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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 /�; /
PCHD PERMIT # t/o -4,��/
WELL LOCATION
Street Address
s S f;
Town/Village/City Tax Grid Number
491« P6,6',rs «, sEF h
WELL OWNER
Name Mailing Address ®Private
Mce4R(Z i1 7OS�P�( .S'f CAKE .%%t' 'KIZL O Public
USE. OF WELL
1 - primary
2 It secondary
.1 RESIDENTIAL
0 BUSINESS.
0 INDUSTRIAL
O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED
O FARM O TEST /OBSERVATION O OTHER (specify,
O INSTITUTIONAL O STAND -BY O
AMOUNT OF USE
YIELD SOUGHT gpm /# PEOPLE SERVED 2 /EST. OF DAILY USAGE .SO gal
13 REPLACE EXISTING SUPPLY O TEST/ OBSERVATION Q ADDITIONAL SUPPLY
O NEW SUPPLY NEW DWEL ING !O DEEPEN EXISTING WELL
REASON FOR
DRILLING
DETAILED
REASON FOR
..DRILLING
0 //l 14
191qCx4e14 S 404
4 P. 5 sue-.
WELL TYPE
.DRILLED
QDRIVEN
[]DUG
0GRAVEL
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES ✓ NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No. V
WATER WELL CONTRACTOR: Name AIOAiAM J 9AJI)6e-e�'J Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
_... DISTANCE' `PO -PROPERTY FROM NEAREST--WATER=
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
❑ON SEPARATE SHEET I
((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. 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 approfriate action. to assure that
any and all water or waste products from such well drilling op.erations.be•contained on this
property and in such a manner as not to, degrade or otherwise.'contaminate surface or- groundwater.
Date of Issue: 19
Date of Expiration 19 Permit Issuing Official
°ermit is Non - Transferrable White copy: HD.File Pink copy: Owner
X89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
i
-. , --
x _ _ _ _, 4r7 7:..
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(914) 225 -0310
Joseph McCarren
1 Mathis Street
Lake Peekskill, NY 10537
Dear Mr. McCarren:
"X
JOHN KAHELL Jr., P.E., M.S.
Public Health Director
October 23, 1991
Re: Well Construction
Permit *W -63 -91
McCarren, 1 Mathis St.
(T) Putnam Valley
TM #106 -1 -101
I have received and completed the review of the application to construct
a well on the above mentioned parcel. The application , as submitted,
is denied for the following reasons.
1. The proposed well is located within 50 feet of the sewage disposal
_ #�olot-- �° 9r5r,.. 9f ca��t� =�9�Ic:. >_:. ; <:,;:_.._..... -,.
A minimum of 100 feet is required.
If you have any questions concerning this matter, please contact me at
your convenience.
Very truly yours,
William He ges
Sr. Public Health Sanitarian
WH /jp
Bldg. Inspector
JOHN MAHONEY TOWN OF PUTNAM VALLEY
Deputy Zoning Inspector
BUILDING, ZONING, AND SANITARY DEPARTMENT
September 16, 1991
Putnam County Dept. of Health
110 bid Route Six Center
Carmel, N.Y. 10512
Att: William Hedges Re:
Dear Bill:
Joseph McCarren
1 mathes St. - LP
TM#106-1-10
Per your request, I have reviewed the above noted
proposal to construct a water well for backup supply
and observed the following:
The proposed well site avrars to be located (see
survey) within fifty (50 feet of an existing.
SSDS on property of the Smith gamily on Lots 95, 96
and 97 as shown- on Subdivision Map of-Ljke,.P9-ekskill
JOWN-HALL..
-'PUTNA ''VAIILE N-Y-
(914) 526 2377.
BETTE STOCKINGER
Bldg. Dept. Cie*
Yours truly,
MARVIN O'DELL
Building .& & �oning Inspector
MO'D:es
cc: Survey
TM #106
Application
146-1
DEPARTMENT OF HEALTH
Division of Environmental Health Services
:1I p��OI.R...ROUTF SI7� .ENTER,: CARMEI., N >. Y;- .•;Q Y( °1!i): R225 0310- , , . _
_
APPLICATION TO CONSTRUCT A WATER WELL
PCHD PERMIT
WELL LOCATION
Street Address
! ANA % /c'S Sf .
Town Village City Tax Grid Number
4A /CF
WELL OWNER
Name Mailing Address ®Private
mclftva" 7osepw ! 1'�rvis: Sfi 44ffC O Public
USE OF WELL
1 - primary
2 L/ secondary
® RESIDENTIAL.
O BUSINESS
0 INDUSTRIAL
O PUBLIC SUPPLY O AIR /COND /HEAT PUMP ❑ ABANDONED .
O FARM O TEST /OBSERVATION ❑ OTHER (specify
O INSTITUTIONAL O STAND -BY
AMOUNT OF USE
YIELD SOUGHT gpm /# PEOPLE SERVED /EST. OF DAILY USAGE SO gal
❑ REPLACE EXISTING SUPPLY ❑ TEST /OBSERVATION M ADDITIONAL SUPPLY
❑ NEW SUPPLY NEW DWELLING C] DEEPEN EXISTING WELL
w w'&' 4 _ 4c<,_1,4 SvCr�LV
REASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
/' O -e X
c X a 3 c% 5 s�-•-
7`4
y "e -epr,
WELL TYPE
❑DRILLED
DRIVEN
aDUG
®GRAVEL
C]
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES ✓ NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No. L/
WATER WELL CONTRACTOR: Name IV(IA4141 PAJi)4 ,F Z rlJ Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO
_NAME OF-PUBLIC-.WATER SUPPLY: TOWN/VIL /CITY _
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED )
7- 23� �/ ❑ON SEPARATE SHEET �, , , /�1,�;
(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. Pump the well until the water is clear.
2. Dis -nfect 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 Departmen
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• 19
Date of Expiration
19
Permit Issuing Official
Permit is Nun - Transferrable White copy: HD.File Pink copy: Owner
�89 Yellow copy: Bldg. Insp. Orange copy: Well Drill/
a �
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S O"Ly REVISIONS SPEML DISTRICT)KCRM4110.1)
PRELIMINARY
106
TOV.N OF PUTNAM VALLEY