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HomeMy WebLinkAbout3034DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www. sca nyo u rd ocs. co m 631- 589 -8100 62.18 -1 -50 BOX 25 me J oil .,L ILI `. 03034 7 0. i ■ i \\4�v70 v1 TWO COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION ;TO- CONSTRUCT yA WATER WELL PCHD PERMIT # WELL LOCATION Street Address (Os- L_,EC-- 4o _ Town/Village/City Tax Grid Number WELL OWNER Name Mailing Address OPrivate D Public USE OF WELL �- primary 2- secondary ;� RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL 0PUBLIC SUPPLY QAIR /COND /HEAT PUMP 0 FARM Q TEST /OBSERVATION O INSTITUTIONAL 0 STAND -BY DABANDONED O OTHER (specify 0 AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED /EST. OF DAILY USAGE %Sd gal REASON FOR DRILLING ONEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑REPLACE EXISTING SUPPLY DEEPEN EXISTING WELL O TEST /OBSERVATION DETAILED REASON FOR DRILLING l_DLID 2 k L WELL TYPE jaiDRILLED ❑DRIVEN ❑DUG []GRAVEL ❑ OTHER IS WELL SITE SUBJECT TO FLOODING? YES _ C NO IF WELL IS.LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. i � Address :tt 0 f _' S'T. PutlVA M IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO V fiLLxil NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED [-]ON REAR OF THIS APPLICATION JaON : E r RATE T (date) ( ure) 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. 2. 3. Date of Date of Permit 2/87 Pump the well until the water is clear. Disinfect the well in accordance with the requirements of the Putnam . County Health Department attached to this.permit. Submit a Well Completion Report on a form provided by the Putnam County Health Department. Issue: 19 C; ti``'�-t. C' 1 'Expiration: 'teq 19 90 Permit Issuing Off cfAl is Non - Transferrable White copy: H.D. File Ye11oW copy: - Pink Copy: Orange copy: owner Well Driller 0— . . .- .' Inspector TOWN OF PUTNAM VALLEY BUILDING, ZONING, AND SANITARY DEPARTMENT January 15, 1988 Mr. Robert Morris Putnam County Malth Dept. Camel, N.Y. 10512 Re: Re-drill Well 65 Lee Avenue - TM#50-2-7 Dear Robert: The proposed reckill of an existing well on the avbve noted property meets with approval of this Department.. TOWN HALL (914) 526 2377 Upon completion, the owner shall submit a completed Well Log and ' Water 'Ahalysis test to the Town of Putnam Valley Building Inspector;Office. MO'D: es Very truly.: y MARVIN O'DRI Building Inspector I- I LAKE OSCAWA NA h � Y� ..� .l .I : .,,- ('!: - «. +. '° �r rte,- 1.. .. ..•:C- w.. .i. ..'.- . - i•- .`f'. TJ ryr K .� .w �r .A• ti. ..i :6.T•s.. w.i. ., ... .. r r i .. i.., 4E � ot • 33- oo °E AdglV3 opcotlC N Lo 09� iy43 Iq- oo E rl co"eErE' i • � � M4S erµy w. µa i ; v L N. ;iA , w' V 9 ;0. o � w� ' ' "339p Ba ; i.6 1 . 11•pSa Loie 7�1 r7 r, /r W PRLY 6 s - N_ 8.43' 8,4 b - ..._. -�i _. - .4a4. r•. ...�.. _ _.S 49 3-0 CIA .'. r s O�G � ✓�iv ©G'J v. .r .._. ..� . .o,< <, _« o. 7 / , i 41 �..:. :t , d y F'� r ,'161. �' v'�•�r -- E AVENUE, & ,e "z ,PZEM/SES.:1;,i ;SNoWN HEZEON AND TMEs`EA5TE9LY . /a' of LoT cm. Ml,IPFENT /rao 'MAo of BU, BELONG/AlS ';TO JOSEPH LEE ES CW . LACE,; �OSCAW q",4. 5 A Ah THE OffltE:-,0 THE ,COUNT:Y CLe j.. CouNrY, t CAeME4 M. Y. ;~As MAC i a I- l' is 4 • e! I r 6x � TITOJe'.;TITLE .- - -� °,� n, 4 `+a {iJ.`w`1f1 '1TIFIED TO: - - UAAtANTEE CO. TCE 8So0490 (05 !ZE: FI V E, PuTN 6 t1A LLEV