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02821
loll 004 DEPARTMENT OF HEALTH
�ivision of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
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_ - PCHD PERMIT #
WELL LOCATION
Street Ad ess....{{
zrhLovQ. tA-A
Town/Village/City /- Tax
Ji�.l 1 y AS
Grid Number
-3 k- "5-
WELL OWNER
lewlAct-
Name p Ma.ilin 4Adress I
1�a 1, C, ®dvl`Y
rivate
O Public
1�SE OF WELL
- primary
2- secondary
RESIDENTIAL
Q BUSINESS
0 INDUSTRIAL
❑ PUBLIC SUPPLY Q AIR /COND /HEAT PUMP
O FARM p TEST /OBSERVATION
U INSTITUTIONAL O STAND -BY
D ABANDONED
❑ OTHER (specify
Q
AMOUNT OF USE
YIELD SOUGHT
to
gpm /# PEOPLE SERVED /EST. OF DAILY USAGE gal
REASON FOR
DRILLING
NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY
❑ REPLACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL
(3 TEST /OBSERVATION
DETAILED
REASON FOR
DRILLING
e - ;; w ► eec t�a� o��
WELL TYPE
RRILLED
❑
DRIVEN
❑DUG
❑
GRAVEL
❑
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES _ X No
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No.
WATER WELL CONTRACTOR: Name
Address-
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
_-_ LYSIAN:2 i0 PROPERTY FROM
_.ctiTEAR.EST .WATER ' hA N :_
LOCATION SKETCH -& SOURCES OF CONTAMINATION VIDED
❑ ON REAR OF THIS APPLICATION ❑ SEPARATES ET i
(•da ) /'lAl. �llJ7LJ/j/Ll �'�� /0,.,S7 7� (signs ure)
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 Department.
Date of Issue: ��-' i ��� 19
Date of Expiration: — 19 Permit Issuing Official
Permit is Non - Transferrable White copy: H.D. File
Yellow copy: Building Inspector
2/87 Pink Copy: Owner
Orange copy: Well Driller
Inspector
TOWN HALL
.. - _ _ • -'FiJ'i ivllfrfl' "�AC�pY;` N.Y. ... ..
(914) 526 2377
TOWN OF PUTN.AM VALLEY
BUILDING, ZONING, AND SANITARY DEPARTMENT
October 12, 1988
Department of Environmental Health
110 Old Route 6
Carmel, N.Y. 10512
Re: Proposed Well
TM #38 -1 -5
Gentlemen:
The proposed Water Well site as shown on the.attached
drawing was inspected on 10/7/88 , and as could'
be determined was found to be a minimum; .of one
hundred (100') feet from any reported sub - surface
sewage dispo "sal area.
Applicants that receive permits shall upon completion
of construction, submit to the Town of Putnam Valley-
(Building Department)a copy of the well drillers Log
and Water analysis report before said well is_.put
MARVIN 0 D LL
MO'D:es Building Inspector
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DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New.York 10509
(914) 278 -6130
- .APPLICATION TtJ;uCWC!rnrinT. -a.. ,W-ATE _W-, %,?,;_,
PCHD PERMIT # dV -3 7 - ?.2
WELL LOCATION
Street Address Town/Village/City Tax Grid Number
li E/9LOGKP014V7_ Ak PaTN M l ALOE YIOS3 T/1 -3e- l °
WELL OWNER
Name .
E/T
Mailing Address
12/ /V"'C Al 40 f !'
JXPrivate
D Public
USE OF WELL
primary
T-_ secondary
RESIDENTIAL
0 BUSINESS
0 INDUSTRIAL
O PUBLIC SUPPLY O AIR /COND /HEAT PUMP
O FARM O TEST /OBSERVATION
O INSTITUTIONAL O STAND -BY
0 ABANDONED
0 OTHER (specifq
Q
AMOUNT OF USE
YIELD SOUGHT
gpm /# PEOPLE SERVED /EST. OF DAILY USAGE Sal,
REASON FOR
DRILLING
13 REPLACE EXISTING SUPPLY O TEST /OBSERVATION CI ADDITIONAL SUPPLY
NEW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL
.DETAILED-
REASON FOR
DRILLING
_PieESEAIT W 'tTER S'y ppi- ' — S uM me'R
AJE .-D Ycak RouAv,D S0PP4_Y
WELL TYPE
DRILLED
DRIVEN
®DUG
[]GRAVEL
0
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 IVOKMr A) 01VW P, SO AJ Address: ,&AmEk ST, PUTAJ9P' �IiIL �
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO
NAME OF PUBLIC WATER SUPPLY:. TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM.-NEAREST WATER MAIN: _
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED a
®ON SEPARATE SHEET
(ddte) I (sie tur )
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 County Health Department.
During all well drilling operations, the applicant shall take appropriate action to assure that
any and all water or waste products from such well drilling operations be contained on this
property and in such a manner as not to degrade or otherw's ontamina a surface or groundwater.
Date of Issue: 19�
Date of Expiration f 19 Permit Issuing Official
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy:'Bldg, Insp. Orange copy: Well Driller
MARVIN O'DELL
TOWN OF PUTNAM VALLEY
BUILDING, ZONING, AND SANITARY DEPARTMENT
October 12, 1988
Department - of Environmental Health
110 Old Route 6
Carmel, N.Y. 10512
Re: Proposed Well
TM #38 -1 -5
Gentlemen:
TOWN HALL
P,UTNAM. -VAiLL `v. _Nd�
(914) 526 2377
The proposed Water Well site as shown on the attached
drawing was inspected on 10/7/88 , and as could
be determined was found to be a minimum.of one
hundred (100') feet from any reported sub - surface
sewage disposal area.
Applicants that receive permits shall upon completion
of construction, submit to the Town of Putnam Valley.
(Building Department)a copy of the well drillers Log
and Water analysis report before said well is put
- .
MARVIN 0 D LL ' .
Building Inspector
MO' D :
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Division of Environmental Health Services
* TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
Y
APPLICATION TO CONSTRUCT A WATER WELL ._
W YO
PCHD PERMIT . # 6�
WELL LOCATION
Ioiacl %v lag�j'i( ity ` " 'tik Grid Number
WELL WN R
,} Q� e
Name Mailing dress
4�L i 4 h ,�i AST �.: ..._.� 1' j � . ooa
Private
'o1lublic
r SE OF WELL
�1 primary
2- secondary
A(RESIDENTIAL OPUBLIC SUPPLY QAIR /COND /HEAT PUMP
BUSINESS O FARM O TEST /OBSERVATION
0 INDUSTRIAL O INSTITUTIONAL O STAND -BY
0ABANDONED
O OTHER (specify
0
AMOUNT OF USE
YIELD SOUGHT
gpm /# PEOPLE SERVED /EST. OF DAILY USAGE gal
REASON FOR
DRILLING
NEW SUPPLY
O REPLACE EXISTING
OPROVIDE ADDITIONAL SUPPLY
SUPPLY O DEEPEN EXISTING WELL
OTEST /OBSERVATION
DETAILED
REASON FOR
DRILLING
-'" J, c,. v, �`Ax c
r SO-) oo s W rA ce t :cvS
of r�c� J rat.
`Y
j
WELL TYPE
PPRILLED
DDRIVEN
DDUG
DGRAVEL
0OTHER
IS WELL SITE SUBJECT TO FLOODING? YES X -NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No.
WATER WELL CONTRACTOR: Name �� c ;'A Cx c-i Addres� T �c�c 5� �. � ,44 rn ' 0 ' +1 e � a
r
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER, IN:
L4?CATION SKETX .: - SOURCES CF'. CONTA.`;T;rTATION - ?'
_� ..
ON REAR OF THIS APPLICATION v _ SEPARATE SHEET -�•
(da e') p fvrA4/if (signature)
7
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;Tof = part 5 of the New York State Sanitary Code, and
.provided that within this "ty 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 Department.
Date of Issue: Oc 2 19 ` �J
Date of Expiration: - )-6-:11 .19 y Y ermit ssuing cia
Permit is Non - Transferrable mite ooPy: H.D. File
Yellow copy: Building Inspector
2/87 Pink Copy: Owner
Orange popy: Well Driller,
DEPARTMENT OF HEALTH
Division of Environmental Health Services
OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310
" '° °` -`AI''i'Y"2�•15i1�F"'�FO � (S UCT A WATER WELL r a.T�...�.: =�,�, •
PCHD PERMIT # W
WELL LOCATION
Street Address n Town Village City Tax Grid Number
/ EM c O A17-D PU EN M Vfi u ' V6- - 31?- /- r
WELL OWNER
Name
K,e / T!t GROG
Mailing Address
'YO E 8.2 "`e's T -/V LC VP, /QO,Z 8
RQPrivate
D Public
USE OF WELL
0- primary
2 - secondary
RESIDENTIAL
® BUSINESS
® INDUSTRIAL
O PUBLIC SUPPLY O AIR /COND /HEAT PUMP
O FARM O TEST /OBSERVATION
O INSTITUTIONAL O STAND -BY
O ABANDONED
O OTHER (specify
Q
AMOUNT OF USE
YIELD SOUGHT gpm /# PEOPLE SERVED /EST. OF DAILY USAGE gal
O REPLACE EXISTING SUPPLY O TEST /OBSERVATION G�ADDITIONAL SUPPLY
kNEW SUPPLY NEW DWELLING O DEEPEN EXISTING WELL''
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
CU,PLY- 5UM14eR CaLv
A)66Z yE14e RE 01vO Su N
WELL TYPE
DRILLED
®DRIVEN ODUG
[]GRAVEL
O
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 No em";yy fiAj,DF,e-SO
N Address: Om"5EQ3'7 . &V4X
j%/fiLt.t�i'�i!}
IS PUBLIC WATER SUPPLY
AVAILABLE TO SITE:
YES �_NO
NAME OF PUBLIC WATER SUPPLY:
TOWN /VIL /CITY
__..,
TI TANCr TO F'RCtPERg: =FROM TFARFST -_ WATFR_i T_N �.. ._� _. _ ... �. _:_ __. -• . -. _
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
O ON SEPARATE SHEET
b - - �
date) (s na 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
thirt;r (30) days of the completion of water well construction, the applicant shall:
1.
2.
3.
Pump the well until the water is clear.
Disinfect the well in accordance with the
Department attached to this permit.
requirements of the Putnam County Health
Submit a Well Completion Report on a form provided by the Putnam County Health Department.
During all well drilling operations, the applicant shall take appropriate action to assure that
any and all water or waste products from such well drill operations be contained on this
property and in such . manner as not to degrade or oth wi contam' ate surface or groundwater.
Date of Issue: � 19 q z
Date of Expiration %,. 19 Perm ft- Issuing Official
Permit is Non- Transferra le White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller