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Home My WebLink About3066DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62.26 -1 -31 BOX 25 I I INNS I I 1 1114111 0 S' I I I I � f �•�� T ■ 4 6: �� b. 1 IN IN ' T I ' 9 Nil ,, I I PUTNAM COUNTY DEPARTMENT OF HEALTH y DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL a..:. -,nw.: .:�:J C.:. i �' :..o . ..r. :: ^: •'. 11, tA. .''t'C .:.:a:: ..i ^cD , vi ?ii ]' Well Location: 4treet Address: I To Tax Grid ` 1 ap Block Lot(s) Well Owner: e: Ad ess: Use of Well: k-e� Residential Public Supply Air /Cond/Heat Pump Irrigati 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought —S"'gpm # People Served '---'—'Est. of Daily Usage _A_Z— 1. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) eepen Existing Well Detailed Reason 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 Lo o. Water Well Contracto2y7 Address.�'S� 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. Date: 02- S Applicant Signature: - - - 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 �P7R in ate surface or oundwate OVED FOR CO STRUCTION: This` twb ears from the date issued unless Y 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. 11 Date of Issue I v z Permit Date of Expiration -P Title: Permit is Non -Tra sferrable White copy - HD file; Yellow copy - Building Inspector; Pink - Owner; Orange copy - Well driller I '7 e� 094 Fonn WP -97 ,e Ii1`~ • ,'E d,. f �'� `., �� ;,i ',� q "• -•� 1 i' x �G, !I -DHVHSION OF ENVIRONMENTAL HEALTH SERVICES -.. .. .�. w ..'s �' ' IC '.s..JVn..- �...�,...v'.:.-._..L -� -n.'. ✓.�:. r- •vr-- .L"J�6..K :M 'n � «:..� - _. ...� wa rw_. . n .-.nom. APPLICATION TO ABANDON A WATER WELL+ please print or type PCHD PERMIT # W ° '® 2 Well Location: Street Address: Town N' age 2� Tax Grid # o Map Block I Lot(s) Well Owner: Name: Address: Well Type: Drilled Driven Dug Gravel Other Depth Data: Well Depth ft Static Water Level ft Date Measured Use off Well: li Residential Public Supply Air /Cond/Heat Pump Abandoned I- primary Business Farm Test/Observation Other (specify) 2- secondary Industrial Institutional Standby Water Well Contractor: Name: Address: 15-Z S N01i1�0a Aw� o ovi &&6vo Vallem, NV10,979 Reason For Abandonment: ew Description of Work To Be Performed: /tepex, f Ca �1 Dt Signature: tai PERMIT This permit, to abandon one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code, Subpart 5 -2 of Part 5 of the New York State Sanitary Code and /or Part 75 of 10 NYCRR and provided that: Within 30 days of the completion of the abandonment of the water well, the applicant shall submit to the Department a certified statement that the information delineated on the application for this permit has been completed. Date of Issue White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -97', / c,.-. T' �r. 1J. ��►--- �n- '!1'9s•.•�:.Y4..w1�.l.FV�ti \Oast: .�'l- VL "^'t40.J•r. Yl•. ..".iF BRUCE R. FOLEY Public Health Director T- . • ,- �oi�TiTA'°`�"dL�r;�iii�ii�:! `Fi:Siv¢:.- �`:.,:�.: 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 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 Norman Anderson, Inc. 152 Barger Street Putnam Valley, NY 10579 Re: Proposed Well Imrich 636 Oscawana Lake Road 62.26 -1 -31 (T) Putnam Valley. April 17, 2002 Dear Mr. Beal: On February 27, 2002, a field inspection was conducted on the above referenced lot by Daniel Hadden, Public Health Technician. The application to replace an existing well is .:..._.w.._. �a�,Yr�v�d��rir�h� ��11�v�ing �tiU ;ul�tio�:�...__ .__ �.:�..�.�._. ___ - .:_:_.,. _ _ -- .., -. - - - • - 1. A minimum of 84 feet of casing must be provided for well protection. As -built plan, Well Completion Report (WC -97), Well abandonment, if applicable, and water quality analysis shall be submitted no later than 30 days after the well completion by the permittee. Please contact the writer at (845)278 -6130 ext.2235 if you have any questions. Very truly your orwrloj �aj� Daniel Hadden Public Health Technician cc: MJB, file B 44.0 `\ N - cu \ \ ® \ \ cu )< C) OLb n 1 42.2 R \ • (JS� 8 � 42-28 \ � \ � 42.28 \ ; � • � w \ \ \ , � \, � \ , • i \ \ �` \ ATM, \Y ".: — a. CL Lij 44.49 4t �f 9p2 tp aorp 22 ROAD po N O 40.07 31.05 9. ! 7 S1'Ob 0Bf 0 261 \ , , 602f \ ° e tv 1 \ LL \ M d 1 F 1 I jJP1kY' �UVS. `�'�GULVSGYI � Q l/L C,I U Ste. 15 LA S e 0-n 0- ma I� U T KS ToLtm �I i•S' �S OAS CAS k Imil.O vt4&.6c.til u� ✓ �. ` 14'1'._ V 44 C�+• d4 r l C� 7� 9 47s- Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Associate Public Health Director Director of Patient Services Environmental Heald (845)278-6130 Fax(845)279-M] Nursing services (845) 278 - 6558 WIC (845) 278 - 6678 Fox (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 279 - 6648 Presetod (845) 228 - 5912 Fax W!4 228 - 6113 Norman Anderson, Inc. 152 Barger Street Putnam Valley, NY 10579 February 21, 2002 Re: Proposed Well: Imrich 636 Oscawana Lake Road (1) Putnam Valley Dear Mr. Anderson, Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: 1. Certified Check or Money Order in the amount of $100.00. 2 - _ Site plan (or #ax map) of property showing.locatons_ of proposed well, - existing I ` ..:: _ ��s.'•C.�5 aa7`ail`ivua: "`i6 well s•'ilailti�dImengioned'roln two fixed points 3. The site plan is to also include location of all existing septic systems and wells within 200 feet of the proposed well as well as all possible sources of contamination within 200 feet (i.e .< salt storage, oil tanks, land fills....) If there are any questions please contact the writer at (845)278 -6130 ext. 2235. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very truly yours, at" Daniel Hadden Public Health Technician A C4 Sheet_ of CAW * PUTNAN I- .COUNTi' DEPARTMENT OF HEALTH 4� DIVISI N OF ENYIRONIVIEHTAL 1iF.ATLR S,FRVtCFC_ L cif'. .3-•..�'° -3 a_. ,:; -'s e° Y.. �.ctc �. a• FIELD ACTiVITY REPORT can Street Town State Zip PERSON IN CHARGE CSR TNTF.R VTFAM i G Name and Title TYPE OF FACILITY: FINDINGS: ,✓' JW e G1 01AA I . �rp -A )Lt 0 Signature and 'Title REPORT RF.0 F.T`UFT) RY: I acknowledge receipt of this report; SIGNATURE; 02/96 Title; Rev. {