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631- 589 -8100
73. -2 -23
BOX 26
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03294
(, PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES q _ SV - 17
APPLICA'T'ION -
please print or type _ PCHD Permit #
Well Location:
Street Address: To illage Tax Grid #
3 97. �c t� t✓Ai -J „�. Y map 13
Block Z- Lots) -'3
Well Owner:
e:
�-
Address: r
�Q
31
�yG��
Use of Well:
.Re 'dential Public Supply Air /Cond/Heat Pump . Irrigation
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 gal.
Reason for
Replace Existing Supply Test/Observation
Additional Supply
Drilling
New Supply (new dwelling) Deepen Existing Well
Detailed Reason
for Drilling
Well Type
. Drilled Driven Gravel
Other
Is well site subject to flooding? ................................................. ...............................
Yes No .e
Is well located in a realty subdivision? ...................................... ...............................
Yes No
Name of subdivision 4
Lo o.
Water Well Contractor: Address: C S'v'
Is Public Water Supply available to site? .............................. ...:........................... 0
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.
Daite -`:�" . -- Apaicant . agnatuxe
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
contaminate surface or groundwater.
APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless
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.
Date of Issue
Date of Expiration
Permit is Non- Transferrable
Permit Issuing Official:
Title:
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WP -97
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SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
ROBERT J. BONDI
County Executive
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
7 _ C�e3
Norman Anderson Inc.
152 Barger Street
Putnam Valley NY, 10579
July 25, 2005
'?• Re: Proposed Well: Guadagnola
392 Peekskill Hollow Rd.
(T) Putnam Valley
P7
ate"
dD�Mr derson,
e*dI have received a well permit application (WP -97), for the above referenced proposed
well. Comments are offered as follows:
1. An Application to Abandon A Water Well (WA -97) must be submitted.
�:........ __�..__ _._ I. --The site plar-1�lst. shove. =the location of thc.propescd Well, (rneasursrd f om 2 -� xed_4..:..__
points), in addition to the existing well and septic on the subject parcel. The site
plan is to.include location of any 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 me at (845) 225 -5186 ext. 2235.
Upon receipt of a submission, revised to reflect the above comments, this application will
be considered further.
Very truly yours,
Brian R. Stevens
Public Health Technician
cc: Mr. Guadagnola
RM, file
Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Nursing Services (845) 278 6558 WIC (845) 278 -6678 Fax (845) 278 -6085
Early Intervention/Preschool(845)278 -6014 Fax(845)278 -6648
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Fee $ Building Estimated. 1300
Total Livable Area Cost $
$ Sanitary
Date Zoning Board Approval
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SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
w � LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Norman Anderson Inc.
152 Barger Street
Putnam Valley NY, 10579
July 25, 2005
Dear Mr. Anderson,
ROBERT J. BONDI
County Executive
Re: Proposed Well: Guadagnola
392 Peekskill Hollow Rd.
(T) Putnam Valley
I have received a well permit application (WP -97), for the above referenced proposed
well. Comments are offered as follows:
1. An Application to Abandon A Water Well (WA -97) must be submitted.
points), in addition to the existing well and septic on the subject parcel. The site
plan is to.include location of any 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 me at (845) 225 -5186 ext. 2235.
Upon receipt of a submission, revised to reflect the above comments, this application will
be considered further.
Very truly yours,
Brian R. Stevens
Public Health Technician
cc: Mr. Guadagnola
RM, file
Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085
Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648
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FARCE_ SHOWN HEREON KNUWN AS A PORTION OF LOT 39
,n ;R ?:� hiCV MAP ENT-11.FD "SEC. B OF PUTNAM ACRES"
ED IN LINTY ._E „K'. OFFICE AS MAP No. 815 A.
SJ8,1C' fO ELECTRIC AND,'OR TELEPHONE CU
c..SEMENTS,IF ANY FUR J','ERHEAC AND /OR
'.,FR'RUUND ,ERv:LE
v;I . A� IN POSSE�SWN,iNo Lines of Possession
, ,WkUCTJALS ANC;UR THEIR-ENCROACHMENTS _
9ELUW GR -DE, IF ANY, NOT SHOWN .
AO'ISE OFFSETS TAKEN TO FnUNDATION LINE
aROPERTY CORNERS STAKED FOR BLDG. CONSTRUCTION
P.RrJSES )NLY
CEkT'FJED ONLY TO.
I. CLINTON L.and LOUISE A.YARD
2. THE SECURITY.TITLE and GUARANTY CO. (RGP•TO284T
3.
J. HENRY CARPENTER B CO.
.V;L ENGINEERING 8 LAND SURVEYING
YORKTOWN HEIGHTS NY
j ;1 4
L
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SURVEYED IN ACCORDANCEWITH DEED
RECORD AS RECITED IN L 774 ,cp'D9c
RECORDED IN THE COUNTY CLERIC ;
':FFICE Jar 28.1'18
CERTIFICATIONS NDIWEC.HERE' I, N r. '4
WAS PREPARED IN AC.JR'DANL E W —t r,
OF PRACTICE FUR LAND SUR' +EY$ "• ~'T'
YORK STATE AhSUC.ATIUN OF
SLRVE'TORS
SURVEY OF PROPERTY
PREPARED
CL,INTO.N L. and LUISE A,, YARD
L',(,ATED IN
TOWN OF PUTNAM VALLEY
PUTNAM COUNTY, N.Y.
I • •Jul 30 1975 Alt_Cer+ifications Hereonore Valid for This Mup and Loptes T ^rr
vie,. 4enry Carpenter B Co Do Hereby Certify That on �--�— Only if Soid Map or Copies Bear The Impressed `;eo' of The gun ern•
:i Sj,.ey of The Premises Shown Hereon Was Made and That ThfyMap Wht,se,.S,pnoture Appears Hereon
5 Mace ” ccordance •ith The nald Notes of Syo Id Suryey ,Alterations of This Ma p Urher Than by
o Licensed ,.and Sun•ly;.r .cc
SCALE. I ":60' :TE JbIy :O
HARD A SEABOLDT, PL S.-No 49010 2 Jai+ :s,.:9•
Jan 28,'9PI