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MEMORY TRANSMISSION
REPORT
__ _ _ ....:,. ," .._ _.. _
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TEL NUMBER 8452787921
NAME ENVIRONMENTAL HEALTH
FILE NUMBER
939
DATE
AUG -21
09:36AM
TO
95262595
DOCUMENT PAGES
001
START TIME
AUG -21
09:36AM
END TIME
AUG -21
09:37AM
SENT PAGES
001
STATUS
OK
FILE NUMBER
939
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DEPARTMENT OF HEALTH
Division of Environmental Health Services
110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225-0310
APPLICATION TO CONSTRUCT A WATER WELL
PCHD PERMIT
WELL LOCATION
Str et Address Town Vill ge City Tax Grid Number
16 A ST ' ToTgkkk N11ni 1,' - -/0
WELL OWNER
Name
�?l64d! JZ
Mailing Address
5 C 4 C1)wCirr+ sr- u
rivate
Public
SE OF WELL
1 - primary
secondary
RESIDENTIAL
® BUSINESS
® INDUSTRIAL
O PUBLIC SUPPLY O AIR /COND /HEAT PUMP
O FARM O TEST /OBSERVATION
U INSTITUTIONAL O STAND/ -BY
® ABANDONED
O OTHER (specify
®.
AMOUNT OF USE
YIELD SOUGHT_ gpm /# PEOPLE SERVED /EST. OF DAILY USAGE 0& gal
REASON FOR
DRILLING
REPLACE EXISTING SUPPLY O TEST/ OBSERVATION Q ADDITIONAL SUPPLY
❑ NEW SUPPLY NEW DWELLING ® DEEPEN EXISTING WEL
DETAILED
REASON FOR
-DRILLING
%�C
WELL TYPE
UPDRILLED
DRIVEN
[]DUG ®GRAVEL
0 OTHER
IS TELL SITE SUBJECT TO FLOODING? YES NO
IF WELL IS LOCATES N`A REALTY S DIVISION, NAME OF SUBDIVISION:
� ► 14� ( mV1XS Lot No. (a b
WATER WELL CONTRACTOR: Name Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO &®A%Y)
NAME OF PUBLIC WATER SUPPLY:
`&0IGT9'UNC - TO 1 1�VL 1 L\ t a Al 1 ' • m T.._u� ret_:. ;
SKETCH b SOURCES OF CONTAMINATION
sc! ON SEPARATE.SHEET
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
thirt3! (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
Department attached to this permit.
3. Submit a Well Completion Report on a form
requirements of the Putnam County Health
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 d ng operations be contained on this
property and in such a manner as not to degrade or q t 'se conta ' ate surface or groundwater.
Date of Issue: 44D, 19 q � �/
Date of Expiration .2°I _19 16 Permit Issuing Official
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
� 4
Applicant: Robert & Caryn Coates
11 High Street
Putnam Valley, N.Y. 10579
Notification Letters Sent To:
Joan S. Onorato
Apt. 1M 9902 Third Avenue
Brooklyn, New York 11209
Philip Fredenburg
10 High Street
Putnam Valley, N.Y. 10579
Pauline Madow
5550 Fieldston Road
Bronx, N.Y. 10471
Town of Putnam Valley
February 26, 1997
Pauline Madow
5550 Fieldston Road
Bronx, NY 10471
Dear Ms. Madow:
Re: Review by.the Putnam County Department of Health of
proposed well for the following property:
Name of Owner: Karen Coates
Street Address: 11 High Street, Wildwood Knolls
Tax Map Number: 62.15 -1 -10 (Town of Putnam Valley)
Please be advised that the owner of the above property has
applied to the Putnam County Department of Health for a permit to
construct a well at the location shown on the attached site plan.
If, as a neighboring property owner, you have any questions,
concerns or information which may influence the Department's
review of this application, you may call Mr. Robert Morris of the
Department at 914 - 278 -6130, Extension 166.
n -'.) � � i�r, - .._..�:... - - _.. -.fit.. - _ -- .. _ ::�:: k ..., -.- _- ._• _ __ _'.
-Z_ .:.;..,.iii: i1 a f'vi" t:iY� -Cep , vREii t.: ' t�Lai- "y0d ilcfv e` i"ec:� r Veil Lit S
notification, please complete the acknowledgement below on one
copy of this letter, and return that copy to me right away, using
the enclosed stamped envelope.
Sincerely,
A
Lenore A. Herbert
District Administrator
914 - 526 -3293
In duplicate
17
Received by: 7 �� �' .� _z; ��� u f (Signature)
Printed Name:; �1r,� �I,7 cry Date: 3
Property Tax Map No. 62.15 -1 -15
265 Oseawana Lake Road ® Putnam Vailley, New York 10579 ..9 �( 914) 526- 3280,�,u....,,,.�,,�i
Town of Putnam Valley
February 26, 1997
Philip Fredenburg
10 High Street
Putnam Valley, NY 10579
Dear Mr. Fredenburg:
Re: Review by the Putnam County Department of Health of
proposed well for the following property:
Name -of Owner: Karen Coates
Street Address: 11 High Street, Wildwood Knolls
Tax Map Number: 62.15 -1 -10. (Town of Putnam Valley)
Please be advised that the owner of the above property has
applied to the Putnam County Department of Health for a permit to
construct a well at the location shown on the attached site plan.
If, as a neighboring property owner, you have any questions,
concerns or information which may influence the Department's
review of this.application, you may call Mr. Robert Morris of the
Department at 914 - 278 -6130, Extension 166.
_rr�li.trc�1an f,�Fii ..v:c' o.�. 3'..�i:+�i �' ..�.
-pa -;f,t as ... �i -at -a �>ave- &cei:vcd-
notification, please complete the acknowledgement below on one
copy of this letter, and return that copy to me right away, using
the enclosed stamped envelope.
Sincerely,
Lenore A. Herbert
District Administrator
914 - 526 -3293
In duplicate
Received by: w4to
QQ _// / (Signature)
Printed Name: D f'e�e� h Date:
Property Tax Map Nos. 62.15 -1 -20 & 11
265 Oscawana Lake Road • Putnam Valley, New York 10579 • (914),526-3280,.__,. -
Town ®f Putnam Valley
February 26, 1997
i
Joan S. Onorato
Apt 1M, 9902 Third Avenue
Brooklyn, NY 11209
Dear Ms. Onorato:
Re: Review by the Putnam County Department of Health of
proposed well for the following property:
Name of Owner: Karen Coates
Street Address: 11 High Street, Wildwood Knolls
Tax Map Number: 62.15 -1 -la (Town of Putnam Valley)
Please be advised that the owner of the above property has
applied to the Putnam County Department of Health for a permit to
construct a well at.the location shown on the attached site plan.
If, as a neighboring property owner, you have any questions,
concerns or information which may influence the Department's
review of this application; you may call Mr. Robert Morris of the
Department at 914 - 278 -6130, Extension 166.
sn:. 1�.� LS uv iiii?Ei1t iivi "`ti c� u - -e— Liicit"yciu"'ha'v'e re- ;eiVe —d- tt1iS _ ..�__.
notification, please complete the acknowledgement below on one
copy of this letter,,and return that copy to me right away, using
the enclosed stamped envelope.
Sincerely,
Lenore A. Herbert
District Administrator
914 - 526 -3293
In duplicate
Received by: 4U.&� (Signature)
Printed Name:. Jo (A"j S : 0A 0P, to l v Date: A"-, /D 7
Property Tax Map Nos. 62.15 -1 -9 & 11
265 Oscawana Lake Road ® Putnam Valley, .New York 10579 ® (914).526 - 3280,,,
SITE PLAN OF COAT -S (H 12.SE N) P2oPf,2TK
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