. J �aG 25 ./ xq 6 8 . � g J d' H . 9� f •y. �i,K a Ig X11 3.46 8 24 0 26 rs s& 32 a 26 '9 ° B '• Aa 23.85 AC, CAL 13.12 A 20 •� 1W 3.2 .x ,2, ,1?AC. '9• 266 r.`A ±\ % za Y f . / ,. .`A �Yi Ac $ ' '3 ; Y:BZ 27 29 a•Y AG - AG 41rY Yr 31 I• o ap0 • k >� �� t IB 1T 4o 7 r, $'2119 J E.27 INA I&. AD2/ AC, a P'D 1'`µ6T•AG K • ,C 20.89 At. CAL 4' vu• 4 22a `S 12.48 At .. ,r 6,3�5•sAC. '}' � y '� s a ¢ .o° Qy, � 31.25 At fJ1+ t 31.25 AC. CAL. DAID Alt' 21A Y 1 25 I ESffi AG . 0 \..�• 8 .•aa`N;M1 I L29 AG 20 =2- 8In. nl.n elnn 26 Fro sa ,4 G61 At. 22 W063 -2 -31 a i P/0 63_2.30 �• • -__� 1'3 -T . i MIT- 881 n7 1.511 P/0 63.3.7 ENT POPOSES ONLY ED FOR CONVEYANCES OAIOM IE'WALL COMPANY IT. OLD TOWN, AOIINE ' .REVISIONS :SPECIAL "DISTRICT IAFORMATI _ 1u.•a•1er. n .. vi rdm -1a. rnur I ••n wim sm QImIcT ,• met 1n1[ .uw 011101.11a. - IOVx UR - wl""KUW -___ IIODt 11mv - - - 1mm! uR alllxa u Nvlllm A11fA/ , MINiMI! wthrmlr Aa00.&V. 4IRm/IAmIlt i MIA Cloin Lin 1a&a /IWIV IN , 'rm a rAlm loam . 0..!- f.ulxaf. •nia wa«. lrimn u Y....d Y+.S...ar.. u Y NY 'a,a u.. vYUw tl �OMalnp nn na a- rata r ImRC1Im n1WIa /n r . 60 mwlm AAw . 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