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Home My WebLink About4171DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.75 -1 -13 BOX 32 .� 9 T J IN q16or V 11 � 04171 PUTNAM COUNTY DEPARTMENT OF HEALTH ✓ DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRU ■/Y`T A- WATER..WELL . �. . iG.C.. �.. .'Yr �_ d..- �� .. .,'AA�. . (•'�•O �. t .w a .�tV - .bs -. ..�.. .. .. 6,14 . -. � .. •Yr R .V f O 'ws please print or type PD Permit # * Well Location: Street Address: Town/Villa e Tax�yGrisi # �., ap f Block Lots), Well Owner: N Address: 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 gpm # People Served Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply volliag) Deepen Existing Well Detailed Reason ; , ,- , , for Drilling Well Type Drilled Driven Gravel 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: unfmtkall Ath Address: Is Public Water Supply available to site? ...01'ti1?� .. �' o pp Y ;�,i.. ,..�..... & /... Yes No Name of Public Water Supply: J {�. � l` Town/Village72R & k viy �A, - Distance to property from nearest water main: f Proposed well location & sources of contamination to be provided on separate sheet/plan. T�2te: plicaant_Signature; J•� 'w 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 W" ater 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'&anner 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 / �' /. Permit Issui g f Date of Expiration/ Title: Permit is Non- Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 U.S. POSTAL SERVICE CERTIFICATE OF MAILING MAY BE USED FOR DOMESTIC AND INTERNATIONAL MAIL, DOES NOT PROVIDE FOR INSURANCE — POSTMASTER Received From: One pieoe of ordinary mail addressed to: 16 9 PS Form 3817, Mar. 1989 U.S. POSTAL SERVICE CERTIFICATE OF MAILING MAY BE USED FOR DOMESTIC AND INTERNATIONAL MAIL. DOES NOT PROVIDE FOR INSURANCE — POSTMASTER Received From: tyo o �' �� ° d�—NA:k( One Piece of ordinary mail addressed to: 7'Y1 ax /�Qc�_�. 1✓1n,,;,�..o1,��f,�Qa�w A,4,Qe„� Affix lee here in stamps il U.S. POSTAGE S a > 0mv LAKE PEEK KILL.NY o ^8 AUG II. 99 o ^ �' bwnsosrerFS AMOUNT a rosracrFav,ca $0.60 r 0000 00093611 -03 n o a m c .Ail XL) -mvy OT C- (�J1JmCD� oO o r a w r m -c az 0 p 0 TM wM t lac o v'7 Z y L a� O (O y ca wO to r- m z 3 W � V PS Form 3817, Mar. 1989 e _ _ _ . • 3 - cc U.S. POSTAL SERVICE _. CERTIFICATE OF MAILING MAY BE USED FOR DOMESTIC AND INTERNATIONAL MAIL, DOES NOT PROVIDE FOR INSURANCE — POSTMASTER Received From: One place of ordinary mail addressed aA oC oyl.as., i oS�q PS Form 3817, Mar. 1989 U.S. POSTAL SERVICE CERTIFICATE OF MAILING MAY BE USED FOR DOMESTIC AND INTERNATIONAL MAIL. DOES NOT PROVIDE FOR INSURANCE — POSTMASTER Received From: �Q-c' One Were of ordinary mar addressed to: `l1 • � 0.- C o u Mo" O N �e ^w r D o x An c o� c an v w l l a 3 —mom, a r � m I •vnu ian nme n. aw 0 00 r a wv o_ —oma -ZIP "✓�� z m -c PS Form 3817, Mar. 1989 I W y a f 0 a w UQQ 2 y ` , Z -ryo Q O Q 0 a J g # 6 O N m E LL y a 090$ ° ° °° 1Nnl�WB 'ter ^airiovso+ 66,' I 9n9 sslvisasav�n L£S I AN "1lIJIS3i3301 d 3)181 ` r 39y1SO ��S'n 3 i. S a > 0mv N Q 0 y S O y m nom m my _4 $ �nf7 y0m H Z y m 9 T 0 rr �; y 0-4 �m >-n o N d 0 n y r Oz 090$ ° ° °° 1Nnl�WB 'ter ^airiovso+ 66,' I 9n9 sslvisasav�n L£S I AN "1lIJIS3i3301 d 3)181 ` r 39y1SO ��S'n 3 i. 11922 — — — — — — — - - - - -- — — — — — - - - - - - - - - - - -- 3 - -- ' 7 67 112.62 — — — — — — - — — — — 15 LO — — — — — — — s 114.09 14 (77 I oir c4s TU Y- 90 13 — — — — — — — — IX40 104.36 IQ4.-56 /7 -77 40 dJ I^^ -t-a 104.56 e9 ly m :I CD .50 UAIK� — — — — — — — — — — I' — - - - - - - 20 o(vc-,s sf 7 10 NP pot 6v — — — — — — — — — — — 104.36 — — — — — — — — — — - — — — — — — — — — — jr — — — — --- — — — — — — — VIM DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 2-78-6130 FOP -MAT NEIGHBOR NOTIFICATION CONSTRUCTION PERMIT BRUCE .R.. FOLEY, R.S. Acting Public Health Director DATE !t _9 7 dZIN RE: Department of Health Review of Proposed Sewage Disposal System and/or Well `7 A:VlE: j?�rL�G� ADDRESS: P6 bC, J` /0-Z3 - l0S7 AX MAP: �.. 4� Dear Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the above captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. _ _.,......: .. -you have -ar_y tion which4nay,bear on -the- Health Departm.- .)I''s... review of this application, you may call Mr. Hedges of the Health Department at 278 -6130. �'ery truly yours, RECEIVED BY: ADDRESS: TAX MAP: BRF /JP syswell DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130, FORNv AT NEIGHBOR NOTIFICATION CONSTRUCTION PERMIT 19-is Deang9 et ct—,yn t '5�t " -- lk � BRUCE R. FOLEY, R.S. Acting Public Health Director DATE '3 — -/- — ( 7 Department of Health ReNiew of Proposed Sewage Disposal System and/or Well NA-NE. ADDRESS: 0' 430 / T () W- N-1: - I , . los 72 TAX NSAP: Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the abo,.,-e captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. - �. _...... - .m Ifyou:have any quesfioris; concern"oririformatio vv ch'may bear on the Health Department's review of this application, you may call NIr. Hedges of the Health Department at 278 -6130. Very truly yours, 'n LE: RECEIVED BY ADDRESS: TAX MAP: BRF /JP syswell gl` Ut R: FOLE' - "' S. Acting Public Health Director DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 FORMAT NEIGHBOR NOTIFICATION CONSTRUCTION PERIVIIT DATE RE: Department of Health Review of Proposed Sewage Disposal System and/or Well ADDRESS: '-?6 .'3 "x `Z3 TOWN: f /677 TAX MAP: Dear Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the above captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. Jf-you have -kly gitestioris,- concerns -or "uifomiat on ",ivliicfi may l ea'r on the Health Department's review of this application, you may call Mr. Hedges of the Health Department at 278 -6130. V e. i-v truly yours, BY TITLE: Cpl ng 'Q '4 RECEIVED BY ADDRESS: TAX MAP: BRF /JP syswell BRUCE R. FOCEY R.S. Acting Public Health Director DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278-6130 FORMAT NEIGHBOR NOTIFICATION CONSTRUCTION PERMIT DATE RE: Department of Health Re-view of Proposed Sewage Disposal System and/or Well ti:LME: ADDRESS:' Ti WIN: 7 A`; P.M J//j J � , �L'Y 10.5'19 TP"%.X MAP: -p Dear �"M,o Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the above captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. if you havo any questiuris, -toffc�efns of irff6rinafio"n' which may bear on the Health Department's review of this application, you may call Mr. Hedges of the Health Department at 278-6130. Very truly yours, BY '117 LE: RECEIVED BY: ADDRESS: TAX MAP: BRF/jp Syswell DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 FORMAT NEIGHBOR NOTIFICATION CONSTRUCTION PERMIT •s,BRUCE-;-R- r'OLEY; " R:S:` Acting Public Health Director DATE 4-- /-/ -q 1 RE: Department of Health Review of Proposed Sewage Disposal System and/or Well ADDRESS: 'IP(0 • &)X / 3 TOWN: TiLY -N,,1AP: 3: 7 Dear Please be advised that an application for a Construction Permit relative to the construction of a sewa?e system and/or well proposed for the above captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. r _ _ If you -ha ,e -arty que-stions. concerns -or informatim'wMch may bS is on e'altl Department s review of this application, you may call Mr. Hedges of the Health Department at 278 -6130. Very truly yours, BY i TITLE: RECEIVED BY ADDRESS: TAX MAP: BRF /jp syswell DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 FORIv1AT NEIGHBOR NOTIFMATION CONSTRUCTION PERMIT BRUCE +R'. FOLEY, R.S. Acting Public Health Director DATE 3 - q - , 5 RE: Department of Health Review of Proposed Sewage Disposal System and/or Well ADDRESS TAX MAP: ��. 7 < ,- % - ( 3 Dear�C�� _. T Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the above captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. - ' If you have °any qu stidnf; "cbric6"r § or iiiforma ion which may bear on the Health Department's review of this application, you may call Mr. Hedges of the Health Department at 278 -6130. V e ry truly yours, BY TI'. LE: RECEIVED BY ADDRESS: TAX MAP: BRF /JP syswell