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HomeMy WebLinkAbout2821DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62.06 -1 -18 BOX 24 02821 Om- )a Irm - 6 i r , : i O 02821 loll 004 DEPARTMENT OF HEALTH �ivision of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 �.. .s w_+. . -w. <_- D.D`TJ�T,C'I•'l ri�_L � /P�i -. T!i_r'�lTi!_I _l TT /.1T -T T�TT TTT�.. LVT�T_T •- ...._.ate ... .�_a.. --�.� - - - � ._ : -� _ - 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 a � . � ... ...:. rw w . • • w�:.:..:.+. —e ru- r�+ssr,.... ,. • �c•�.e. � . a;,e•.0 . •, .a .. .:....:.. "' .rl.. � � •,C I� ..� _,. w -. e_. �. v . •-mil �0,. D i1/ /D °n /E. /00 54 ` � • ,� t Q 0'da' . .� e � � i � . ` �i 1 NOM/ O. 'SAO t tv��',4v, r � C Ao IL w , d/• `- y Pb. Oy �- • • IV • C°. \ � •`\ `ACS+ ,t +� '•� - •a 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 : .�-- o � • ... ; �v.io °nip-. ia�. sue' f• 1 tA s4 u vvj ,� . _,_._._�._ ._ ..-z . • 7 � j `� � c : '�- I .� - � �.......�.� -yid s'O \ � ���. �,;.� • i � °asp, •' � � � Y , it .� �• , tq , _ - - - _ }Z .SCE. Ira NZ Ole i • I e - -__ ,_- yea . •.• y � f v � ♦ r j N. 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