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Home My WebLink About3064DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62.26 -1 -18 BOX 25 ME I I,yL i , rol No 1 ,;or I`r � �. i�l I ■ ' -L No oil xl • ' DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 C:�JLV►�J�1itlll.�- L�-�WATER WELL PCHD PERMIT #lN" WELL LOCATION Street ddress T wn Villag City Tax Grid Number _5— t W A f os WELL OWNER Name r� Mailing Address r vate r ✓li /`�0 Public USE OF WELL 1 - primary 2- secondary m RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL OPUBLIC SUPPLY ❑AIR /COND /HEAT PUMP 13ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify, U INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED /EST. OF DAILY USAGE gal 0 REPLACE EXISTING SUPPLY O TEST /OBSERVATION Ll.ADDITIONAL SUPPLY O NEW SUPPLY NEW DWELL NG -fit DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING M i !cfi i Is S We #Qjrdl WELL TYPE M16RILLED D DRIVEN DDUG O GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES No IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: #V6 Lot No. WATER WELL CONTRACTOR: NameAlDr MAO t!i%V71511 Address: QT )+_Jj./&,j IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES JZ_NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER RAIN:-__*__'... LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED P o'( ON SEPARATE SHEET i (date) 2,6 1 C / v OW �� (signature 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 thirt7 (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 any and all water or waste products from such well property and in such a manner as not to degrade o Date of Issue: /0J/t/, 19 q_3 Date of Expiration c7 19-- e�—� -- shall take appropriate action to assure that drilling operations be contained on this r other s contaminate surface or groundwater. Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller T3 72 ` 7/ 70 69 68 N.75018 OOe W. I ( 160.00 0.a4'CLR. T �J 1 //1 1,7e�ClA. .� E ' 101.44 3 0 O CY a STONE STEP r� let y O 1 FR. GAR. 1 3 s' o' MACAOA1� 59.77 ylgWq T Hq STONE PW 0 MO O N '°•— "•` RET. WALL I H, W t) W � OL Op' _ .O n. 4•S3 pp.ppr O R =Sf 2jl i OF POST e WIRE FENCE NOTES 1175' I. PREMISES SHOWN HEREON ARE BEING LOTS 106,107,108 AND PART OF 109 PS SHOWN ON A MAP ENTITLED LAKE OSCAWANA EAST Nol (GONG. 27.03_ S I` PAD PUTNAM COUNTY CLERKS ON JUNE 24,1927 1 1/2 STORY. FRAME O.4S'CLR. 29.67' CONC. E ' 101.44 3 0 O CY a STONE STEP r� let y O 1 FR. GAR. 1 3 s' o' MACAOA1� 59.77 ylgWq T Hq STONE PW 0 MO O N '°•— "•` RET. WALL I H, W t) W � OL Op' _ .O n. 4•S3 pp.ppr O R =Sf 2jl i CERTIFIED TO: CUSTOM TITLE SVC. INC. AS MAP 94A. # CTS 91331 Z. TOWN OF PUTNAM VALLEY TAX MAP DESIGNATION: CHICAGO TITLE. INSURANCE COMP. SECTION - 31 BLOCK - 2 LOT - DOLLAR DRY.DOCK BANK, ITS SUCCESSORS AND OR ASSIGNS. SURVEYED: �cTnaR.- 2!, /Sfr BROUGHT TO DATE BROUGHT TO DATE JOHN S. ROMEO P.C. Consulting Eogincers& Land Surveyors 1 NORTHRIDGE ROAD PEEKSKILL. N. Y. L. S. NYS LIC No. 43855 BY:JOHN C. HOFFMANN NCROACHMENTS BELOW GRADE IF ANY NOT SHOWN Certifications hereon are. valid for Bank, Title Co. d Owners for this transaction only. Certifications are not transferable to subsequent Bank, Title Co. or Owners. All certifications hereon are valid for this map and copies thereof only if said map or copies bear the impressed seal of the sur- veyor whose signature appears hereon. "It is hereby certified that this survey was prepared in accordance with the existing Code of Practice for Land Surveys adopted by the New York State Association of Pro• fessional land Surveyors:' SURVEY OF PROPERTY FOR DARIO & KAREN UNGANIA SITUATE IN THE TOWN OF PUTNAM VALLEY PUTNAM COUNTY NEW YORK SCALE: 1 30' Oq, NOTES I. PREMISES SHOWN HEREON BEING LOTS 106,107,108 AND PART OF 109 PS SHOWN ON A MAP ENTITLED LAKE OSCAWANA EAST Nol SAID MAP WAS FILED IN THE OFFICES OF THE PUTNAM COUNTY CLERKS ON JUNE 24,1927 CERTIFIED TO: CUSTOM TITLE SVC. INC. AS MAP 94A. # CTS 91331 Z. TOWN OF PUTNAM VALLEY TAX MAP DESIGNATION: CHICAGO TITLE. INSURANCE COMP. SECTION - 31 BLOCK - 2 LOT - DOLLAR DRY.DOCK BANK, ITS SUCCESSORS AND OR ASSIGNS. SURVEYED: �cTnaR.- 2!, /Sfr BROUGHT TO DATE BROUGHT TO DATE JOHN S. ROMEO P.C. Consulting Eogincers& Land Surveyors 1 NORTHRIDGE ROAD PEEKSKILL. N. Y. L. S. NYS LIC No. 43855 BY:JOHN C. HOFFMANN NCROACHMENTS BELOW GRADE IF ANY NOT SHOWN Certifications hereon are. valid for Bank, Title Co. d Owners for this transaction only. Certifications are not transferable to subsequent Bank, Title Co. or Owners. All certifications hereon are valid for this map and copies thereof only if said map or copies bear the impressed seal of the sur- veyor whose signature appears hereon. "It is hereby certified that this survey was prepared in accordance with the existing Code of Practice for Land Surveys adopted by the New York State Association of Pro• fessional land Surveyors:' SURVEY OF PROPERTY FOR DARIO & KAREN UNGANIA SITUATE IN THE TOWN OF PUTNAM VALLEY PUTNAM COUNTY NEW YORK SCALE: 1 30'