Loading...
HomeMy WebLinkAbout3787DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.06 -1 -14 BOX 29 -T� I,y% ,,r L I IN IN 1 P6 :111 IN ;- .9.11 1 X ININ IN r 1 -4 IN Kim nam�m I on t 03787 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION. OF ENVIRONMENTAL HEALTH SERVICES q APPLICATION. TO CONSTRUCT.A WATER WELL.. L ®�� _ 7 please print or type . W .. .. ..11`lf) Perrriit #` �'r Well Location: Street Address: TownNillage Tax Grid # Map Ty, Block I Lot(s) / Well Owner: Name: Ad ess: - El.' 0( 107 %t✓� �` 094 Use of Well: .4k Residential Public Supply Air /Con eat Pump Irrigation 4rimary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought _`� gpm # People Served 3 --5— Est. of Daily Usage 600 dal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) eepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? .. r .............................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision �� Lot No. Water Well Contractor: ,r�/c�.�/Y,d� ,s�n,/y --say Address: coo14 Is Public Water Supply available to site? ...... ............................... ........... Yes No 0C,, Name of Public Water Supply: /�� Town/ViIIage Distance to property from nearest water main: ; Proposed well location & sources of contamination to be provided on separate sheet/plan. Date �,/3 �4' 7-- 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 ` ee- Permi Date of Expiration ri 2._ ozo Title: Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 SEP -03 -99 SUN 09:02 FREBAR CONSTRUCTION CORP 914 248 5444 MOV -04 -98 38,24 FROM:FUMC B 0 : 91006�9669 IRnwi m� - 8 6 1\ i I :0 0 Lae sra 0 O ij. 1 S3 3/.67 t ' n . B• 3 j r 9 JI t 1 9�. b � O 01: w 1 vie, 0 1 � -11 a R 49 w 48w q : V IQ v e(s,0e t (� %° n d�-- ...... --�.m 8 °• oa'• OQ' er -- ctmrlPfeO sA icr SAL 6 .avrd4S _ �iO ^' SURVEY OF PROPERTY ..��.. -.� -. -.� FOtt - g4 ,gyp � N1 I( f�p ® x"A f , SVrxvR'ra0- /ipi:� 14. / 8 i p .e.._. . o 0....... gaoV4gr To s'Ar. + Jw•Y 8 /OmY / i Nt®tf4elY vo &-spire.' pevav ®C• de Ibtl► _ / $1YVATt IP THE JOHN 3ncvA7oRE �oREO -Tc)wN OF PUTNAM VALLEY / WORTPIM1006 ROAD a roM eo gym, oro v;Q Izr 0:. PUfMAPf COUP47Y ®LEKSKIIL. M. v ppD ef4 tef+v. *M,ad see I .ea 0-0 of NEW 'WORK s . jo 6.., 46 d A so-Val so— ro,l+,u Wt ma 40-- P Y. & 6.D Pr'8 11C. at0. Qt ©4aA••A $CM,%; f• -" 49 ... __...... ..w• ar!.vr 54VRYKvlt9 as IN aossezutpfu P.03 PALM 2.111 SEP -03 -99 SUN 09:01 FREBAR CONSTRUCTION CORP 914 248 5444 P.02 --• . -_. .:ll ^ n:: :�t:iy'sa '_I�: fit:. %C: � 1, ^, ..... �;',. ... { -r- - -' f. - ' PUTNAM COUNTY DEPARTMENT OF HEALTHj/.('� .. _ „•� +``' �H/n @fg �/�aN Q /,����C1\ Yi KJ �/��} /M� �i yq� {►��j, (�{� �V�� l3�'i. Y 4.. . .. ... ._. .e •.. • . -r._.. f 9 R MJ- APPLICATION TO CONSTRUCT A, WATER WELL y ettaae nfant nr t.n. PCHD Permit # Well Location: Street Address: Town/Village Tax Grid # oK4iV�G Ve.." : 41 06' Ravrr ,t3Rva^CRot " luryAm X Map gf f, Block ! Lot(s) , �I Well Owner: Name: Address: ivs« U of eve!!; sidential Public Supply AirlCancL'Heat Pump Irrigation rimary Business. Farm , Test/Monitoring Other (specify) 2- secondary industrial Institutional Standby Amount of Use Yield Sou m # Peo le Served Est. of Daily Usage gal. t - Reason for .Replace Existing Supply Test/Observation Additional Supply Drilfi g New Supply (new dwelling) Deepen Existing Well Detailed Reason" ©!� for Drilling Well Type 'lled Driven Caravel Other Is well site subject to flooding? ..... ............................................ ............................... Yes No Is Well located in a realty subdivision? ...................................... ............................... Yes- No Name of subdivision _ Lot No. Water Well Contractor: lr�o� ✓�'��V-/ Address: �' titer/ -1 y Is Public Water Supply available to site? ...... .......I -- ..... ............................ Yes No IX Name of Public Water Supply; A-Z/11 Town/Village Distmce to property from nearest water main: ^_ Proposed well- location & sources of contamination to be provided on separate shcet/plan. �ai�'':"' jA' =✓ : i �. __. _..- .�pi11�L`�pT�l$rla�tit�t': ���,�.....__ _ __ _._ __ _ _... _. .._...�..�.��_ ^ ____ PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted undbr provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5-2 of Part S of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well constructioA the applicant or their designated representative shall! 1) Pump the well until the water is cleat'. 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 approprWe 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 contarninate 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 t ' 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 Putr County. Date of Issue Pemit Issuing Official: _ Date of Expiration _ Title: PgMit 11 Noe- Irgalf4rrable SEP-03-99 SUN 09:00 FREBAR CONSTRUCTION CORP 914 248 5444 P.01 9141 A48 r#V11 ve jv FREBAR CONSTRUCTION CORP. Box-C, MaP10 Ave. LincoIndale, N.Y. 10540 03• A 0, ISMIe",^ 'FAXTHAN DATE: 9.-J-!Qp TV: FROM: FAX#: .2 V 8 rJ 7' FAX# -2 M — '194 .0 Message: Z& &0 Ald - I-*C ., A,&ad �ACA- A-*.,V.O �- Wf-# Number of Pages to Follow: -7, Signed: FAX-Form Copyright 1989 Deflecto Corporation, Indianapolis, Indiana