The URL can be used to link to this page

Home My WebLink About4431DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84.11 -1 -44 BOX 33 04431 a hk 73 r r No I IN IN NN No 1 a k6wi or IN N' ,�,, - - " 4a ., ` 61 r �1 No No o or MJ— Ia �, III 04431 V0,4, ., - e�5�01� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES �.... r . ,APP.LICATI.ONTO.CONSTRUCT A.WATER- .WELL, please print or type PCHD Well Location Street Address: Town/Village: Tax Map # 9 l plf4 t' Vp4fte IlMap �! Block Jr Lot(s) Well Owner: Name: Pll O An/16 Address: Iry hi (r �S'f � �a� ULA Phone #: 3 Use of Well: ;/ 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 Sr"gpm # People Served Est. of Daily usage gal. Reason for Drilling , //Replace Existing Supply Test/Observation Additional Supply L/New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Tye Drilled Driven Gravel Other Is well site subject to flooding? ....................................................... ...........................No-t--*" .. Yes _ No1 Is well located in a realty subdivision? ........................................... ............................... Yes _ No Name of subdivision Lot No. Water Well Contractor �� Address: %�,l* �.��C�� Is Public Water Supply available on sit e? ....................................... ............................... 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. Dater 0 9 Applicant Signature: ` 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 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 bV the Putnam County Health Department. 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 06years 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 Commissioner of Health. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam C,punty. � n If Date of Issue PP /11/c, ei Permit IsWjing Offic' _ /, �� / Date of Expiration Title: ITS AP Permit is Non- Transferabfe White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Rev. 3/06 G. AkPPU�CATgQ' N TO ABANDON A WATER WELL n -_ _, please print or type PCHD PERMIT # Well Loc don: Street Address: TownNillage Tax Grid # SY Ao44,4, ve, /I,-� i4� Map ' Block Lot(s) ell Owner: Name- t d ti 14-G ti /o!A/ Address: r s" f- 4140 t t4_ 1A j Well Type: Drilled Driven Dug Gravel Other Depth Data: Well Depth /D ft Static Water Level T::Date P` Measured d� Use of Welli Vkesidential Public Supply Air /Cond/Heat Pump Abandoned I -pi imia iy Business Farm Test/Observation Other (specify) 2- secondary Industrial Institutional Standby Water Well Contractor: Name: Address: �1/o Y K-\ C1 h ,�� Y-�d'k �� Cii jyj a Reason For Abandonment: I Description f Wor To Be Performed: red: Date: Applicant Signature: i JAX(A ze—, fn QiN PERMff ' This permit, to abandon one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code, Subpart 5 -2 of Part 5 of the New York State Sanitary Code and/or Part 75 of 10 NYCRR and provided that: Within 30 days of the completion of the abandonment of the water well, the applicant shall submit to the Department a certified statement that the information delineated on the application for this permit has been completed. Date of Issue White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -97 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health . " Lo R ETTA .MOI;INAR:; Jt v, -MSN. - : -, _. Associate Commissioner of Health ROBERT J. BONDI County Executive I " RO�ERTIVI(�51tRIS:pEL Director of Environmental Health DEPARTMENT OF 'HEALTH . DRINKING'AND RECREATIONAL WATER Norman Anderson, Inc. 152 Barger Street . Putnam Valley, NY 10579 August 17, 2009 Dear Mr. Anderson: Re: Proposed Well O'Hanlon 80 Mill Street (T) Putnam Valley A field inspection was conducted on the above referenced lot by Mitchell Lee,, Public Health Technician. The application to drill anew well is approved with the following Stipulation: I 1. A Well Completion. Report (WC -97) shall be submitted no later than 30 days after . the yells' completion by the permittee:. .... Please contact me at (845) 225 -5186 ext.2233 if you have any questions. S.ncerely t Mitchell D. Lee Public Health Technician cc- e. 110 OLD ROUTE 6, BUILDING 3 - CARMEL NX 10512 (845) 225 -5186 FAX (845) 225 -5418 Ir i. - ------------- 7-; v -2 7 j AI y 44n=s z- ; ;N4 - rme: C; I, "7nw, M 0 ''j' IV A -a i. Cc Qj l000C o 11 Lli OWC 14J (b Dn 0 j 30- 0. 1 50 03 L 0 e- 10/.4 490 IV-9- 36 - 9" 36 S70 10L Z;;Ze ou t" W4-4 'SS45'Z 75 . O S,�, I I 0 :o:p... `- r. - ...,, .— . ..-. ":�, «rn'4: i:4_gi y6 o'i � v.:. ' � _ .a ; ?/..•� ..... :yes.::';'- ,�-:. - �..., . , � .-. `:j. �.:;i,: ri^i';al.i :...a .� :.� ,... -. •. - -. 0 1, v� 0 0 °UMp HOUSE ..... y } N 9 -I _ SIGN sG F � E rn . A /p✓, 28 *4 4 A. o J (� W 0� ✓ ST FR DWG 6 I `^ J / ✓'7-57- 30- I' l '�C L ✓` J 4 lil CO N'6 /4- - 40.03 � �G F /✓-0- CO A°° \/ °UMp HOUSE ..... y } N 9 -I _ SIGN sG F � E rn . A /p✓, 28 *4 4 A. o J (� W 0� ✓ ST FR DWG 6 I `^ J / ✓'7-57- 30- I' l '�C L ✓` J 4 lil CO N'6 /4- - 40.03 � �G F /✓-0- O C, Oil 1000, lb pUArp I ko N. It I I I O -9-36 -a0- -0 S , W4Z, ,I QC LQ I. S O 1 O14qj QD _ SrREEr - SURVEY OF PROPERTY FOR JOHN P OHANLON SITUATE IN CERTIFIED TO NATIONAL, L A /IV, �N B J. Henry Corpenter 9 Co. PUTNAM COUNry,my Civil Engineers 69 Lond Surveyors Yorktown Heights N.Y Scole - 1 40' Sept. 10,1968. H.£. FROMNHOLZ, P. £.a L.S. Aug 22, 1972.