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HomeMy WebLinkAbout3436DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.18 -1 -4 BOX 27 m ml lirm N� ' � �` . JuL 'I I y■� , 9, T� I' L I' IL 03436 -C G DEPARTMENT OF HEALTH Division'of Environmental Health Services * 10 OLD ROUTE SIX CENTER;. CARMEL, N.Y. 10512 (914) 225 - 0310;';.;,;;. . PCHD PERMIT #W-J69- WELL LOCATION Street A $ dress r� �� / # To Village Ci y Tax'Grid <7 _ ��� ll� . Number WELL OWNER Name Mailing Address S Cl; vn L- JgPrivate O Public USE OF WELL 1 - primary 2- secondary' %RESIDENTIAL O BUSINESS 0 INDUSTRIAL ❑PUBLIC SUPPLY QAIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION U INSTITUTIONAL O STAND -BY C1 ABANDONED O OTHER (specify 13 AMOUNT OF USE .YIELD SOUGHT gpm /# PEOPLE SERVED / EST. OF DAILY USAGE gal REASON FOR DRILLING 0 REPLACE EXISTING SUPPLY ❑ 'TEST /OBSERVATION GE ADDITIONAL SUPPLY NEW SUPPLY NEW DWELLING EEPEN EXISTING WELL DETAILED, REASON FOR DRILLING Goers WELL TYPE MDRILLED DRIVEN QDUG GRAVEL D OTHER IS WELL SITE SUBJECT TO FLOODING? YES No IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: X11 Q Lot No. WATER WELL CONTRACTOR: Name (2n .Address,: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO It INAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY I DISTANCE:.T�PR iPEItTY- :FROM- NRAREST.. WADER.MAIN. -. - - - _ ... . ti P w yao.•- RTY -,. +..w_.we.w.. -. w ..q �++v^•• - -.,.. •-.. _.. �►1 w Vi+.- .mow. - + +•— �e'�^w_Mw.Y`«. ._ _ _.1 .._.•.......s•. _ —,w LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED (� ON SEPARATE SHEET (dat) (signature) Ww'130 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 Health Department. Date of Issue: A 19 Date of Expiration: 19 Permit is Non - Transferrable Rev. 10/88 Report on a form provided by the Putnam County (" 96 Permit Is-suing OffWaT White copy: H. D. File f -- Yellow copy: Building Inspctor` Pink Copy: Owner Orange copy: Well Driller - , ;,,r i 1. �- p,-_ .._�nvy,•;w_''iw ^a. .:,<'A9.sh > ' -,� .,�� � Via. a,:?�y 4. .. �u�. -. - -. 5'" .. ,;C.,... -_ ..y.':.i:'+i�.. J^` 3ac.,.s ; `°'.,�"' , ' ,r '.S. ,. -r.+?, _ d .l.S' k""'a 'rF'... :• G s�r...e_3'y" �.,�?.?Y y -. MARVIN O'DELL TOWN HALL PUTNAM- �V�A�LLEY, N.Y. TOWN OF PUTNAM VALLEY BUILDING, ZONING, AND SANITARY DEPARTMENT December 13, 1988 �.� Department of Environmental Health -,110 Old Route 6 Carmel, N.Y. 10512 Re: Proposed Well TM #74 -4 -29 Gentlemen: The proposed Water Well site as shown on the attached drawing was inspected on 12/9/88 , and as could be determined was found to be a minimum of one hundred (100') feet from any reported sub - surface sewage disposal area. R6asons for drilling - .Existing well dry. Applicants that receive permits shall -upon completion of construction, submit to the Town of Putnam Valley (Building Department)a.copy of the well drillers Log and Water analysis report before said well is put_ in service. <_�*t.^• . �. w v- ..-,.s .oc+. •..,.. <..�.. ..c. - i P -^• C'�c�'- .rm- - .a.s�+- -+�•.+ e.ao- a+.c..i -,.. w. c- .s —,.z �- .y;......s.... a w- ...-� +o �......o. +r -°i P -^. Dom- •w.•- '9- ee.:.C+.�.+a+.w•ow +• .n r MARVIN 0 D Building Inspector MO' D : e s