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HomeMy WebLinkAbout2658DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 53. -3 -11 BOX 23 ills . . Im r r � 1 M =; , JU .�� 4 1,.!�:� 1 • :' : Division Of Environmental H%aA Services . . Y4 TWO COUNTY CENTER — CARMEL, N.Y..10512 (914) 225 -3641 _ APPLICATION TO CONSTRUCT A WATER WELL , e. ) • SrZ . WELL TYPE DRILLED DRIVEN Q DUG._ ED GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: -- LOT NO. WATER WELL CONTRACTOR: Name ffh e� tr Address / �t 4 e1,1 11q �i IS PUBLIC WATER SUPPLY AVAILABLE TO SITE:. ___ YES / NOS • ' - NAME OF PUBLIC -WATER SUPPLY: --" TOW -N /V /G DISTANCE TO PROPERTY FROM NEAREST - WATER- -MAIN - • . LOCATION SKETCH -•' &' ' SOURCES -OF -CONTAMINAT IUN (date) Onll M77� 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 provided by the Putnam C unty Health Department. Date of Issue: a 19 ermit Is ing Official Permit:-i's-non-Transferrable • 'r:•- _ k AUDRESS. WWNIVILLAGE/CI I Y tax GAiU Nun+6ER. WELL LOCATION �. >� �()X .2 os P`tna (/a_ / /�-( N'% /03'7.9 WELL OWNER . NAME • dSr AOORESS: . ,2 0 ELL CB"PSIVAT( ❑ pUSLIC USE OF WELL RESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP O ABANOdNEO 1 - primary ❑ BUSINESS ❑ FARM - O TEST /OBSERVATION ❑ OTHER (specify) 2 - secondary ❑ 1NOUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY O .MOUNT OF-USE YIELD SOUGHT gpm. /NO. PEOPLE SERVED Z / EST. OF DAILY USAGE '�d� gal. REASON FOR NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑TEST /OBSERVATION DRILLING ❑ gEPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL WELL TYPE DRILLED DRIVEN Q DUG._ ED GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: -- LOT NO. WATER WELL CONTRACTOR: Name ffh e� tr Address / �t 4 e1,1 11q �i IS PUBLIC WATER SUPPLY AVAILABLE TO SITE:. ___ YES / NOS • ' - NAME OF PUBLIC -WATER SUPPLY: --" TOW -N /V /G DISTANCE TO PROPERTY FROM NEAREST - WATER- -MAIN - • . LOCATION SKETCH -•' &' ' SOURCES -OF -CONTAMINAT IUN (date) Onll M77� 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 provided by the Putnam C unty Health Department. Date of Issue: a 19 ermit Is ing Official Permit:-i's-non-Transferrable • 'r:•- _ k DAVIb".0. _9R.6tk County Executive DEPARTMENT OF HEALTH bivision Of Environmental Health Services RE: Proposed Well Construction Application #-N JOHN SIMM�bNS', M.D. Deputy Commissioner Dear Sir: Review of the above captioned application has been completed. Additional information or clarification is required as checked below: l.- A detailed reason for drilling the well is required. Ashort narrative is required. For what purpose will the well be'used,.i.e., drinking, lawn. watering, etc. 2. Is the site presently served by:a well? .Explain_ Av zi Q 3.: Is the -site.presently served1by'a sewage-dispos''al system?.; Explain. Icil 4. :Is -the,present structure to be reconstructed? • Expanded?, How?. PQ) 50 , A sketch ,showing -the'location of the proposed well -em--cn- - this .-parcel —the existing'.-sewage sys� - the existing house on this parcel - existing sewage systems and wells on adjacent parcels within 200 feet of the proposed well. - all of the above is not provided. 6. The sketch provided is not sufficiently detailed. See #5 above. Upon receipt of the above information this application will be considered further° very truly yours, John Karell, Jr., P.E. JK:mk Director Environmental Health Services cc: Bldg. Insp. F/L/jk-3 TWO. .COUNTY CENTER., 7 CARMEL, N.Y. 10512 (914) .225-3641 7. ,C) Cn ti o10 ,<iz, O 66.55 IV 46 &7 =3S C, -Z IA rh A-7 v o, r, �,_ mfr /� L-ow 61 14 0 T0,W/,V LINE)7 o� Z- )< IA N-I C9 v 15,3 V -0 6 oof60.36 /4.? 0, 0C I %A 4 CA) c4j 10 'IV 0 N, IV 10 Vv