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HomeMy WebLinkAbout3911DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.20 -1 -4 BOX 30 y - .. 4 , '�� 64%16 sm r ;. L 4 f •T��� ap 03911 DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION ': Te C`OgSTRUCT A WATER 'WELL_ _ Prmn PERMIT # 41 U. WELL LOCATION Street Ad4ess 4/S// j, Town Village City T x Grid Number WELL OWNER Name Name- ailing S ddress / -4' a�C lo- '11/1!- l�' _1 'L ivate O Public primary IV-OF WELLSIDENTIAL secondary [] PUBLIC SUPPLY Q AIR /COND /HEAT PUWd 0 BUSINESS O FARM O TEST /OBSERVATION 0 INDUSTRIAL U INSTITUTIONAL O STAND -BY O ABANDONED p OTHER (specify' p AMOUNT OF USE YIELD SOUGHT gpm /# © REPLACE EXISTING SUPPLY O NEW SUPPLY NEW DWELLING p po.7 - eXi��,�� PEOPLE SERVED /EST. OF DAILY USAGE Sal ST /OBSERVATION M ADDITIONAL SUPPLY EPEN EXISTING WELL �t / REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE RILLED DRIVEN ®DUG [--]GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: - Lot No. WATER WELL CONTRACTOR: Name ,L:57eP� a &�ml Address: . } -. -, h -` IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES0� o NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY k-a r„ _.. P.T_-5TAiGE._T.0_ FROPE.RT-Y -F,?CM NEAREST:.WAT.ER,MAIN, -: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED / ®ON SEPARATE SHEET A � (date) (signature PERMIT 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. 2. 3. Pump.the well until the water is clear. Disinfect the well in accordance with the Department attached to this permit. requirements of the Putnam County Health Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or 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. Date of Issue: Date of Expiration 19 I�-- Permit Issuing Official' Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller Frank Rush 15 Rush Drive PD Box 4 Putnam Valley, NY 10579 Dear Mr. Rush DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 JOHN KARELL Jr., P.E., M.S. Public Health Director November 25, 1991 Re: Proposed addition - Rush Rush Drive TM #113 -5 -9 (T) Kent I have received and reviewed the plans for the proposed addition to the above mentioned residence. The plans indicate that a two story addition will be added.consist.ing of a kitchen, dining room, garage and living room on the first floor and three bedrooms and a bath on the second story. The survey indicates that sufficient area exists to expand or repair the sewage disposal system, should it become necessary in the future. Therefore, based on the information sub_ muted: �.. .the:a6�ive..r�s�ti:�a'adslit- ion -fis• APPROVED- r�ai- th.- the�fo- ilbrr�irrg •coeditiohae ... � �- -- , �: 1. The total number of bedrooms must remain at three without prior approval by this Department. 2. The area of the existing sewage disposal system, and its expansion area, must be maintained. 3. All plumbing fixtures must be replaced or updated with water saving devices, i.e., low. flush toilets, restrictors for shower heads and faucets, etc. Approval is granted for sewage disposal only. Any other permits or variances required are the responsibility of the applicant and the jurisdiction of the Town of Kent. If you have any questions, please contact me at your convenience. Very truly yours, William Hedges Sr. Public Health Sanitarian WHJjp: cc: BI (T) Kent