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Home My WebLink About2738DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 61.08 -1 -25 BOX 23 16 L. 02738 PUTNAM COUNTY DEPARTMENT OF HEALT DIVISION OF ENVIRONMENTAL HEALTH SER APPLICATION TO CONSTRUCT A WATER WELL . Please print or type - PCHb - Permif #� (j Well Location: Street Address: Town/Village Tax Grid #--_ 2 Trail of the 1r11aples Putnam Valley Map 61.1 Block Lot(s) Well Owner: Name: Address: Fred Carlos 2 Trail of the Maples Putnam Valley, NY Use of Well: X Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary xxxxx 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. Reason for x Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) . Deepen Existing Well. Detailed Reason To replace existing loxr yielding well for Drilling Well Type y, Drilled Driven Gravel Other Is well site subject to flooding? .................................................. ............................... Yes No �. Is well located in a realty subdivision? ...................................... ............................... Yes No Y, Name of subdivision Lot No. Water Well Contractor: 11ill Drilling, Inc. Address: 75 Putnam Ave.. Brewster, la' Is Public Water Supply available to site? Yes No X 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: / °12/04 __Applicant $gnature:__ 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 the approved plan requires a new permit. Well to be constructed by a water w iller certified by Putnam County. / Date of Issue 1/o o Permit Issuing Officjr4. Date of Expiration O Title: Permit is Non- Transferra le White copy HD file; Yellow copy Building Inspector; Pink copy Owner; Orange co PY- Well driller Form WP -97 PU7NAM COUNTY DEPARTMENT OF HEALM IN VESEGN OF IENWRONMIENTA}L HEALTH SERVICES APPLICATION TO ABAN)<DO A WATER WELL please print or type PCHD PERMIT # Well Location: Street Address: TownNillage Tax Grid # 2 Trail of the Naples Putnam- Valley Map(6,1? Block Lot(s) Q57 Well Owner: Name: Address: Fred Carlos 2 .Trail of the Maples Welll Type: X Drilled Driven Dug Gravel Other Depth Data: Well Depth 12 ft Static Water Level 11 ft Date Measured 8 12 L 04 Use of Well: X Residential Public Supply Air /Cond/Heat Pump Abandoned I- primary Business Farm Test/Observation Other (specify) 2- secondary Industrial Institutional Standby Water Well Name. Address- Contractor: mill Drilling, Inc. 75 Putnan .Ave., Brewster, NY 10509 Reason For Abandonment: Replace existing low yield .well. Description of Work To Be Performed: Well to be filled with sand and top 20.' to be concrete cut down & capped. Date: 8/12/04 Applicant Signature: PERMffT 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 info io delineat d on the application for this permit has been completed. Date of Is Ate V Permit Issuing Official Title White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -97 A P-4-0ell V ° o ri _� iI �b SAYS 03' .. . - '. . . .. .. 1. - I . . I 01 0 00co ()N 100.0 00, ,� Ode PP 090( 9 660K is q Approx. Loa t (.A ? 0�10 Sep g rank Cs ROW of NOS tJ co 'SION Geneva, load ' New York 10509 • Mlu; Q : RILkINQ, INC. Brewsier; . . N MEMO Frad ['arlos -.,2 Trails of the Maples- Put.Valle 11802? ?0111' 1:2 2 19 709801: 898 0606480.111. WILL DRILLING, INC. 2'7.701 •, 8/13%2004 Putnam County Dept. of Health 150.00 Fred Carlos Well Drilling Permit 2 Trails of the Maples 150.00 Business Checking Fred Carlos 2 Trails of the Maples -Put.V Freegilpe F-I Town Lines Parcels Old Parcel Lines IV Streams Lakes and Ponds Wetlands Carmel Road Names Kent Road Names Patterson Road Names Philipstown Road Names Putnam Valley Road Names Southeast Road Names ://imsserver Page 1 of I ?RMTOUT TffLE rr- Disclaimer: .coni/Freeance/Client/LandRecords/printFrame.htmI , to 8/16/2004 r 11, •1