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HomeMy WebLinkAbout3270DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73. -1 -75 BOX 26 03270 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 # I WELL LOCATION Street Address j Town illage Cit u a Il Tax Grid Number �,3� 1- �." WELL OWNER Name c4 o'16. Q e ailing w' e r Address OPrivate O Public �E OF WELL primary 2- secondary d( RESIDENTIAL O BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY Q I AR /COND /HEAT PUMP O ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify b INSTITUTIONAL O STAND -BY 0 AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED /EST. OF DAILY USAGE 2Q2 Sal REASON FOR DRILLING Iq REPLACE EXISTING SUPPLY O NEW SUPPLY NEW DWELLING) O TEST/ OBSERVATION 13 ADDITIONAL SUPPLY © DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING 3 - d WELL TYPE DRILLED DRIVEN DDUG [:]GRAVEL O OTHER IS WELL .SITE SUBJECT TO FLOODING? YES _�NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name r1c) - 3�1 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ✓ NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY . P✓1iieiT AIL ii l A vr L' l Y t i� , cicSi w'tirc: . _lc• i .i: i V: . _.. .. o .._.... a.... _...r -.... _......- ... r ..... -w- . _......._.- «..«. LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED "ON SEPARATE SHEET (d to (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 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 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 drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: /10 Date of Expiration 19 Permit Issuing Official r Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller ,�.�., . w w !, t" 61-j-, , s 'Ar sA' MARVINY�O'DELL. �_ ...:' : - - . � ...<. �.._.;�:.�� ... • r' � = <, _ . : .. .. .. Bldg. Inspector E` A� JOHN MAHONEY TOWN OF PUTNAM VALLEY Deputy Zoning Inspector BUILDING, ZONING, AND SANITARY DEPARTMENT November 12, 1991 Putnam County Dept. of Health 110 Old Route Six Center Carmel, N.Y. 10512 Att: Wm. Hedges Dear Bill: PUTIVA(1VALLEY, N.Y. (914) 526 2377 BETTE STOCKINGER Bldg. Dept. Clerk Re: Relocated water well Owner: Dwyer 415 Peekskill Hollow Rd. TM #PV73. -1 -75 A review of the above noted site indicates the proposed water well location shown on attached drawing by owner, is within one hundred (100') _ _.f_PPt,of.:a. ,.SUS .a_rEa _a.Gro.s.s Peekskill Hollow..- Road.,.. It is recommended that this be further reviewed, whereby a more suitable site may be located in the best interest of health, safety and welfare of property owners. Further note, our files contain a well drillers report dated May 14, 1976 indicating a water well was installed on this parcel (copy enclosed). ; Sincerely, lwaw:'r� MARVIN 0 DELL Or Building & Zoning Inspector MO'D:es enc. DEPARTMENT OF HEALTHj�y �� ✓n' �S 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 # -/0 WELL LOCATION Street Address Town illage Cit Tax Grid Number 7s, . WELL OWNER Name ate (� W e Vbw- iling er Address QPrivat.e 13 Public USE OF WELL 0 primary 2- secondary (RESIDENTIAL D BUSINESS D INDUSTRIAL ❑PUBLIC SUPPLY ❑ AIR/ COND /HEAT PUMP 0 FARM 0 TEST /OBSERVATION 0 INSTITUTIONAL 0 STAND -BY 0ABANDONED ❑ OTHER (specify D AMOUNT OF USE YIELD SOUGHT .s gpm /# REPLACE EXISTING SUPPLY O NEW SUPPLY NEW DWELLINGY PEOPLE SERVED A /EST. OF DAILY USAGE 2� Sal O TEST /OBSERVATION Q ADDITIONAL SUPPLY D DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING z 4 r — �L WELL TYPE DRILLED DRIVEN ®DUG. O GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? . YES _1--"O' NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name- (,&f.C'C)fN Address IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: i1TST5_N .a TO-T- CTERTY FROM NEAREST S.I/ yyT` lui A' l• . TOWN /VIL /CITY LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET 7 w-la",_ (d to (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 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 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 drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: Date of Expiration 19 19 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller V4. 'VI L. rmit is Non-Transferrable 89 rt-LLIIIU issuing Utticial White copy: HD File Pink copy: Owner Yellow copy: Bldg. Insp. orange copy: Well Driller • TOWN OF PUTNAM VALLEY WELL DRILLERS LOG AND =REsPORT WELL COMPLETION REPORT This report is to be completed by well driller and submitted to Bldg. department, together with laboratory report of analysis of water sample indicating water is of satisfactory bacterial quality. Well Location Tax Map i ",1 .. Well Owner N Well Drille N Street Sec. BL, Lot am Mailing Address City or To,4% TP1. # 2-;��. CASING DETAILS YIELD TEST WATER LEVEL I SCREEN llETH1LJ Bailed Measure from and surface Length ,; Ft. or �oS Pumped Hrs.IStatics Ft. Makes When Bailed I Slot Diameter -.4, Inches Yield: (r GPM lor Pumped Fti Length Ft.Size Kind: Z TOTAL DEPTH OF WELL /, 2- " Feet WELL LOG r Depth from Give description of formations penetrated, such G:Lound Sur ddC;e s pe ^t qy. s� �.+ s: :ands iia =�� ; .::_''•.�1j7 y i cir,dpr:,I^:?_ . ,.:. . shale, sandstone, granite, etc. Include size of gravel (diameter) and sand (fine, medium, coarse), color of material, structure, (Lose, packed, cemented, soft, hard). For examples 0 ft. to 27 ft. fine, packed, yellow sand; 27 ft. to 134 ft. gray granite to Feet Formatinn Descri tinn r / Date Well Completed �`��' Date of Report Well Driller;'_ ��� ---- Signature BZS 1 -77