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Home My WebLink About3688DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.17 -1 -20 BOX 29 .. , "113 I-go or 1 � go r kT , � 1961 re 1 P� Ej go . . : - = PUTNAM COUNTY DEPARTMENT OF HEALTH ' DIVISION OF ENVIRONMENTAL HEALTH SERVICES _ _ .. ._.., _.. .. AP LICA"YIO►N' i O' ABANDON A WATER WELL please print or type PCHD PERMIT # �W Well Location: Street Address: TownNillage� Ta Grid # G Map Block Lot(s) Well Owner: Name: dress: Address: ` O/I Well Type: Drilled Driven Dug Gravel Other Depth Data: Well Depth/ ft Static Water Level ft Date Measured Use of Well: Residential Public Supply Air /Cond/Heat Pump Abandoned 1- primary Business Farm Test/Observation Other (specify) 2- secondary Industrial Institutional Standby Water Well Name: Address: Contractor: Reason For Abandonment: ! 14-,) Description of Work To Be Performed: v� G- f )% Date: 11ZV Applicant Signature: 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 informati n delineated on the application for this permit has been completed. r 5�4 Date of Issue Permit Issuing Official Title / White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -97 �d PUTNAM COUNTY DEPARTMENT OF HEALTH - Z Q DIVISION OF ENVIRONMENTAL HEALTH SERVICES �iPPLICATION TO COI�STI2UCY A WATER WELL please print or type Well Location Street Address: Town/Village: Tax Map # ap Block Lot(s) Well Owner: Name: Ad re s: r le #: Use of Well: Residential _Public Supply it /coed /heat pump� rrigat 'ion . 1- Primary Business Farm Test/monitoring . _Other(specify) 2- Secondary Industrial Institutional Standby Amount of Use Yield SoughL___9z==gpm # People Served Est. of Daily usage gal. Replace Existing Supply Test/Observation Additional Supply Reason for Drillin 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'-V _ Is well located in a realty subdivision? ........................................... ............................... Yes _ No-A-1— Name of subdivision Lot No. Water Well Contractor: Address:11�& 'oe Is Public Water Supply available on site? ....................................... ............................... Yes Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separve sheet/plan. Date:�,(G�-`-- . , . ": 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 Deaartmei 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 Commissioner of Health. Any revision or alteration of the appro�ed plan requires a new permit. Well to be constructed by a water well driller certified by Putnam Coulity: �� Date of Issue -- i Permit Issui Date "of Expiration a Title: Permit is Non -Trans era le White copy - HD file; Yellow copy - Building Inspector;. Pink copy - Owner; Oge copy -Well driller f Form WP -97 e I1 0 7 3- e- CaA,rle �a� � � b. 3/06 S 2014 -12 -01 08:00 USYKTLE2 9149454184 >> 8452258420 P 2/5 _ - ,.. .,- .�.. ,. a ... _�....w.. .. _, .a �o.� ... .. .a � - .. �t -e -•u .+•�sv ... i. �- .. .�.r -c: .. _, �..... .. _�.... Y.. � ... .. - . . -ten .. w.•.m. _ -, TOWN OF PUTNAM'V'ALLEY PERMff WAWER C'.HAPTER 144: Freshwater Wetlands, Watercourses and Waterbodies Ordinance of the Town of Putnam Valley, New York The Town Wetlands Inspector, as Approval Authority, has detemuned that the proposed action is an Unlisted Action under SEQRA, and will not have a significant environmental impact Thewfore, a PERMIT WAIVER is granted subject to the conditions noted below. DATE PERMIT ISSUED: SC7111 DATE PERMIT EXPIRES: SR.6/12 APPLICANT SPONSIEER: J zini.s..Tobias 28 Sommer•,et Lane Putnam Valley, NY 10579 PROPERTY. LOCATION: 28 Sommerset Lane DATES OF INSPECTION: 5115/11 TAX MAP #: 74.17-1-20 PROPOSED ACTION: Demolish and reconstruct wood deck with a wetland buffer. WAIVER RATIONALE: Action is to remove and then reconstruct an existing deck . in a previously disturbed wetland buffer. No measurable negative impacts to the wetland or wedand buffer noted MATERIALS REVIEWED: _. WetlaadPernait,Application WT# 12/11.. CONDITIONS OF PERMIT: 1. Homeowner provided sketch is incorporated into this permit by reference. 2. Erosion controls are to be installed prior to the commencement of work and shall also serve as the limits of disturbance. All disturbed area shall be immediately seeded and mulched. No other site disturbance shall be permitted other than as shown on the plan. 1 40 4-'IL-U'I UO:UU U41KILCC YIYYY7Y IOY �� OY7GCJOYCV r �/� 3. No machinery is permitted in the wetland area 4. All debris shall be removed from the site and not stored in the wetland or wetland buffer area. S. No other site disturbance within the wetland and/or wetland buffer is permitted. If additional modifications to the site are anticipated the applicant will be required to file for a new, or amended (if applicable) wetland permit 6. A building permit must be obtained for all applicable site work prior to the commencement of any work 7. All conditions of the wetland permit waiver to be satisfied prior to the issuance of a Certificate of Occupancy, Wetlands Inspector to submit final sign -off letter to Building inspector. 8. When erosion controls are required, they must be maintained properly throughout the construction process and remain in place until final site inspections for compliance with condilions of permit have been completed. 9. 'Tire Town Planning Board, Wetlands Inspector, and/or the Building Inspector, shall have the right to inspect the project from time to time. 10. The permit shall be prominently displayed at the project site during the entire duration of the activities authorized by the permit. 11. This permit waiver is specific to the granting of a wetland permit only. Applicant is responsible for securing any other required permits and approvals from the Town and other jurisdictional authorities as may be necessary. 12. A copy of the Wedands Permit Waiver shall be attached to the approved Building Permit that is granted by this application. Noneompliance with the conditions above will invalidate this Permit Waiver, and may result in a Notice of Violation and/or Stop Work Order. Any questions regarding this Permit Waiver should be directed to the Town Wetlands Inspector (914 )-962 -7733, or the 2 LU14'IL'UI Uo:UU UJINILCL yl9y- t741o't » o'fJGC�O -tav office of the Town Building Inspector (845 )-526 -2377. Date Permit Waiver Prepaid: 5/2711 - ... a Bruce Barber Town Wetlands Inspector Cc: Applicant Building inspector Planning Board $trvironmental Commission 3 LV 1`t'IL'VI V1 ;.07 VJINI LCL 71T1TIT IVT �� VT /r. r. /Vi�v 1 iii TZD MAY WETLAND FEES AND ArfACHM1EN:['S Wetland Permits: W-0too Permit Waivers Attachments: Original and 2 uopfea of applieadon Copy of short EAF ✓ 3 copies of deed 3 copies of torrent survey and drawing showing project Fee S 50.00: Processing 5200.00: Permit Review or $100.00 07 SCREENING VAS IM DONE) $500.00: Escrow Renewal (samoas stated above for waiver except escrow acct must be replenished to have the sum of $500 in the account) Violation double application foe Plannine Board Wetland Pcrmity: Attachments. See Planning Zoard Requircmenta Foes: $ 50.00: Prow sing :.. _ •g200.00:•Pcrmit.1Rcnca' or 5100.00 (IF SCREENING HAS BEEN DONE) $1,000.00 Escrow Fees are to be paid wit three separate cbeW made payable to the Town of PuMam Valley and delivered to the Town Sanding )(aspector. Note: Additional escrow bees may be needed as determined by the Wcdand luspector. Wetland delineations and verifcationr. .y Attacbrncats: Sigaed request form Survey of property Fcq: Found on ScreculaoclimmtionlVerification Form Note: As part of your application process, the Town may require tither a wdlaod "oeation or verification. Wedand delineations may be conducted by the Town Wetland Inspector or a wetland consultant of your choice: Please note however, that the delineadon of an outside consultant will require veriticatian by the Town Wetland Inspector. The Town fees An quoted under the Wetland Screening Section on this form and arc valid for a period of two years Town wetland delineations and verifications are valid for two jcc,••s or as determined by the Approval Authority. A wcw. .: ddio ttitia utay be regaircd ai auylime'at the discretion of the Town Welland Periuk Approval Authority. V Unen eonrnlesiox ofPM4W MAx iMM remrest IV jaMa, and payment of_Srw__Lb9l rWMWdtrom wetbtred-ummLror any gwAw rem -04b n,olll bemleased: REV. 3/18/09 rl .,� +..... :. 1 s. . . t .' • ... 1 � r � . .�- � .._:...�. • ,r • t.. ✓'..Nt +. .. t � y - _ .. .... __ t .. _. - 1. � ..J . .. .. ... ..... ... Lor ?3 1 i ;.Oo i , ! SIO£ L/Nts ryor r0 : CACei Lor 24 ! Lor 22 i� • _ `7,�,�TB � ArcK Owa jS t 21 18' r0 THE WEST fN0 OF i 30 hA0• CURYf 4r P4R4LAN r ffGf i 43.85 ' LAAIE �. PCRCEL $q.OWN NER£eN KNOWN AS + LOt 23.0N ;ECr/oN A OF PUrNAM dCRESr' F/LEO 4r rNB PUTN4M IwNr), CLERX S OFF /C£ AS MAP NO. 815. prrFO IJAI Yd$,4w°S B F/Lf0 JLIN•411957. I i t SURv,y OF "pORi =RTY FOR i BR /AN LA VIN. t i :5:zrrvifo ro u4NK SITUATE IN , G:,,.r ;sVINGS t s£CJri' /•Y 'llrLE 9 GUAR. CO. taM♦av '� T s• r 1�1 1., . CF►��ENTER & CO. J dti/•1%3�� t7i ;?I,� I R�r'�1'iR VI �%��+ � :.IV,L eNGIN£ERS & LAND SURVEYORS O'RKTOWN HEIGHTS, N. Y. PUTNA.M COUNTY, N. Y. SCALE. 1',-40' OAT :: J4'1" F.4Q:•,.mmOLZ. gh.E. !'s L.S. 1-•400 ! t M n» \7,•r(• M1 1VMw 14C« pr{4AU,�'w �' Iwn MI.1• IM.RrwM1 .. ►pill r• •1,.r•w4. yJ► ' . . . • , . .. . CV14•le-VI VO :VU ualAl�[c i I �% � ..... �,. v ... ,•JfR:/ /// iITS7�Trv-r •• ...., . _ � .. r -.r ... ., ter. � �,.... � r / i . •, r / ' Iii •,c2'?o• ?0•� /19.30 n j cor .3 1� ,.00 .C. � I \ ` S/or twe's ,vor -0 :CALF cot oz . for 24 1 i oECx w FRANC. I I ti 1l4 18' r0 i NE we sr £NO OF Rs r 1 30 RAO, CUPVC Ar PA rR OGf aJ.BS E �j� X74 -LANE: i 104RCEL SHOWN HEREOH KNOWN AS COT . °J.ON "?£Crlom A OF PUiNAM CLeRK' S O. -F/CE S NAPrMO. 815. J.1 A: 0 IVAY Zs, J. ^C6 S AIL CO AIA 4, 1957 s�arl�l�o ro: ;4V/l163 SANK SrCgA' /'r Nr4C B G. /AR, CO, j. ;•;ENRY' CARPENTER La %CO. .:iViL ENGINZERS & LAND SURVEYORS YOPKTOwN HEIGHTS. N. Y. E. r .4G. S!•1HOLZ. P.E. & L.S. 1-..400 SURV =Y OF PP,OPEPTY FOR BRIAN LA VIN: SITUATE IN T o Ski OF PU NANI VALL:'i I I i PUTNAM COUNTY. N. Y. I . I. I SCALE: I "= 40' OAT =: JO e . w.•,:. w vV`.w 1 \Cr YR�•a;�'« ^1 Iw•......, Ir•e. «^ ..wn1 �., �Vw�N.« iia r'- i I I i i SITUATE IN T o Ski OF PU NANI VALL:'i I I i PUTNAM COUNTY. N. Y. I . I. I SCALE: I "= 40' OAT =: JO e . w.•,:. w vV`.w 1 \Cr YR�•a;�'« ^1 Iw•......, Ir•e. «^ ..wn1 �., �Vw�N.« iia