Loading...
HomeMy WebLinkAbout3094DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62.64 -1 -25 BOX 25 I I I oil tv I is IN 1 me J i :I• ti� I ■ 'm IT g ■ I 9 03094 Public Health Director WSI Y _ ........ - . Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, :New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early .Intervention (914)278 - 6014 Fax (914) 278 - 6648 Timothy Greenfield- Sanders WIC (914) 278 - 6678 Fax (914) 278 -6085 August 20, 1999 135 E. 2nd St. NYC, NY 10009 Re: Addition- Greenfield- Sanders, 44 Cayuga Rd. No Increases in Number of Bedrooms (T)PV TM# 62.64 -1 -25 Dear Mr. Greenfield- Sanders: I have received and reviewed the plans for the proposed addition to the above - mentioned residence. The proposal for the addition has been approved as per plans bearing the approval stamp from this Department dated-312-0199--The addition is approved with the following conditions: 1 3 The total number of bedrooms must remain at th kee without prior approval by this department The area of the existing sewage disposal system, and its expansion area, must be maintam* ed .. .. .. o -.. .....- -. • . • _.... .., - .r. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Putnam Valley . If you have any questions, please contact me at your convenience. ML:kg cc: BI Very truly yours, Michael Luke Public Health Technician DEPARTMENT OF BEAU H Division of Environmental health Services 4 Geneva Road Brewster, New fork 10509 Tel. (914) 278-6130 Fax (914) 278 - 7921 PROPOSED ADDITION APPLICATIO-N_ (RESIDENTIAL ONLYI �a�lt 2S STREET TO WN PAA40' TX MAP # 102- C�i � t NAME 11 Yh +k PHONE 2` 2 PCHD # —q MAILING ADDRESS S-r , 'N 4 C 1 0-1 1 boot, /-�ESCRIPTION OF ADDITION 2 k f a kc JCL -r CL'% 2 0 NUM 3ER OF EXISTING BEDROOMS 3 PROPOSED # OF BEDROOMS (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) *Any addition which is considered a bedroom requires formal approval of plans (Construction Permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 4 Geneva Rd., Brewster, NY 10509, Phone 278 -6130. 1. Certified check or money order for $100.00 2. Sketches of existing floor plan (drawn to scale, all living area including basement) * Non - professional sketches are acceptable 3. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map #) * Non - professional sketches are acceptable 4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Cert. of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE Comments Feb 98 i elm ?Cot ose ;r puss 4W Y�tw w(Al �v W%k�o--j mvi kcik�) � \ 0A 9 6010. ti� 00 C , 1. � i fir' of 11 <`, Iill Alk ft 4 -dk Mkft qft d�ft d�ft qq Gz�clq v 6 2.- 41/ 32- PUTNAM COUNTY DEPARTMENT OF HEALTH HOUSE PLANS APPROVE . 1) FOR BEDROOM COUNT OtlLy, Eo D2- -- I- BrOROOms ) natu i9nature & Trallp i T(w Plea syoa� �at�/ L akd Jvv �OV h� ve " T94t s-►ruv II� &Ak 32 04d?.. .o. 3Z. ?7 mold e' � r i PUTNAM COUNTY DEPARTNIENT OF HEALTH . HOUSE PLANS APPROVED FOR :rye (�Q _ SQ,���rs BEDROOM COUNT ON Y; 4V c`7�fA � 3 BEDRGCf;iS -T) P✓ Signature & _Ti tie Date loneog 0 a , +,Ma•.Z r`;.Kftn .�}ti'."VC�•: Aa9: ana+m•rc +i�l••iax .o<.��<OM�•.•W+...�". \'u•/�• 3aN!: I�:.� .a+•• -r .:tea. �.KYW'r».0 r'Yr�. �^'�r. v �c A"�, rr• < .n�. r!b •.r�i.'1 UIIUC@ IL I'OLLY, .11 $, Acting Public Iluallh Dl.'f'ARTMI:N7 Of HEALTH . Division Of Glvironniental 1•Ieal.01 Services ' 4 Gcncva I:o.icl, Brewster, New Y6rk 10509 (9.10 270 -6.130 Putnam County I5chl. of I-Icalth 4 Gcncva Road Brewster, NY 10509 Rc:. 59�/D�iZS Rcsidcltcc Tax Milli Town `t.r.;604' f/v ll GeiiLlcmen: -Accord.inrl to records maintained by the Towel, the above. noted dwelling is . c./ in compliance with 'Town cocle raid the lotal number of bedrooms on record is This information has bccn obtained 1ro�»: CERTIFICATE OF OCCUPANCY: ASSESSORS RECORD: S� �o��o�� `lr G�� Lol 4\ eem f14 13 32.E I Now Znedj I 4 � - , I N*oq for pass' Awk1ju vww.M6 as ... waof 6 r. • \VIHy �`�Jw� (Qk1Sk���} � _ /00 12� . JP?4x.A&a064 I /.mac I Q �' Lpi 0 o Lo &4.0 m Oc, - 4i A\ ("t VA C% k vt kK -t ICL i "�.,%�,,��;itr� , � ,- V- - ,13,-, . 'I , ; � " 'T , t- 4'. � , I ", " ;, ,e .,�", . �,', ,,.,. ,�;-! .��' �i��t . -T,�`, - . :" .�i.!-� ,'. ,.'-I �,.' , ":-��: " - .;, t- ., - � � ,:, I I 1-1-� �-,- I�t�ll- - .. 't , � � .. , , - , . , I. , 1 , ��� - - - .. . -�,,- 4 —�:�'. , --�!�.�'. " . . - --�-,- . . . - . I I , . .: . -.- ; . . , , . , . , . i .. - I I " " " , —_ ,��,,' ��-'. .1 -'t" --""-,,.-- - , . . . . . .1 - ..., I � ;�--:� I , I � I., 1. � ", Y, I `,tE � . . - ,- .. - - I RP , ERS, .1 ,i, I - .. . - . I -1 �. � " - �-. ;, a'*, "'.1 - - �1,!- .., , I � , , - ,- , ,7- s. , -- I bi7 .. I , ..." ; , 11 P,7.�,C)� , . I. - -� ,.�71 . -2 �Ak ,.-R , � I e 11 " , .. Cl�,!A � I 1- � — � . . �4 , � .. P�%,.i �,,, �� �',:� P E�PK S K I U -,�,NEW!- . � �. �- il- i.,, ,,,,'-Y "t . .. i � . . .. . , � - , �,' "I . ' - '75,,� --, ,q���.-.(�-9:1�4),,,7,39--8!,7�2 1-`�4�',� 1��Il . 11 .1 � I `4'. - '',v , , -,, * " , , . , .'-� ", "' I �� !�i.t:!V5-.,",: ,,�f,e,�,.'.". '�`� -, - ,," � �� , ��, - �� � , , ,--[. MR*/ MRS.,, "SA!QERS�,�,,�.:'-'�, �,�,, "' , ,"c', ,ot"?*.A--. 7i�v, �,'*, � . � � tf -""�',,A'.o*p,."iA,mf�, ., , - . I . . 11-1-111- '. , . I ' I , -I.- 1-7�7--- . � ...., . . . -- � 6 .� -;'...."," " .1 �..-.,,�,,! 'ito;'l- - , .. ''' 4 ,:"3404110,',__�,� , . — 441��C-A,Y.UGAi.�IDR..�I'VE-11��r --�,,,��,` -'A - -" ","4';1-,-A � I -�Ii'!-,�.oili `�,, I., . i,�i-,;N $ �i,Vl I . �tAW , A ," �Z;, , i- I I !--- 4l,, ., ' � -�, ,-� - " . ' 11, � .. � , - ` - 't I " ��I,- -Fr - .'�-h-�,,',`�,"PON �. . " RUTNAM '-Q A L L E,�,7e-., �'-'V- t' :' , 6-, ,-, ,.,--.. - i� -�:N-,Y��!-�AICZ-7���9'4-,��"' "' ' lr � � I , �'.:'.. % .. � — .. . - - li.: I- -- �,,�.- - -S" 3� 1 _..- j6,i;, -.411.,.7,�,��,!�����:,.��.,�"t.,.,.��.-,.. " - -f , I . ,�o:F,.- � -, I I. , t,;,',;..,-,�"."�- , - i- - � I -,� 'I".. , �. " , ;t-��,." - I . I . '. .� ,. "7,� "' ,!.,':�,.�� " -:1 - . ,� - - - I -� ��, .,f.,- . , - � � . .. %-r...l:,. ,:, .- . �'_,';�,�,,. " , ,.-� %. " .. - -� ., '..... . o , .�, � I-, : . , , - ,�, .,�.�-,!,!, , . I � ! �;- - � t. . � I -�, .:;,. , ,:-i�,�,�.��!--.,.,--.��..�.;,�..".-,.,,��, "� , ,.�t-;",-,� ,:� ��-. , - ,�-'A �,,,- '��'.;-��-11,�.,.��5:1 I : � � " i ` �, ., � . , " � - ; - -1 ,�,,,��: 4 . , . !.. .. .. . � * I I . . . .1 -' , - ,� t . s ...1-1 � . - --- :. ' " , 11 ,- � .!'M..-�,1,4�,-',� 777, f-,�! - 'I, .. 'I, - � , Q <F a �� , " ." j .11,1�. , , ,.�A - IE,t�, ORPEWr'Np�. -�-,*�,,, � ,, x" . ".�-`-- � , . ,. _p � . —,� . � . .... I I ,!.;,t,'�tl.l . ,� I � 't�'L W - " , .. I. ii,"igl— I #� I-C,�,,�$E-�,RV.�!:-,�fE�,,-,'��,.' .-�,--�Y,. .. -111�" - 9,',--,�,� Fy' --� X,� li , �5 Q . � , . . . ' - . . q � . � I . I . I F,;;== ====;=Fp;,:;F=;;;F;�FF9SR ,..�., lF=o;;;F!;Fm- iF:;; , - . I - - - ... t. . . . .. . � . . ".. —�---'I.- - I t'..''O . . - . ` . I t�, .. ., , I I � ;� I I , , , ,,.tl" � . , � �,"-,t�,."QTY-t ,,' ,�,' QTY,,--,.--' 2k�,��,:I,-T�EM.,-..,�:;,,,;�!�:�l,��'i'��,��,'-�,�".,�- �.,r"`,;t�,,-v���, ,� 1.�,�-,.,r��-,,,�,,�".,I�,�,�- - �- , I I - I . � ok,*;,��,, ,7 �. ,�,��,4�,�,��,-.,�,,,�,��;',"�� . . ,., . ., ,.'� " - .. _:. 1. �-'.. I i��---Q-.-`,-!, '� � - : . f!�.,.��,-o, ' ;, " ,-., -; , w'.. III , , ,.,ji .,��!,--!., � ,`:,�V,, - i, , 11 " 1*11 �7�JPU, -, .-,.-- S -, -1: -,`��,- CQDE '- ,,;,:��e-A-,�t-zbgs . I "', '- - t-��M*l ��J:;:., ,)F H p - --,,� , - -": 77 �-":- , I . I , , , "., K; a �;t,,, I . I.-: � , t,-- l z l-, , .., , � ,1-17 , 'a - .:- , - - '';, , , " . ':!- l;,.4"l','-- - T r, _7 -, -, ,rr77 ... - . . � 77777 7 " -'" " -- ,-�.- I .. - ., -",--�, *r77 ­7 . , � "77:, '--�74i7i'77,7 -7-71,7 ��T4.m---t--r..!---7T�--�.,m-�,-- ."T �or , P , ,. - . ... , � .1 , I . � - . 1-11 - . - � *'� - . 1, ";" , ' " '� �- 9 %F -�E -q.--;--�,�;;, .;, � ��,:Pzum , " -,, p -, ". . -.L:,:,! -; -i-" �q �40 -, - - I-, "I - I:.. ,, , , F --".,, -.11-11.1 �-,t ..... ; , SOL'tj g - , � � , , , " f , - , . . ,.,.-. , ��, -.-' -�,.;`�' " - .- � , ,,, . ...... " I I..." - , . _� . ..... - . -�.,,',-)-',...,, , � --,Igr-.,,rx�----j�g- ",,I�''-, ""'4"Z, !�:., � I'll , , , . ; -, - I'll -n ... �, j?& , � i.---:-� -:,,;.", -, � , , , - , �, - , ,-, -,,�!--,,',�� `',�� ........ --!� " -, '--x - fl, i,? , :. i"K. ­'. o , � ti", ; z. 4- 4- 4- � . , ", ., ,.' .�� � " .� ��, � ,..----;, . .", ,",j - , 1 --k-l"t.-W , " ,- , - - . .:.,, � . . � -,��l " i -11; " 'l-A, I . ... .. , . . - ER . � 4 0-',k,-'�!"-� . - .", .�!:,�.','.,e.!r�,-,,rz'.i�,�-,�,"",;.�','t",",,..-";,��-!*t���, , , 4 .i'.�,- t ,,��.-,,�-�'.-k,-J: -".; ,,,,�,W�,,,,��, :"t. " -, - - - . , , , J -�.!,.i , " . .'' - - ..". .1 �,-,-,,�� - '�t .. . , "., ::,t, , NDER �F ..g,iV�" .- ... .-- � , " ."'. ,',,--� ,.,.�,, ,�,',�� I L,yl � . '.. ": ., L , J��;""`--,�"t mki,l 7,�9�.,�!!,-�:!.."",i�:,.�,�,�-,,.; .,,,, *.-'�`,'-!-�,�'t�'� ��., � 6 - - .,. ��O t_.- . ,�', ,".4 , � _5 - � - , , _ , , . "" , " , . -'..,:., -:I�-", ,�.,�-'�!'�.'�.,-', .tlz�: �,-:---:;",v , � �.� -.,,�,...,',�--..,��.��,,�;� %�l , . , " " -,: - - , , , �,:,, � "'.. ,.'---.,4 '- t , -- -;-.--; - ,."Ltv=4===�:i3O,� ' 1� , " -,- 1-11 . -= - - I.- � C�',7j, -.117. ",.- , i n.11. - 59;'FF21!�,-�,F�R-`- .41 q , ., �.T.,�-,,�-,-,:,---T -- -1 I &?-.'-�-: " - - ,� �, , Vir ... , - - ,TERM -�`O ,,,,*.:.,�,'.�....."-":��,,,",*,:�.,�.,.�%��,�'�'�"- � ,'� �V� . � . , , , , Ul— .. .". , - ., - , ,,. ,'�-.`i 1, � p .;*A i'. , .4% , - - its . , ", , - ,.l. .*, - �- I ..",,I . -I ,- ,m- I �Af :,�,-t',�,'-' .-":, - -,-, ..; , � �,�-,, � * - " - , -�- .�. "., ,., I.;, •".1%, I t: �i, . - j'Fo, -,'' - V, I . . . ! ; � ",.", - , .... , � - - , - , - :1," .;'I���.',�.'-.-:",-.""�:,i.� *-*.,"�IJ:, ',� �, �,�_,�-.,,,-,. ��:�' �.,�,u�"I"�T.:....,;,.",. '',''"',.t . "i "-'- I.' , � , ...`-�:O -, " , I � �,;,% , . ,�,,, -i"', . , . �. f? , - � ; - �,, - � - ,­'.. IV *-, ,� j tl,!".t�,�,*, �;Y,i - O'l- - ',r ` ",,,-�,�'�t,4v -"A ' . � � �%'8- 6t? � , 'i "i'P ' Fl%,'� tE-�':,' 4.7 AMOUNT N ,T,, �'-"i'�'i -' i,"� ', i � - -, - "- I.., �. - - — �k-f- ry ".,;-4, 1, 1XI - V t ' ' 9=. , � " - , , -' �-'-' . ',�� - , � - �- , 'i �,%.",- 'j, ,,, , . ,� -�, - � , 4 5A - 6,, - ,j �cicr) *,- ." �,,, ,'�N' P �4 PpI , . .-,. ,-,�-. ,-. -, * ., ., -"t -,,, - , - - - - --.. - ,,, - 40, -1 ,�,,. 1,� .. �,, " x .. ,., - I. - - :-, ;;i -il - t. , , - A, i�l7�,-,-��,."..,.�,.."�-,, ., . , . � ..�,, � - - , , � , , ,3.;,- " m "i-l" �Wk,z ��, . . ".-� , ��r�,hll%�-�,W. ,f � �u , .i. ,:C��7N.�z - z;v�,",: ,-�- ; -', �, �'� - - " , - . .�, , " (�, `114 ,ff,��,��-�.� iv , I t", - " . " ,--..--!",.3, . - ll� I., �,- ... I : 'I.: I `-"�).'-.'i",--"t--, --.,151"�O.� �,Ur"(�Im --,Oz; "3�J!7,,7�'7�,',, -,!"f�,,,,��,�,.,�-,.�'-"",�411.�";"",;�'.��'�. -- - , ". c �*! , -f4,4�, 'v " '� .� � 1171, A - 11 , . � , i -t. , ,;5"-.,!-., , , " I - I . , . . . . -,-;l--.,- . -- , .W­N �!' -!e, 4�- -1. I _ .�,,. ! , . 'IV I 'Zlii_ - , . ". , !.. � � , ., .. I I Z� - :, ., . , �, I -. I - ... . ;- " �. -"� - el-�-,-�� -e,v. �0 - -, - -; I i-N' - ', ... �Vi- , -1- .1 " " -11".- 10, � ; , " . ,". . � - . I , � . ;, ,. , �, , I�V 1;� Si t ,,��' t'. .� . -; .. - , I ,; -� ". ��-�:l � -, -:",�,. .,,�-,� ,,-,,, -, '� �"." , , -..�,,,�-�.�I'�,,�T�,-..,'�,"��-,�l*,�- - , - -,--,.,�.�:: � ��t��', � - I ".,. It.', � M� ,,� -�-,.','.�,,���,�.,,.,'�,,�:��� I %.. . � ".N , , . " - , , �.�, � 4., , 1� I . %- . , T'� i, . � ,:�,,'L� %�41!�- , T: �,,Y,, " .., fR , . I - , " ,'� ,q j� � , V�' � . " I - , . ..; � . -�� '41 , - -,; , ` ", , ,'', , N, - - ,.,- � , ,; -, - , i. , , I . . . . 1 -�.'-, . ��,,- , .t�l,-,, - �,,-�.! �; ; ,',`;��o%'.'.t, --*,. .. .I- � I 11 , . . - - -!r . "i � .. --- -'-' t�,�,,'i,�,-:.�,;-�L-,.",��,��,� , � - � . ,',I. �' ,tz," -1, ,,,� .t� 1- . �t 11, ,:: � �`j� �, - i , ", �'.,!, .- ��-'t.� ;-�,,%,;�;� i,�Zit� I, - - ,. , - ,�� "'. ,.-,.,.,." - ,�,,,, 'Ir , , � �' ., ��" - , . t., � �1, 1.1, 1� I - '. :. �t , * - 2-�.Ps ',t, , . - . . ��,, �;,:�� y � � , . -�. , . � . ,, , - - , , ,i,W' *,k�.Illl. ., ", I , .? 1�11'1. ','�� " , "..'% , , , _ ., � ,� "I 't- itt !": '��,T,:,��, � � , � , I . �l I ...., , I � , , . ;,''. " :-t�*- t". ,��,,j'7,1,r�s),wl":�,,,l�,�,,-t �,, � ,-.,"' -.1. .- , , .� � - . :, ..., � q� - ., , , 01 , �, , , " �'. ',�,'. .. " - - I . .. - , -,.� �,-tJ ". -it "�- '. .. I " I .111, - ----- , . . 1 - -, ,7- - . . � -., -11, � -'� ... " - �� ;-, , ,�_ , � It - I I - ,�i.,',,,,-�� ,- �, i ". - - - � :. - �,,,',';-,- ,,'t'-,,"!,-" , �,,A!f -,- �-", �t�� � ; 1 , ,�. -111�1 `� ,_""'�'*"'!: -�-,,��, . - I g ? � - . , ll�. "4 '! , - s, z t I c " �,'- : ��,� � t: - .:.:" � :," I - - � , , " . � � � , - � - , %,.. :., - - - - �"'�'_'�� ," ?I -�'.. � �r.t;-t- v, ., - , -, -., , ;.. -- - - -;,, .., , , I,�%,", t`�-c, , ;�. 11 1� l,jl �Z,,,, 4 ," � W� , ,,'.f,� . )t--v�l-,', '-w,., � , , -';', , �i :i, ,�,,t.)'�%,:,-, . . , -; "' �' �,' " " "2", '�,, ;,'�',-tll::�� " " ,.,. ,-,�, *"., �, "", -., . _ * ` " ` • - � . . : .t'j ! "', '� -- � ` I �' 11.1 � �11 ": - - I " � . . .:`y,� - -, I I � -, - I- , -,!;;� � - -,,,* �. I . - - j,� : :� ", �'. 'I ,' ,c , � - , . , . : , ,i�-ji; , � , " . , - , , - . , ; " .1 . � ", ., .1 - -, , , . - " ,, ,5, ��,�,- . � . - , ;:, -� I ,. .,..,, .�' , .�,! � , , , :t, - � �,--��, -�i� , ,.. , -, , �. . . -,,�-, ,� ; - � t. - , , � . I. " �- .,-: ,,--,�--- * , , r . , . � ��;, . . .. . . . . .. , ... . � ,- : - � , - � . . . " , , . , . -!�t, . , . -�, , . ., sm , , t .1 '. - - .,� �-- ,.-q, . - ". , � . - , ,Ei, "t, , � � I * , � . . , / t:-. ,.,,u.-��i-. i'l". ��,,, ---, I - .1 1� " "I . 11 I - ,'�,,-,',�:*-'*; - .. � e., """', � ­,". 'i. "I". f"ll 1-111".1. "Ill- . ��? " . ,, "! t , 't, �.,i- Q ll�' . �,.-TIIN V� .. - It:. . , I j , 1; , wl�, ��,t ,,�� ,� il�;WIWZ- ft I . IiITT7 -,-,P`�',�, ., �- .'TY-' . I " ,I," �': � ,-,;�,".q - ., , , "k . *" - , � : ""t& � r . I :�% - . . �., . : "q,tt:,�;:; �, ,,*�:, .� . . t �-- - r - I - -1. , . .. , , '-' ... , . � ., �.-',-*5F�i-.��_, � . . ,� -,, � , I . "",�?"". ."", ',',`� I , : . * . . ; il , . I I I . � . . . . . �tt - , . . 11 � . 111.1 . .. :,.. . I . , .1 . - ... . I . . . 1. � ; - -V * I I � t . . � . � � . , - , I " *-, :;_-'*� '!", " . I . , � , l.-'t--::'-..-, �,-��,-,�i��-.,]:.',--,'.'-�.�",-'�*�,,��.i..;��',-�i"ii..-,,,,:,�- �,- , � - ,I -.e t 1- I , : . . ..� f " - - - . � - 't - .- ':� '-,�-�-, z , , - :�Illt a . .� �- �';, Mt�!IIINZil :.. - - . I -, 11, � ll,�-.,-�, *. * . - � - � ;-,, " , " " 'P, 11 �, , - - w-r I r - ----.�--- �,, - w';, ..,.-, -:n � . , - ,,��l - - , I ; . . . " ': ,*�, � . , 1�151' � , .1 I;- 4'�' --.�-- � , - , - , , , i t I " I ,,, �.,-..,�.�"r,.i-i", , - � , I . 7 � , , I , , � . - -, � . �,:.�� ,�; . ,.''i;-;�--Ti�,, I I 11 .1 - ­v�--l' gi3Oh"A lld� ,,,N,�,,.,, - ",f ;�: : -1 . ". . I ,�., 4, - .. -�-�:, t- -;,%-,��t,-Ml , . , , ; - .L��, - ., .1 - -.0,151i.- , -'!'� � 1. .: i ! - I , . . :15ZE t, 91 �", ,f - . , . - - - - -4, -1 -, 1. " . I 11 .-L �,'?t, -, �.,:� :. - �.,:: ,*'-.., .'� :! ,* �� � .� .*; - ,. - , ,-... . : ��, , � � � —, 11 14", ki , , , , ,� I '74��,'.�� , ', I , � , , "'It, .- '- "-,i � , """, " -��,', '46" � , .; , " - , , , -�',---;- , � ,,,, t .. - ,v , - , t . . - , , il t ", . �I!�,f,�",'.�-,"'; i) � 1, , , , , ,�. Z�; �". � � , �"i-v, , . I . - � � , 1. - ". _ p, �h " . . , � !�',' " -, :�,Mn':. �, -,� :,-,-:: : , -;' . � , , -�,441 � I , , , .1 � -� I: l-'-,!! ,�,-' -,��, ; . - .� " to '�- - �": . :," ,;�� -, ;�,, " ;, , . . . ... .. • :. 1. , . . : " I -.'. "V I 'I ,., � 1. � � vl'.,,,!"�, , �, ,,, -�;, ,--" ,-'--,�,� -,:7 I . I ", . .t".... I. - . '� I I '�, 1. ... - . �: , "s, , , , , I " , , , , . � ��. :". " � ". -,�,,,', """ ,�,T.`.'ti' .,., , t" _- ." . ,!'I ,-!,,tla 11 1, , ^.;. - ;�,' . . - i. .. . : . , , � , . . - . ,:,\: , . I .1 � , .-IN'., : --, " . -', - .: �. . . ., . , . . - - � . , . - � �1`. , � . . ` , * � . I - . � I , , , i t %. . . .. " I . I �- 1 " . ..'" ,,� ,-",-:-�� -, ,-,�-,: .,. � - I � ---:t-, ., ,� .. . . I . � . , I , , . .� ;'. 't. ",.,. , � L� ' � � ..; �� - . � I . ,��, . .? 1. I I . z, , , . , "' - .� � :., �. � - . . . . I . I I -- .�, ,,;i ..",; - 't, F" �, . t , � . I -:- � " ',.,.. ,,-;�, " . 3 " f': � t- ,.,-,,�_�-.i - , '. . , ., . ,- , "'tt, , . � . , -",;� .. . � , . , " , . I " "I 13� , 1, . . - ;. -, ,:�,,- -, , . �1.,' ,-, -.� !'-�,,--�: -*- -, - ., - : -,!� t. , � ; . .. ... �� t . : , , �, , , .� "I I � -, ; : - ,� f,:� .,;., � �, �- ,, -,. -, i . , -, . i'- : " - .. : , . . . I , .'I.. , ,- " , � . ,�. .-� , : ", , -... 1 � '. :t, - * r , . " , _, , - ,�-;'�.:- "'. .: . ., . ,t'. , � 'P- . , ,�.;. ,,, � '� � � " t . . . , -� � ., - -,� . . . I . � �- ,� " , ,, - � 1. . , -. -- ': "! - .� , , - , � .- � - 1�1 , '� :.-�&,�',', - , ,�,;,�i . . �, , , , : . � * -.,--?,,-',' , �i,' - I. V,� , *, '- , - " ', . ,�,t ! � .. , ,�, , . . , "-,.� �, I !�,�,,'� ", . . . , I ,", , , , ', _ ,,-�"',�,''� ,- , *,-� " t 1 � z ', �*�_' t'. . . L', , , ,f .* * 1. , , I'll I I , - ;,,�- -,, , ,� �, , * �! ", �- .,.'., ,�":�, -, - " -,j -.� V.1! -.,-, I :, � . t�', . " " , t� , , .� . - �,,'- �- � - I - - ,.-'-',l�,j. ,14 -. " � 1, V�V' ',' - 1, , illl�4 � , :_�� o I � '-� ,.: �� .,.' �,,': ': - . � � , � , . � . ., , , . , Q � ) ., 7� - t ;. , ., , , 1, . � . �. � .j. �,-- ,, .*,'.t'. , . , . , " .1. I - , I ` - .: � . - , 1, . -, , . - , .� .- 11 ,� , L", -, ;,�r�,,*�tt- � � N..�! '��, . , , - � ,� -I' - , , , I - t ,,� , - 5 , , " , , .. -- , " " I , � �' o, � . , - I � . �' " - I � . � � ` V , ,-,, ,,,, '-' , �, '! . , , I - ", ."", , � � * ': �,�� �, -",."� -, , - , ,;, -!� , . . .. . 1 4: " , , . 'r � - ".4-;-,� .-'I,. '­ , -,-vit - �N� � �,, Tj . . . I ,,I .. A, t� , ,�� ;% I . , - � -1 .-.- ;!.-,�,i-�ttt� � , ." � �� , � ,� � :: ��', " " . ;. � . , , �t I I , � , � 1, " ,�� �-�; ,-� , ,j� 4 , - ... � .;��., , . � .�, ; .., � � I I I "" t,v,r�, - , " -'- � - �, 11 . . . . -t - " , T, , �,, �.,:,� . : ,:,. , �,., I � !. , �;,,, 4" ", " ,tt , I � , � �,�-., � � , � I � � , . , � I- , - ." 11 , - . . , . � . . I . I , , ; - , , " � . ,� . . , - - q , �', , ,� "",".-tt"', ,'�,--�-"-! 't ri �:.,, �, -,� :�*. ��, - - - �,'l �,; -, �A, � I � . " , � . I � .., �� 4. , �.kt� I . , . � -', � .", - .- �' -, � -- - - '.. - -- , - I � --:ii�� � ,ZA-, .. -, '. . ,t,!,�,�,�-� ;li,�!�'�,-� , Z.�', , . � � ". � ; ; . ': t. , r�', .. -�.< '-. �'- -, , , , , � ` , , �,, -..-..,. - � �,; . : ;. S '. � ,�". , , , -,� � - ,'. , ., ., , , - - - .. . , , , �;. tS �! � ". ,.- " �1.'�, I - ,�. , � . � "., - � . 1. . � " . ,:.,, :, " �A . 1, ,,- , I- - - - , - - �,�',,-;.���,�i��""-".,.,��;-� , , �,, �P'.,�' , , - :1.4, �,' , -,-., -,,. 7!:�. , . .� ,:,� ".,;, , , - - - - --;!�. ,; , i. ,-'. ,Wj.� �n- ': a 1,--': , !y . ;'i"i't,; .k� . - , , , , �; ;,,: , , . . ., . ,:�L, i,-,: ,-,:;:� " � .. . - - . �j��,,�tll,l t, " - � � .�v , ,Y , I , , �;, ,' ...... . . , .. , , , :,-A ,111. , - ., " . , � " �T ,��,,��Z,Tl.., ,. - - , � t-,��,-',:A,�,i�7-:�j,l"..:;.','�,�,,, I., �.. I -.� i�,-, - ,-, �,-,� � - , , 'A� ". :: "I . � "I .. , . . I ... , , , , : , ,� ,� � � '� .. �I�i I ��, - .. I � -�I,lt 1, '. , , ,,,,,, � � , r� . I-x , . � " � g,t-*,� � .t,.,* .,,� , , . , .*,. .,�;" ;�,,�,�,�-c, ., �t,�; . � , , y, � � , . , � - r, �;, �,-t.�,-, �, `.'C-j,',,�' 4, ;!,--i!",-, g;t!,� j , . , -,,� -XI2, : ,,A�, , I . , , - �- , - . , , � , " , �V:,� , - , , ti - , -, �- , . , ;�-�t%�j '�j ��,, �," ;;� �j . , " .:f*" � t, ! , � . � -li . " ti s', .";. :, ""I - ,-.. �Z,i -F I , , ��f --,-,--"A--t ; - ., , �': e, `;� . .. I -_ t,,;.-" - � , , " -, , � -t ... .1 I I i.- , .� ,' I ', � . " - 1, ", --1 - V. -,Z I -, - -11. ,: 'V � � .* . 1, ., ,,, � I . . , , , - , .: - , ��, "I., I-- '.. I .. I " t , ;., � , , ��`,. �� , 7 . , � � " ,A.t� ,-��, , � �. i . , � . ; '.I , I... , . r, "', - � , . - , ". I , * : ., '. 'S , , � ,,, ;,:P" �*X': 7f, . , I . ,' i., " . " . . , .. , , - -, -, her � ,,, ;,,q,,,e-,l,7 '�I-;,� ',, ,* -'�,i:�, , .., I 11 ,.i . .. ,;t " , - - t� ;,--,-� i,, , .:,-,-.' 1 l � z , , , -, - I '"�� ),�,�i:�' , . t,�,,�,�� ,�, ,lt�,�� ,�,,�, .��.`, . "" " - Ll'll � 1, .. . � . , , , * - ,:,. - -, . , - . . ; , - ; - � ,,'�-.,t%',�� �_ . , . . ,.. ,l . � - � � , , , � , . ,,� i , ., , ..,. , 'i .., .� , -Nt-, -"f � -;,-!:',',, - -��,-v- -3 �. . �. . .. t-, ,�,-",-"-,.�, . . - �* , , - � - � ,,,��'; it;V,'-,-';�,14� j.":,- , . . W. � I * - - : -,,.�. 11 - , , - ; - , , r - " ,�""'-tt�l,,'-'.! . , .: �, - , , a t . , . . Z�!,-*� � "I. --.��, " � � , :. , :', :�c .. � -, b - - ---, --,�.R;-, . I I .. . -p:',� " .'- , � '\'-,:-,2,- �, ,��".,. . � � , , - -, -e��i�,,,.'.'. " -.';� --� �'�!; � 11 -I.;., . ", '. .,� � tilt-'- -, .'�, - " - � , - - ., - - ��- )�` '.c,.,* 1, ... 1. I . � ;� w, , : - . -, , i � - �, - - , - -� � , , �-1 ', -s , -'.'-" " )� : , - , -,,- -�---f, ', �� , : " , `:^-".., � '. - :1, 4-:t:l'.,Y t,* P*� ., ,,�: ,'- - , - - - .1 I I" "I : ,* -,.. , .. " �' I, � 11 - . . . �, .: , ',"i:;:, j , �, , - - --,,`,��, -.,,;,,,', , - - , ". , . -.; ,��,, � I , -,,�� � �.,, . � .1 , , ... - , . - .. - . � , 'i - , - - , !t t '. �t " ,;�A, � �j I- ;�it -,' ,� ,' , " , � ..: � . . � ,p , :�:,�t, ,.Z,. � .4 4, , , ,k;!�..!, �,,,, � . . , . � � . . , ' - *, I ", !L� �,4 ,,�;�.',',,;��i,,.��t ",;, ;" :"f'n ��,!,- . - . D. .. �t��'.., - .,."�4�',�',� ",A,' !,.�',, , - � .. . �,� - ." , - -1, :.-,��,",; ,-I�, ;�� ;��,�,t�, ,,,'..-, - � "I,-, , I h, ;," t& �t - ,,�� tt�; , � � . ` , " � � � ',,z, 4 &5 - , .. -t, ..I:. . �. � 11", V�' I, -;, � ,� d � . �� , �, ,., , t .�,�14,t� ,t'. , ,t, - n ".., " . - ... , � . . , , ,`='" ,�,l * - * !� , . �-- itl ,,� fl.','t� , P -�',,, ., -,\ . . , 'P� - - -� I't, , . - , lF. -.,. M, ".Z,. , " " , - , ;- � , ; ". ITIA , .. . , �. ,, ,V:,�t: ., `,�� ,13��,,��, X-t�----j, - � -, �-%:�.7t � , . . , -, .�, , . . - ., -, f t. I t, --- '< '�--v�-�,*-.Atl-'. , 'F , -, .... . �,-,"'.", -":, ` - r� 'F� -.�� . u -� ,��j�-%, ',,,. ";---,-", , -��-,,, �, , ... �`-"",,,', ­ - ,t�. . .11 , - I�z . ;, . .11 , .. ,� M's, !"V �, �`. C'4-�'. i3ti A - -,.-m-� -I t: , .-,!', " , '. . , , � , --.- *� ' I 0 E I , . ":, . ... - . , j . � I .1. , I , . -, �,t RK-,�,A-51'4, I ,'.. , , L 1.11.- ;�P, , - . -� � A",; , ,.,.* , A �- . ?R ANG� ."%,-, �.,,-;-E:111- A' I r;_114.1'^� i � "I � I - . - %% I .4 ANTS ;4A N,' P,V ,W2NTS-,,i R i�rM , : , m . . . ;., t . , .1 , I � , . - 't I ., , -�,!. �,..� � , _ � . I I .i , . , : . _ , . , I ... , �� . „- 14; - . , , -, � ,, - - ; : : . .. -., .1 I ,.- , 11 . ., -_�., '-�:-” -1 ; . t. .. - - . --.. ,,,�!,, " - . ; :.� , ,., - z ;,. �: . �,- '. � I :.`� , �. . -!,;t! , V. - I . .I- -1. � � 11.1, - - t:.. � �� . ­ � . t.: I .. . .. -�! , I I . . = - -- .#� = � -;, 1. . . � - �'.. � � i , ,I..:. .. ,9 -T ". ,�,---� .. I �. -.1. 1. I..., — . - - I -.1 . ..� f--;;�.;F"7-;F-�;;4F:;;�������=,;F77�r-�'�'",7,-�',-�,-'- "----77,7F, , "",F,',7 - � . I 6 ` - - : \ -,;.,.;.":. - �.- �-,: .;;fa 7a �� 'T -, . . ' * ' �� '-"�74` 2-1-_ 1- � - -- .. -'�`--,, - ,� m ,�,, " `:" * TOTAL` "�,"-,; .; . !y., - I - , 3 , ,�, , : , . , - 'T - , , -BLE----,,"--SUB,,'.I-.'�',�:-.��F,-,','- - -1 NV ti ftN * I 1-,,�,KA 71J-10,�,",4�'T'� . .. , � , -.,,,!�*�7t,' , TAXABLE , , - - . , , � . . it. *-�"l, �P ", . . . ! " --" ; "I I .1 t, . . . , � , - - .1 ;--, . . 1, . . '. . :. . - . - , , . ....'�, - , :.,-, I I � . - - ; .. I " - ., ; - 1 .,5 ,-.- ��,',",'."�\�q �� 'e-, I '.- ,.,4.1--��"%",.��;��--t,-,-,-, -�,, -.... — I � ; �� lr'.., - . � 7-: �,:,�., , , ,�::-,"...0 lovaa, -)�,., " -,,�: " � ..'� I'li, " ; - - "�4,�-- ,'-4 - --, � -, ll--;�!� ,�,:-��,)!.9,,,,,�l-,4,,-:��lk.: �,-, " , - Ptoc - . .. ., tt, , . . �, . I �� t�ili� �,. � ,,.,.,,::: ..: " ..j � . ,�. . , '! - , , 1. C. � " � . � . . 111. , � rp. W, - I . - � . w ".�� � , � � . , I - • �: ... b �, j�L! 1 . , � m I � .,:--..�--'--m;-P==-m: - - c-:*,i � *,;= - -. - , -=-=--;:;M=--:;;!C�- '. 1---------,-"; - - - -, - . r.�..-�,.,. - !� , "' - "'.. ,--'`-�.'.- 1. , .-, �- -. . '. . ...,:, . 7 IV.. ,r ,�e,j� .. ,:�'- ,---t:,�%',�:! , .1 ,.l, 1, �.� , ,,- . , � -�,�,:, i:�,Ff , . , , ,- ; , ;, - I . ?j�''I'j4"R. -.0 , " *.,� � ."', �. - .1 -, ":� ", T I .. T , �--- -1 � .:�,� -� ", ,, , I - , �,t �-,, z� 'k,:"�,� 7 .. .. � I � I .1., - W,,� .. .�; ". - $�, --,;::� ---'P�Ao,, - - - ''t . ... ... ... '�-:,'� P 3�i',.%-'E-'.,ONATUF�E4','"�'� ,- � 1-1- . I : ..!, ,!;�Y,gWii - , . 4; '! n..-,, �i -`�,,� - I "I %ll,tl- .., � , . � I ,-" -I - - - .:,- -'. ­-­ 11 , . I �' I. 99� - p"o-, l-'i -� -- ;..1 -,,T;-TE W'�',, � -"-:.i�l ,4- 0�-zPER E ,l ER,�tmoNTH ,",,* " HA "".A.S.T���-'*�o,ul-�,-�,,�.'I N k:;.',,'.-'.�.4X!�P.LE), T . . - I ". , , � � IVL .,*. , . ��,, """A4 - " -f , t I I: �,,; I 11 , �'. 1. . : �. ll,:': %�-","�`, , S ".1 --. �', �,y � � I - ., , ".. . . . . . � 'li� . .., . ,", - N-, . , 41�` .�. ,'�,:., - � .. � � i-,`ttt��,'.t, - - . . , � �V *! 'I , . � - , , . . . . :.---:,.- 4' :, .. " v � �,.,. . -�. - , . �� - ,;, 'i !�"` , - '. , !! , , c N "It"P �-"**44 INAW itiP7. !lltwll'll'*",P I , , ; . .. . , . I I -, �", 1; " � I -1 .il WK lo, 11.1 n ,'� �� " , , � I � � 00 I :. '� " . , "� " I , . I . � - . . Rm W. ,Alti: . , �,., . . . �'Il I . , , . :. . - q �,- , I I " - N - �---- - - -, ',% I ,-, - -�va-, , , I,- .1 . ,-j I --� - , , , -A '* �4��,,� �, VQ, r "'I ,;,. , t, .. . 1. . I , M � , , , .. ., 1 � � - . ... . I - . I . _ .% t� , ,.. � , . ._X j t I . q. , , . I . - . � I ,� .�. ? t, - -i�,`. �'. �.- - . ... I Ex�s��g ftoo� Ply ��\ . N tir..�- ..- .....,_....n....;e -:I �_. :.»..r�v..•�..:.�:•.: =b -:..cam a ... ••� -. ,r...»..- ..T -n.s, .- + '-:.. .. •�� .. r�.v�+.,•�' ..- :.o.:- .�.eo�+,y... N�m`� ..n.'. ' �,r�„ ,...a•.. -. es doz. w Iv Iw►h�luw k���� %r pusiky� htw . Wtiy w . w.:a....:.K yaw= clok } • ti 32.e� .31. •7% /.del Q c��J��rJ w,ll � V S me co 'J'�, s fie � P �1 If.J a r��� auto �b WJ�� W l� X12 Cum h S40 IIAV Cl NG16, (A rah r ' j y w l fk- VA MV+ tK -t 1Cl t 1&4-h `CI 11 VL\e o e: + >•.. -.. .��. -a .-.t. � .-r i s a.. .. 9� —. ... av ... .. - _ ..t4'..c.�..v. s�..` .�. . � .. -.; _ aa, �;�.:.sz... _ o o" 1TOs� ru. ..�2.adz L��° %Art� Sk oa RA ote O � 0 1. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH'SERVICES' INITIAL . INDIVUI)AL ADDITION/REPAIR FORM SECTION A: GENERAL INFORMATION Name of Project K)—(T)(V) Year of Construction Size of Parcel. TM# SECTION `B. TOPOGRAPHY' (Please check all appropriate boxes) 1. 0&111y--"C]RolEng CJ 5teep Slope 016entle Slope'' OEM'. 2. O-Evidence of wetland [01(ow area subject to flooding O'Bodies of water ❑rainacye ditches ❑Rock outcrop 3.-:Tropeq)�- in(;jqvid nt,?- - 4. Water courses exist on, or adjacent to parcel: L�J O 5. Existing individual wells within 200ft of the existing SSTS?. SECTION C. EXISTING SUBSURFACE SEWAGE TREATMENT SYSTEM(SSTS) 1. Physical character of existing SSTS area. A. ❑evel MZGentle Slope ❑Steep slope B. OWell drained 7Moderately well drained ❑ poorly drained OPoorly drained C. Area available for SSTS. (Primary & Reserve) ❑Extremely limited Cl`omewhat limited OAdequate —ft x ft —JFIZ16 D. INSPECTION Date Inspector— 1"79 0- <oevidence of failure DEvidence of failure DE-vidence of seasonal failure ra 3 HOUSE ----------- - ------------- 00 (1) Indicate location of SSTS A. Size and type of septic tank gallons ®I9eta1 ®Concrete ®Plastic B. Type of absorption area 1. Fields ft. 2. Pits 3. Gallies ft. (2) Indicate setbacks, front street, backyard, and side yard dimensions (3) Show location of Well (4) Show location of driveway (5) Note physical features (steep slopes, rock outcrops, streams /wetlands) ------------ SECTION E. EXISTING WATER SUPPLY ®PR'S Shared well Dfrdividual well 016e-illed ®Dug MCasing above ground CONI&ENTS REPAIRS ONLY: Status: As Built Inspection Required: As Built Submitted: As Built Inspection.Done: . . Inspector: J!Fv QN .. + I X44 00 Jx �r Oisj -1 NOS- m QV Afma/irM6. Aa.,0.410 Z kNi ki fA A A IKE., 7p is i -l)n NAIAI OSCAWAAK "'i, -i 00 lip 90VAI-7 .97 Ir 2 5 IV41 1-0 Ax I wt 00 lip 90VAI-7 .97 Ir 2 5 IV41 1-0 Ax I .. �. • _ e; ��,. !:e�.�? -1_t._ :w►t?3e•.y �,!_ % f� �v �.: � C n J;,•a: ;�:; �. -1: � :..;�,:- ..:..;�_. -., : • y.� .. -...._ _ .. �_ t ors IT 614gs,.�a UW11) A 11 15 (`Mall "r mm oalm Y)zw V12� brwo47 L� (a L/ u ILI FS fu 7" 1�tcl^ e� RndgI S �-orca ,� Cyeew- e Ij- Solite-f I?Daj / pv4Ar4a, 4 /1 -07/ °5 �1 �c--� uirsj L kj V-Ac kc 'r 1c:. �, 11.4 t I 6L'I -zs I— q 1, DEPARTMENT OF HEALTH Division of Environmental Health Services TWO TY CENTER - CARMEL', N.Y., 10512 (914) 225 -3641 • v APri LA'l 'viv -' 0 01vStRvCT- A.'"-. - PCHD PERMIT #111 -hV DD .WELL LOCATION Street Addrewn Village Crity Tax Grid Number WELL OWNER Name / Mailing dress " / !j'bt �CrillG�.Q/Q 15- cC� �'`�1 �i A) 1 rivate AgbPublic -4. . USE OF WELL )I RESIDENTIAL 0PUBLIC SUPPLY OAIR /COND /HEAT P 0o AB' D 1 = primary 0 BUSINESS O FARM 0 TEST /OBSERVATION 0 OTHER (specify 2- secondary 0 INDUSTRIAL O INSTITUTIONAL 0 STAND -BY O AMOUNT OF USE YIELD SOUGHT gpm /# PFOPLE SERVED /EST. OF DAILY USAGES7 0 Ral REASON FOR ONEW SUPPLY OPROVIDE ADDITIONAL SUPPLY ❑TEST .OBSERVATION. DRILLING :, ^� G TT . LY _.. O DEEPEN EXISTING WELL DETAILED"`-_. REASON . FOR _.. - DRILLING WELL TYPE DRILLED DRIVEN ODUG GRAVEL C1 OTHER IS WELL SITE SUBJECT TO FLOODING? YES DC. NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: oL�t1 ^...Sly iv IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE-TO.-PKVPkiffY Fk6M-- !iEARESi -WATER LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED DON REAR OF THIS APPLICATION j,0 SEPARATE HEET (date). (sig ature) 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. 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 J �fi�'Y Department. '� � Date of Issue: ' 19 Date of Expiration: IT 19 .5�b Permit ssuin f is a Permit is Non - Transferrable 2/87 White copy: H.D. File Yellow copy: Building Inspector Pink Copy: Owner Orange copy: Well Driller Boyd Artesian Well, Co., Inc. n. R.D. No.,5 Rte. 52- - �- �� �rLarme�, N-. (914) 225 -3196 CER11FIED ABILITY -� S@ eAJ �l�c Ufa. f 4L OANA �Ff K peor, OSd m oo i c� -- --------- X, S�i pi 41 �+.�. �� Wniiij Office-Use Only DEPARTMENT OF HEALTH PUTNAM COUNTY DEPARTMENT OF.H.EALTH 'STREET ADDRESS: W'GRIO NUMBR-- WELL OWNER NAME: ADDRESS: V i ff, /-000,9 P0 ATE [ 09 USE OF WELL 1 primary RESIDENTIAL' 0 PUBLIC SUPPLY 0 AIR/COND./HEAT PUMP .0 ABANDONED - 0 BUSINESS 0 FARM 0 TEST/OBSERVATION 0 OTHER. (specify) AMOUNT OF USE YIELD SOUGHT gpm.1NO. PEOPLE SERVED EST. 0 . F DAILY. USAGE REASON FOR DRILLING 9 NEW SUPPLY 0 PROVIDE AODITI61NAL SUPPLY 0. TEMOBSERVATION' 0 REPLACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL DEPTH. DATA'.' WELL DEPTH �-205' —ft.1 STATIC WATER LEVEL ft-1 DATE MEASURED JQ:i22/–eJE', DRILLING :EQUIP.MENT 0 ROTARY COMPRESSED AIR PERCUSSION 0 DUG 0 WELL POINT 0 CABLE. PERCUSSION D'OtHER (specify): WELL TYPE 0 SCREENED 0 OPEN END CASING. PrOPEN HOLE IN BEDROCK 0 OTHER CASING DETAILS TOTAL LENGTH tL MATERIALS: ji STEEL 0 PLASTI C 0 OTHER LENGTH.BELO - W GRADE */_ft. JOINTS: 0-WELDED 'RTHREADED 0 OTHER DIAMETER in.' SEAL: ='EMEN'T GROUT. 0 BENTONITE 0 OTHER SCREEN LTAi DIAMETER (in) 7SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? HOURS SECOND GRAVEL'PACK O'YES 0 NO GRAVEL SIZE - DIAMETER 01� PACK TOP DEPTH tL BOTTOM DEPTH — ft. WELL YIELD TEST It detailed pumping METH00- 0 PUMPED 1 tests were done is in- ,V COMPRESSED AIR formation attached? WELL LOG 11 more detailed lormation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE I W . afar Bear- n4 well Dia- In FORMATION DESCRIPTION cool! ft. fL WELL DEPTH DURATION DRAWDOWN YIELD Land Surface J0 _r4111 ",0 A.,1 A-.I 3 305 ffIELD _F5e�77_)AQ_Iz� WATEP 0 CLEAR TEMP, 'QOAUTY 0 CLOUDY HARDNESS 0 COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? 0 YES 0 No S TORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE LMAKER Moo EL CAPACITY DEPTH VOLTAGE — Hi WELL DRILLER NAME CA - ADDRESS t9044-a SIGItIftit