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HomeMy WebLinkAbout4179DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.75 -1 -35 BOX 32 04179 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A.WATER WELL please print or type .P�HD Permit' Well Location: Street Address: TownNillage Tax Grid # AOP,R -ISSE� Dei FLI-r UAUEL Y MapU j.j,%lock Lot(s) � Well Owner: Name: ALA9 WkINNEV Address: A a str Use of Well: Residential Public Supply Air /Cond/Heat Punif X firigation 1- primary Business Farm Test/Monitoring er (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm #People Served �-- Est. of Daily Usage �5- gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Apra— Detailed Reason W A Z- p, Pop- r4V C Pg t l,(S w ms- teavitk., SL 1Ec.. 2- 0N1 " -.,t ON c 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 L A Lot No. I J 5 — 2 b Water Well Contractor: N 0 T S Et,. Address: Is Public Water Supply available to site? .............................. ............................... Yes N ... Name of Public Water Supply: j'l TownNillage Distance to property from nearest water main: K lk Proposed well location & sources of contamina ' be provided o s arate_shee an. Satz: 1-41 :.applicant Signature: _ _. ._ ..... PERMIT TO CO T CT A W TER WELL This permit to construct one water well as set fo ove, is gr ted 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 P tnam County. Date of Issue Ododflool Permit Issuiri Official:. Date of Expiration 1. ® ZI U Title: Permit is Non-Transfeqrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller 4--, 1r1J iii. C) S "i v'cz '� y Y V A*Jts S t., r (Z— Form WP -97 ,, ::j m- ._i - IF I February 4, 2000 ARCHITECT'S REPORT Well Permit for Alan McKinney Morrisey Drive Putnam Valley, New York 10579 T.M. # 93.75 -1 -35 Mr. McKinney, who runs a landscape business, recently purchased the above mentioned property. At the present time, he has no intention of installing any sanitary. facilities. Purpose of this application is to obtain a permit to drill a well. The well will be used to water the plants and shrubs that Mr. McKinney sells and installs for his clients. A meter will be installed in one of the existing sheds on the property. See site plan. The well pump will be shut off during the winter months since none of the sheds heated— The.meter will.be.:z Neptune: brand- Model: #- Tr1.Q:.:_ The site plan also shows a location for a future septic system. However, as noted above, there are no plans to install one. JLG:STW v EO \g �RSNCe 0 � 4�i•n.� � �p 01105 0 OF NE`N �/ U,.. -,-Qi et6 =R. FOLBY : Public Health Director February 2, 2000 LORE TrA' MOLTNAM R.N`1 *"M:SX `_ a Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road . Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 FILE Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention (914) 278 —6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 Mr. Joel Greenberg, RA Two Muscoot North, RFD #2 Mahopac, New York 10541 Re: McKinney Well Permit Morrissey Drive (T) Putnam Valley, TM# 83.75 -1 -35 Dear Mr. Greenberg: This office has reviewed the most.recent set of plans for the above mentioned project received on January 27, 2000. We would like to offer the following comments for your consideration. 1. a) Provide this office with detailed use of proposed well. b) Further explain "Water for Landscape Business" c) Report to be in the form of "Engineering Report" of site. . d)�ApprovaI.—wdIL= require - instal ati0 -n=dfvvater- usage - meter: b) Provide in Engineering Report model, location and installation point of meter. 3. a) "Future septic" area is within one hundred (100) feet of an existing well (TM# 83.75- 1-34). b) An "approvable" area for future SSTS will have to be provided prior to issuance of the well permit. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj Wt -FOLF, Public Health Director February 2, 2000 � "i�itETTA MOLINA�I R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH .1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 . Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 Mr. Joel Greenberg, RA Two Muscoot North, RFD #2 Mahopac, New York 10541 Re: McKinney Well Permit Morrissey Drive (T) Putnam Valley, TM# 83.75 -1 -35 Dear Mr. Greenberg: This office has reviewed the most recent set of plans for the above mentioned project received on January 27, 2000. We would like to offer the following comments for your consideration. 1. a) Provide this office with detailed use of proposed well. b) . Further explain "Water for Landscape Business" c) 'Report to be in the form of "Engineering Report" of site. . - : 2 � A a) Approval will require .installation r;f wz iLef usalge b) Provide in Engineering Report model, location and installation point of meter. 3. a) "Future septic" area is within one hundred (100) feet of an existing well (TM# 83.75- 1 -34). b) An "approvable" area for future SSTS will have to be provided prior to issuance of the well permit. This office will continue its review upon consideration of the above mentioned comments. Please feel free to contact me at ext. 2157 if any questions arise. Very truly yours, Adam B. Stiebeling Assistant Public Health Engineer ABS:cj .Q -��•M- 4.. t.. .Cb -' r.- -• • •i J T • • 'F' •r •..•w,w �Y BRUCE R. EY -•_ " Y .� • - Public ­Heakh : Drf�ctor w DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 May.7, 1998 Mr. John M. Zarcone, Jr. Putnam Valley Medical Center P.O. Box 642 11 Peekskill Hollow Road Putnam Valley NY 10579 Re: McKinney Well Permit Morrissey'Drive TM# 8175 -1 -35 (T) Putnam Valley Dear Mr. Zarcone: This office has received and reviewed the submitted application for the above mentioned project and has determined it to be incomplete. We would like to offer the following comments for your consideration. - Please find enclosed procedure for New Well Permit Application. A. Site Plan: A Site Plan showing the proposed location of new well, existing septic, all existing wells and septics on adjacent properties is required. B. Neighbor Notification: Applications for Well Permits will not be reviewed until such time as the Department is provided with proof that notification of the application for construction was made to all property owners contiguous to the property in question. A location map, showing the contiguous properties along with the property owner's name and tax map number, must also be provided to the Department. Notification shall mean receipt by each contiguous property owner of a copy of the notification form in Appendix E along with a copy of the latest site plan. f.-- Letter.to: -Mr. John -.M. Zarcone, Jr. .�,May Proof of receipt of notice by contiguous property owners can include either of the following: 1. Copies of registered mail receipts. 2. Copies of the notification form signed by the contiguous property owners. Failure to provide the. Department with adequate documentation of the performance of the notice will result in delaying action on the application until proper notice is executed. Transmittal of this notification should be sent to the contiguous property owners by the Design Professional, or Authorized Representative. This office will continue its review upon receipt of the above mentioned materials. Please feel free to contact us if any questions arise. Very truly yours, Adam B. Stiebeling ASB:tn Assistant Public Health Engineer enc. APPENDIX E FORMAT CONSTRUCTION PERMIT NEIGHBOR NOTIFICATION LETTER Date RE: Department of Health Review of Proposed SewageTreatment System for Property Name: Address: Town: 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 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 questions, concerns or information which may bear on the Health Department's review of this application, you may call the Health Department at 278 -6130. Very truly yours, Title: Received By: Address: Tax Map n: August 1997 DEPARTMENT OF HEALTH Division Of. Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 PROCEDURE FOR NEW WELL PERMIT APPLICATIONS Acting Public Health Director 1. Well permit application is to be submitted along with fee, if required. 2. Locations of all sources of possible contamination within 200 feet of the proposed well location are to be shown on a plan or tax map. 3. Contiguous neighbor notification is required. 4. Feasibility of well location is to be confirmed by a representative of this Department. 5. If the proposed well is within 15 feet of the property line the approved well location is to be staked by a licensed surveyor. If the proposed well location is within 100 feet of any Source of contamination the well location is to be staked by a Licensed Engineer, Registered Architect or Land Surveyor prior to drilling. 6. As built and well log to be submitted no later than 30 days after completion, _ by.�pe'r- m�.;ttee,.- BRF /RM /jp August 1995 1 • T H E L J ITT I STREEET • 1 aWCRt Ta . 11 A lAOI.MwTQ i" �QCrT v. oiwQ mv¢a 'SUM DQTcSiPltQtiD a,^,� y�- � � I• I• pAheYMnT• 4e <n +tou s♦ NSF rwva ONY Hl F MUP PMY H /F MURPHY QDITO YMrk � rnx'ra TAX S. D, TAKT•D.85.73-F -4$ N gyp;: Pyq M ANA 60 UN TY e ]175 -1 -50• 83.75 -1 -4A TaK T.D. 4'D.78 -1 -d-7 N1F CONUOLLY " VACANr tr pVAGANT < VdOGANTu TAK T -Tx ®'5.79 -1 - ©1 W�1L To 3 ,f y QL POWR w ELL -'.)Ao N!F" M, IKOL � . TAX X.P. s375-1- ExIiY I,<a MGTi: gvlLOluG ,4l: PTU n {a ' • . 6KICTING %ko� %{. � I I O � N/F McK1 NN 4+,Y . f I I TRx Y•D. 89.79 -( -9.g 7 M 5J®w..µ4-T PROPCR.IT�Y. � .. ^� (�, _ AM, ga><1nNYQ ✓' FOTUP- J N�{'' MULTIPI -Q R.SO.JpB6S,11.1C. :ul.11tSW l•UU4T.y Dupar Cm.11 l<c�neq Q► a.u,pp• 55 QS w. 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