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Home My WebLink About3747DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.19 -2 -12 BOX 29 rm .� .. 03747 0 X'-"' % / '� �g ) y 7 PUTNAM COUNTY DEPARTMENT OF HEALTH l a gF a 9 -1 Yg/DIVISION OF ENVIRONMENTAL HEAL.TI SERVICES a Ill °� - APPLICATION TO CONSTRUCT A WATER WELL PERMIT TO C S RUC A WATER WELL °, This permit to construct one water well as set fo above, is granted under provisions of Article I f the Putnam County Sanitary Code: and Subpart 5 -2 of Part 5 of the New York State Sanitary Code anrovided 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. , If Date of Issue Permi Date of Expiration _ Title: Permit is Non -Trans errable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 lease print c r.type _ _ .. P.CHD :Permit # . I Z — 0 treet Address.: TownNillage Tax Grid # Wood Street Putnam Valley Map74.19 Block 2 Lot(s) 12 Well Owner: Name: Address: 6 S ky v i e w Lane Michael Marino Putnam Valley, N.Y. 10579. Use of Well: x Residential 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 5 gpm # People Served 4 Est. of Daily Usage 300 gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling x New Supply (new dwelling) Deepen Existing Well Detailed Reason New Dwelling for Drilling Well Type x Drilled Driven Gravel Other Is well site subject to flooding'? ........ ......................................... ............................... Yes No x Is well located in a realty subdivision? ................................::..... ............................... Yes x No Name of subdivision Michael Marino t No.1 . ,t Water Well Contractor: ; a " ^ ' $�RL Address. , Is Public Water Supply available to site? Name of Public Water Supply: _ N/A ownNillage Distance to property from nearest water main: N/A Proposed well location & sources of contaminate to be provid d n separate. ee plan. n-! -aJ i iJ +' 27 6//2007 ° Date. Applicant Signature: PERMIT TO C S RUC A WATER WELL °, This permit to construct one water well as set fo above, is granted under provisions of Article I f the Putnam County Sanitary Code: and Subpart 5 -2 of Part 5 of the New York State Sanitary Code anrovided 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. , If Date of Issue Permi Date of Expiration _ Title: Permit is Non -Trans errable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO ABANDON A WATER WELL' please print or type PCH D PERMIT #/ ' Uj ` —0-7 Well Location: • Address: TownNilla Tax Grid # tlwy WOOD ST. P'uT w PM 2' M pl-/ Block Lot(s)!� Well Owner: Name: Address: (2 Se-yV I s%,,v A , MIUA E L APdN C1 PI-k°tWAAA LI L`. A Y , o5 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 - rimary Business Farm Test/Observation Other (specify) 2- secondary Industrial Institutional Standby Water Well Name: Address: Contractor: W -STE P�, may, Reason For Abandonment: � �'�' -roec PP--jL1 -v D A4 f-- 5usDmi ilw Description of W- ork To Be Performed: F1 LL / N 0LC> Wig LL- kll� .... -.. .�.<.. w, h4 a_ s.s ... .... e_ _....Y V .- .....c r- .. _. r•. s.> - v-r ns.r . ..- t .......+..e.>....>r... ....r ,. t vv .r. \ � �- co co Date: Y Applicant Signature: 7° 0 PEWIT IV 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 information delineated on the application for this permit has been completed. q, I --0j Date of Issue White copy: HD file; Yellow copy - Building _ Form WA -97 TWO MUSCOOT ROAD NORTH MAHOPAC, NY 10:541 P 845,628 -6613 F 845- 628 -2807 TRANSMITTAL DATE: AUGUST 27, 2007 TO: PUTNAM COUNTY DEPT. OF HEALTH ATT: BRIAN STEVENS FROM: JOSEPH FASACESSIA, PROJECT MANAGER RE: MARINO, MICHAEL, WELL PERMIT FOR LOT #3 ❑ ❑ F] ❑ As Requested For your use Review Comments DEAR MR. STEVENS, ENCLOSED HEREWITH PLEASE FIND DRAWINGS REGARDING THE ABOVE MENTIONED. VERY i TT,V JO H FASACESSIA, PROJECT MANAGER PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of MICHAEL MARINO Located at WOOD STREET TNPUTNAM VALLEY Tax Map # 74.19 Subdivision of MICHAEL MARINO Subdivision Lot # 1 Filed Map # Gentlemen: Block 2 Lot P' /o 12 Date Filed - - - - - -- -- - - - - -- -- This letter is to authorize JOEL GREENBERG a duly licensed Professional Engineer or Registered Architect x to apply for the required waste_ water treatment and/or water supply permit(s)- to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145 and/or 147.of the Education Law, the Public Health Law, aad`ihe Putnam Couuty'Sanitdry Code. Countersigned: P.E., R.A., # 11056 Very truly yours, Signed: 140�� e (Owner of Property) Mailing Address 2 MUSCOOT ROAD NORTH Mailing Address: 6 SKYVIEW LANE MAHOPAC State NY Zip 10541 Telephone: 845 628 -6613 State NEW YORK Telephone: PUTNAM VALLEY 914 760 -3618 Zip 10579 Form LA -97