The URL can be used to link to this page

Home My WebLink About4010DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.65 -1 -35 BOX 31 04010 DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION TO CONSTRUCT A WATER WELL .. ro,?aPCHD PERMIT # Gr1)9 -PS WELL LOCATION reet Addres To V 1 ax Grid u ber ,� (o _ S6" WELL OWNER am Mailing S Addres rivate /�% ,6) O Public USE OF WELL 1 - primary. 2 - secondary RESIDENTIAL O BUSINESS ® INDUSTRIAL ® PUBLIC SUPPLY ❑ FARM ' O INSTITUTIONAL, Q AIR /COND /H T PUMP 0 ABANDONED 0 TEST/OBSERVATION ❑ OTHER (specify, ❑ STAND -BY O AMOUNT OF USE YIELD SOUGHT gpm /#. PEOPLE SERVED -/EST. OF DAILY USAGE dp al REASON FOR' DRILLING ';" CE EXISTING SUPPLY 0 NEW SUPPLY NEW DWELLING) O TEST /OBSERVATION Q ADDITIONAL SUPPLY O DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE DRILLED DRIVEN []DUG [3 GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name Address: 1s:P- IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: tkit' lu_.,.,j 11'u1 � TOWN /VIL /CITY /V DISTANCE TO PROPERTY •FROM NEAREST WATER Ikkn: •° -• LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED DON SEPARATE SHEET (date) (signature) �c�=' -- t0 PERMIT TO CONSTRUCT A WATER WELL <r C7 This permit to construct one water well as set forth above is granted under the OAvi(glons 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 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 drill g perations be contained on this property and in such manner as not to degrade or othe wi i ontamina surface or groundwater. Date of Issue: � 19� Date of Expiration 19_ Permit Issuing Official Permit is Non - Transfer able White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller DEPARTMENT OF HCALTH Division Of Environmental Health Services n Geneva Road, Brewster, New York 10509 (914) 278 -6130 September 14, 1995 Norman Anderson 152 Barger Street Putnam Valley, NY 10579 Re: Proposed Well Kase Pleasant Road (T) Putnam Valley Dear Mr. Anderson: BRUCE R. FOLEY, R.S. Acting 'Public H&@Ith' Dirdc'tbr Review of plans and other supporting documents submitted at this time relative to the above - captioned project has been completed. Comments are offered as follows: 1. Enclosed please find the current guidelines for proposed well construction permits. Revise submission accordingly. Upon Receipt of a submission, revised to reflect the above comments, this ' .ppt ?cati,o:r wil1 to. cons der.cd further.. . Very,truly yours, VJ Robert Morris Public Hcal th Engineer r ii j p .. f.. , "i f ,sj ,, t" 7M s a it., I o na, q ve v:o ;;. v. IrM wrx n ipM Ooee not f . ❑ AddromW a Address RaruMt Radelpr RegyaCred' on the maR;Ifte below tM artlde Wnbor. 2. ❑ Reetitled Delivery The Return Ast*1 t wiff show to whom to WIG was dAvred and Isle date delWerad. Cron sult poatmester for fee. A ILI*Ie d dsd t 4. ANber . l - 6 A AY " , E E 4b. SOMCe Type ® Express malt C] Irtsursd . ❑ Retum use ❑ COD Da w S. ROCOlVed By: (PlfntName) yllregtt®ttded U us la p6 �!ti RPS 1alI Deosrne 1 ! 11 FM YOM name and awrgse on the revorse of this form 90 that Yle W rtatuft Ira form to the front or me maitpisoe, or an the Meet It e0603 dome not m, w Rstum Raoelpt AsQue AW on the ma iplew boa* the ankle number. o The Return Raoeipt Alf to ~ft ddIVO ef" Wide waa O MiVered. and ft date m 3. Article Addressed to: 48L Attic 4b. on AN7 R, �. D EW tQ, 7. Data I 5. Received y: (Print mom) 8. Addre and h �. 6. Sign Ar : or ) 2 r5 ram X11, Dar 104 I dtdW theft W POW" ft foOotMng services (for an We fee): . . I . ❑ Addr®ffiaws Addt&ft' 3. ® Resbicted Delivery Cansult postmast6r for fee. ` ilber pa �CerSfied �! ❑ Insured, Ad -ftea (oMyIffVQEW d so A c.A 9tr:trS 96 92 &k APR 26 '96 14:44 �akePeriy Ce, �� -�c ,ems„ , /061 �4- a.eE �(a.- 7`— ��,.Zeeio, PUTNAM VAIIEY ay -OWN KATZ: MARVIN O'DELL PUTNAM VALLEY, N.Y. Bldg. Inspector • E` (914) 526 2377 qp BETTE STOCKINGER JOHN MAHONEY TOWN O F PUTNAM VALLEY Bldg. Dept. Clerk Deputy Zoning Inspector BUILDING, ZONING, AND SANITARY DEPARTMENT April 30, 1996 T0: Putnam County Dept. of Health RE: Proposed Water Well - Haskell Kase 68 Pleasant Road - TM #83.65 -1 -35 The above noted property has been reviewed and meets Town zoning requirements pursuant to installing a water well. ARVIN 0" MO'D:es & Building Zoning Inspector r r Xz' U 1ct. c+_.. _ Ato 1 ! 1 1 I J' qp il �lv NSUI ... 1\ / Ar �• 1J \ \ jr 39 W` \ \ ' �. � `�� \�� l' \ ,� r .�•, fir, r �.�.