Loading...
HomeMy WebLinkAbout4221DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyou rdocs.com 631- 589 -8100 83.81 -1 -54 BOX 32 J61ILI I �� ., I : .� df..' M. 46 a" I ` ' T ' of 04221 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health K LORETTA MOLINARI, RN, MSN Associate Commissioner of Health February 25, 2005 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Edward & Kathleen Madigan 222 -94 Braddock Avenue QueensVillage, NY 11428 Dear Mr. and Mrs. Madigan: ROBERT J. BONDI County Executive Re: Well Permit Application for Madigan Property — 46 Laurel Road (T) Putnam Valley This Department has approved the well permit for Well #W11 -05 at the above referenced site. Please be advised that if site conditions and/or site plans change and/or are revised, thereby compromising the approved separation distances, siting approval of the well must be re- approved by this Department. This letter shall serve as record of approval and by initiating construction of the well covered by this approval of plans, the applicant accepts and agrees to abide by and conform to the following: 1. The well location shall be survey located and staked prior to drilling. 2. The proposed well is approved 75 feet from on -site and/or adjacent subsurface sewage treatment system areas. '- �- :��3,•...The well.shall be. installed: with_ a. minimum:af.(6.feet;,.ofca�ng ;�. - 4. An ultra- violet light disinfection unit shall be installed on the incoming well line to the dwelling. 5. A water sample shall be collected and analyzed for coliform bacteria after the well is drilled. The sample result is to be submitted to this Department along with the well completion report within 30 days of completion of the water well. 6. All necessary Town permits f6r the installation of the well are required to be issued prior to well construction. Should you have any questions, please contact this office. Michael J. ] Director of MJB:cw Cc: C. Santos, (T) Putnam Valley Insite Engineering Environmental Health (845) 278 -6130 Fax(845)278-7921 Nursing Services (845) 278 -6558 WIC(845)278-6678 Fax(845)278-6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 PUTNAM COUNTY DEPARTMENT OF HEALTH IVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION T.0 C®NS.T.RUCT A WATER WELL please print or type PCHD Permit # Well Location: Street Address: Town/Village Tax Grid # 3 gJ — I -- S y ,'/ G L A v re EL L iF c" sk 1 L Map Block Lot(s) Well Owner: Name: E_j> w A P- P--P d Address: av E /[,, S eA-- T4LE',v /nA-DIt -A->v 2'R9� - >ockABU£ ., V /CL'4G•c IV y I/y,�" Use of Well: it 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 A Est. of Daily Usage _gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason c T7%z Lv _ 5 `, L for Drilling Well-Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No i Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision Lot No. Water Well Contractor: Address: Is Public Water Supply available to site? .................................. ............................... Yes No _ Name of Public Water Supply: Town/Village Distance to property from nearest water main:+ Proposed well location & sources of contamination to be provided on separate sheet/plan. -, . A licant:Si nattirew_ _.... - -- .Dat�:r: �._ ��n� -� a pp g PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article J, of tfir Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and=pro4faed 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. A _ n A Date of Issue 25� U `o� Permit Date of Expiration 2 o Title: _ Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 ., t7 LEGEND NOTE These sketches are tweed on New York State Nigh Resolution Approx. Location Existing Well Q Statewide Digital Orfhoinogery ProRmn (2000 Plot — Present) and digital tax map Information M1om Putnam County. These sketches are Intended to show Subject Property Approx. Location Proposed Well - approximate property lines, dewigm and septic systems for use in assessing possible wel locations only. Mese sketches are not Intended for my other Approx. Location $$ © Direction Of Ground Slope SLOPE and to be seandd. Pryor to my proposed Existing SSTS Arrow Points Downhill s� th appropriate su � must be y; d'slr; permits must he aato6wal mmvc" LAKE PEEKSKILL '"""a"" / N S / T E az 10 -11 -04 WATER SYSTEM SHUTDOWN --q ENGINEERING, SURVEYING& srue 1 " =30'' LANOSC,4PEARCHITECTURE P.C. nrocerxa 04183.100 PLOT PLAN T l 46 LAUREL J Garrett Place s Corme /, New York 10512 Ph— (545) 225 -9690 • Fax (943) 225 -8717 8391 -1 -54 rww.lnsite- eng.com