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Home My WebLink About2856DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62.10 -2 -14 BOX 24 ILK k. how L�., , r I6 �L , 02856 °ar PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ APPLICATION TO CONSTRUCT A WATER WELL _ hh - please print or type Well Location: Street s: , / Town/V'1 age , ax Grid # J � -- Block` Lot(s)� T a-fJ G�/ ,p Well Owner: N e: � Address: Use of Well: -70- Residen al Public Supply Air /Cond/Heat Pump Irriga ' n 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought `J gpm # People Served - --- Est. of Daily Usage dal. Reason for Replace Existing Supply Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason ,7k) for Drilling Well Type - Drilled 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: -`-� 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. . f �� I o Applicant_ Signature: �?_ .. /. Datc :.; �'�r?e -►.� : _- .Y_ . _.' . .. _ ... 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 well driller certified by Putnam County. Date of Issue Permit Issuing ffil A.., Date of Expiratiod I o Title: Permit is Non- Transferrdb White copy - HD file; Yellow copy - Building Insp ctor; Pink copy - Owner; Orange copy - )ell driller Form WP -97 LL .'�_hy TITLE NO. ZOI -P- 7135 CERTIFIED TO; PAUL GRCOOKY EMPIRE 5AVI,NG5 DANK FIR5T AMERICAN TITLE INS. CO OF N.Y. IN ACCORDANCE MIN THE EXISTING CODE OF PRACTICE POR LAND SUWIYS ADOPTED ET.TNt NEW TORX STATE ASSOCIATION OF PROFS SSTONAI LAND fUt.ETORS. CERTHICATIONS SNAII AVM OMIT EO TIgSE INOMOUAIf AND INfT1TUIIONS $NO-N NEREON UNDER THE TITLE NXICT NUA•RER SNOW. ABOVE SAID CERTIFICATIONS AXE NOT ER ANS F E EA EIE PREMISES SHOWN HEREON BEING L075 4, S. AF-10 18 , BLOCK D AS 514OWFJ ON MAP ENTITLED 'AMENDEO MAP OF BLOCKS A 4 b - WILOWOOD KNOLL 5, !TA 1 D MAP FILED IN THE PUTNAM COUNT`( CLERKS OFFICE ON DEC. 15, 19ZS AS MAP Na 9•D. I. W Z` Q J 110x/ OR FZDk^11 =R.LY FREq 4 COROTH'( KEIM 3 v+ :a: -.a; �:�_ �..• ;F:i :.i.2y:Y:' �: "�= '{is.' t. .•;. .: �,. ...NtTJ OR fORMERLY J a P� NN - CgRTHUR LgHES .. i i� .....3..w;y 'i;�; '_ ry'•'- •', ;4"-c��..:: t ?+ M ."9eCKLER 140:02i* tI. N P 21 . �. O 3 cot 0 A _� Pe•p. t- 66.16 ti 1 1 1 F• i 18 S{{S O I yfOR"= N IRKt I-A i 5 HOU SG 26 .S ` if •N J- _ .•= .•,'.- . ' .!' IQOsr. i � 1'j 1, •�:3. y, - .,,.... . man •�'' :, �r'p'I"' -.:.:� . - ='t, In i;n t.�A "s'•'A' .eta. .. r0�.. ,...j:;;, ri <',• ��' �T: Itt� R1�' p15 i + J. r! \. �r .,4.GS.'{..Q.e.L,�t:._si:,i O'= N pp�1 P 0 Z t W aw dj Z t F Q i P�ti�jti[r L•?1 A AREA • 24, 5'40 . 1 ` SURVEY OF PROPERTY L SITUA-fE IN THE rul'aets,u t;Tt.��ut, „Ugt��otiipl:ui�:lAapb u }r�SA�eist+�ay4� yew TOWN OF PUTNAM VALLEY AN ..ntlka:Ne• AN..e o.. •Bed Iw IM -*P and 1-41 'ivision of Environmental `ffp� Mm 43`l rvicb, ...eT II mae ....w....e. .......d PUTNAM COUNTY, N E W IA. ....... • _�.,. .iyee•ur• ePp.el. F.r.on -• YORK Lpproved as noted for ao�ormanoe w:ttb SCALE : i'= 30 SURVEYED & PREPARED BY ip i.Cable %eUnd ]Re latfOY]� � D?ITE JUNE IG' 1987 BUNNEY ASSOCIATES pp..�� /1 T � LAND SURVEYORS C{L n Co th 6/e 'rtmentn - RURAL ROUTE e2 FIELDS LANE NORTH SALEM. NEW YORK 10960 1 w N I s I.Ic N. "232 . �E.IIdre A 11",+1 .t 1 �� FILE No 7676: �10 I�— 0 4' R i ° f� FOCUS LIGHTING INC ... 4... ••- -- aiPa.fe_. ..x'`vr;l? �'r}.:�_iJ?�•'L�:.at�: .� ..e. ' •....4.. ..._..�:_ ... '._ ....._ ",� .. ., . •,a..._ ..�• -. ..:. �•. .. .... _..�..., :... Norman Anderson Inc 4 March Hill Rd Putnam Valley, NY 10579 Tel: 845 - 528 -8698 . Dear Mr. Anderson, It was very nice meeting with you the other day. I am enclosing my address and tax map number as well as the addresses and tax map numbers of my neighbors. Please go ahead with the permit, as I would like to do the well soon. Feel free to contact me if there are any questions or concerns. Paul Gregory /�� 2 -14 120 Lakefront Rd. 'tN Putnam Valley, NY 10579 Home in New York City: 212 - 865 -4216 Business in New York City: 212 - 865 -1565 Below are my neighbors: Arthur & Ann Seckler 62.11 -1 -36 12 Swan Lane Putnam Valley, NY 10579 UOfiJiny Kelm 126 Lakefront Road Putnam Valley, NY 10579 -2225 Steve & Kathy Circelli 118 Lakefront Road Putnam Valley, NY 10579 Mrs. Eva Miller 128 Lakefront Road Putnam Valley, NY 10579 Dennis Stanishia 21 Evergreen Putnam Valley, NY 10579 62.11 -1 -7 Tax map number unknown 62.11 -1 -26 Jayne and Beat Ries Tax map number unknown 135 Lake Front Road @ Swan Putnam Valley, NY 10579 255 WEST 101ST STREET NEW YORK, N.Y 10025 -4974 TEL: (212)865 -1565 865 -4217 www.focuslighting.com FAX: (212) r# Public Health Director — - -- LORE IA IVIOUNARI R.N., M.S.N. Associate Public Health.. Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 October 1; 2001 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Paul Gregory 120 Lakefront Road Putnam Valley, New York 10579 Re: Well Permit Application for Gregory 120 Lake Front Road, (T) Putnam Valley TM# 62.10 -2 -14 Dear Mr. Gregory: This Department has approved the well permit for a well at the above referenced address. Please be advised that if.site conditions and/or site plans change and/or are.revised, thereby compromising the minimum required separation distances, siting approval of the wells must be re- approved by this Department. The above well to be drilled will be required to be sampled for the parameters listed in Table 1 of Bulletin. ST -19 (enclosed). All necessary Town permits for the installation of the well are required to be issued prior to well Should you have any questions, please feel free to contact the writer at ext. 2157. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj cc: (T) Putnam Valley Building Inspector 17 3. If the water supply is from.a dri) ed well:.. a. Satisfactory results of a water analysis, for the parameters in Table I below, conducted and reported by a NYSDOH approved laboratory under the "Environmental Laboratory Approval Program (FLAP)." CONTAMINANT Coliform bacteria Lead Nitrates Nitrites Iron Manganese Iron plus manganese Sodium pH Hardness Alkalinity Turbidity MCL (1)(4)(5) Any positive result is unsatisfactory 0.015 mJ1(15 ug/1) 10 mg/1 as N 1 mg/l as N 0.3 mg/1 `0.3 mgll 0.5 mg/1 No designated. limit (2) No designated limit _ No designated limit No designated limit 5 NTU (3)- — - -- NOTES: (1) Maximum contaminant level. (2) Water containing more than 20 mg/1 of sodium should not be used for drinking by people on severely restricted sodium diets. Water containing more than 270 mg/1 of sodium should not be used by people on moderately restricted sodium diets. (3) NTU means Nephelometric Tur PUTNAM COUNTY DEPARTMENT OF HEAL' (4) mgll means milligram per liter. J DIVISION OF ENVIRONMENTAL HEALTH SERVIC (5) ug/l means microgram per liter. ADAM B. STIEBELING ASST. PUBLIC HEALTH ENGINEER 4 GENEVA ROAD PHONE (914) 278.6130 EXL 1 BREWSTER, NEW YORK 10509 FAX (914) 278.79