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Home My WebLink About4463DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84.15 -1 -18 BOX 34 I loom Al . 660 r. sod N , no. -, � 'tif 04463 �r a PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES Internal Use Repair Permit issued in last 5 years Repair within Boyd's Comers, W. Branch or Croton Falls Res. ❑ Repair within 200 ft. of a watercourse or DEC- maooed wetland SITE LOCATION OWNER'S NAME MAILING ADDRESS TOWN PERMIT # 1. ,L-' tin Watershed L-- Delegated ❑ Joint Review TM# PHONE # APPLICANT Name & Relationship (i.e., owner, tenant, contractor) DATE Aj F CILITYY TYPE }�C'i _ PCHD COMPLAINT # PROPOSED INSTALLER " lam' G PHONE # 2 1 C11%G e7 ADDRESS // �r J �., /Zi' REGISTRATION /LICENSE # Pro osal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed system) NOTE: The Department may require submittal of proposal from licensed professional depending on the nature and extent *of the repair. I, as owner,agree to the conditions stated on this form ` SIGNATURE TITLE DATE (owner) ;i,::th,e q-eptic, h Mll' .ag tca c lyWth th0 c;driditidns of th a permit fdr tlieseptic system repair .,. SIGNATURE "� �. TITLE DATE (installer) Proposal approved with the following conditions: ; 1. Procurement of any Town Permit, if applicable. 2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing: a. Owner's name, Site Street Name, Town and Tax Map number b. Location of installed components tied to two fixed points c. System description (e.g., 1250 gal. Concrete septic tank, etc.) d. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and conditions 4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the completed SSTS repair will function. 5. No completed work is to be backfilled. until authorization to do so has been obtained from the Department. INTERNAL U5E ONLY Proposal Approved Q Proposal Denied ❑ Inspector's Signature & Title Datlb I Expiration Date Repair proposal is in compliance with applicable codes Yes 21 / No O COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509 (914) 278 -6130 -APPLICATION' .TO' CONSTRUCT `-A WATER' WELL ' PCHD PERMIT # f/ � 47 ' WELL LOCATION t re et s - ill a ty �-� c Tax :i.� .1_. Grid Number WELL OWNER Nam Mai ing r � 3 ivate O Public USE OF WELL 1 - primary 2- secondary .RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION U INSTITUTIONAL O STAND -BY 0 ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT S- gpm /# PEOPLE SERVED '�- /EST. OF DAILY USAGE -S,U�' gal REASON FOR DRILLING O REPLACE EXISTING SUPPLY ® TEST/ OBSERVATION GIADDITIONAL SUPPLY NEW SUPPLY NEW DWELLING 0 DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING -' WELL TYPE [;,3pRILLED ❑DRIVEN ODUG ®GRAVED ®OTHER IS WELL SITE SUBJECT TO FLOODING? YES >< NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: 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 [30N SEPARATE SHEET � / ��`�` d te) 7 (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Szbpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within third, (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. Dur iag 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 conta e—s face or groundwater. Date of Issue:-- �"� .�G 19_ a Date of Expiration 19� Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Roaa`,--'irews ter, New York 10509 (914)' 278'6130 PCHD PERMIT # WELL LOCATION I Tax -Street AfWr gss i e ity Grid Number WELL OWNER.. Name M AAdrems )MW-rivate 0 Public USE OF WELL 1 primary 2 second.ary -G14ESIDENTIAL 0 PUBLIC, 'SUPPLY _53 BUSINESS 0 FARM 13 INDUSTRIAL t3INSTITUTIONAL (:]AIR/COND/HEAT PUMP 0 TEST/OBSERVATION 0 STAND-BY. 0 ABANDONED 0 OTHER (specify AMOUNT OF USE YIELD SOUGHT ..... gpm/# PEOPLE SERVED /EST. OF DAILY USAGE al 13 'REPLACE EXISTING SUPPLY 0 TEST/OBSERVATION 12. ADDITIONAL SUPPLY 19ANEW �SUPPLY NEW DWELLING ) ,13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING - ---------- ------ WELL LTYPE RIL LED ODRIVEN ODUG GRAVEL OTHER IS-:WELL . SITE SUBJECT TO FLOODING? YES 74,. NO IF.WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No.- WATER V&TiR WELL CONTRACTOR: Name/,Ii�.i IS PUBLIC.WATER-SUPPLY AVAILABLE TO SITE: YES NO Isilmi OF PUBLIC WATER SUPPLY: TOWN/VIL/CIT-Y. .- DISTANCE: TO PROPERTT.FROM.NEAREST WATER MAIN:,._, LOCATION SKETCH &'SOURCES OF CONTAMINATION PROVIDED OON SEPARATE ,SHEET _(& ate) (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 thirt3• (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 accordanree 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 Hedlth"Department. 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 conta ,�aa�iac�, _uLia&t-e-s, face or groundwater. - Date of Issue: 19 Date of Expiration 19_2 Peiiit-Issuing Official Permit is Non-Transferrable White copy:. H.D.File Pink copy: Owner 3/89 Yellow copy:'kdg. Insp. Orange copy: Well Driller xj oz - /Z <�2 e Box~ 37 Putnam Valley NY 10579 June 16, 1997 Bill Hedges Putnam County Dept. of Health 4 Geneva Road Brewster, NY 10509 Re: Application for a New Well Permit 74 Mill Street Lot # 84.15-1-18 Enclosed are: 1. Copies of surveys dated 6-6-63 and 7-25-89. 2. Diagram of proposed site of new well. 3. original receipts of certified mail sent to contiguous n . eighbors, listed below. John P. O'Hanlon 80 Mill St. Lot 84.11-1-44 Tel. 528-4100 R. & C. O'Callaghan 8 Mueller Mt. Rd. Lot 84.15-1-20 Tel. 528-4091 Claude MacQuignon F. & C. Revis e-1-1, e r *84.15 -1- �.—.:- .-h Lot '�8 4-.'-l--1 3 4 --'l . ------ Tel. 528-0296 Tel. 526-3541 Herman C.Brunke 70 Mill St. Lot 84-15-1-19 Tel. 528-3500 Please notify me when the permit has been approved. Your help in expediting the above matter is greatly appreciated. Yours truly, Marion M. Brunke Tel. 528-7460 ze) -5le � V Iq 44 77, OmMkim W. I OW1013 �� ON NJ 06 T728 -15 P23 -11 July 25, 1989 .w ._: : ? -� .' e?`;... .'ar .c- -��S UR'1PTY�N '\i�y �r 3�'Vt L'Si [�"i`� �1V -BE - s��.�',..• .�_�o.': i�,�v ,r.: { - .. _ «,: c,.. - DEEDED TO MARION M. BRUNKE FROM THE COUNTY OF PUTNAM ALL that certain.piece or parcel of land, situate, lying and being in the Town of Putnam Valley, County of Putnam and State of New York, bounded and described as follows. COMMENCING at a point on,the easterly side of Mill Street, where the same is intersected with the northerly side of Mueller Mountain Road, as shown on "Subdivision Map Known as Mueller Mountain Estates" field in the Putnam County Clerks Office, on April 7, 1987 as field map number 2221; thence along the easterly side of Mill Street, as it-now exists, N.29° 541E 56.60 feet, N.36° 231E 33.30 feet, N.39° 25'E 9.13 feet; thence along the new proposed easterly line of Mill Street, N.28° 091E 86.72 feet to the point or place of beginning; thence along the new easterly side of Mill Street, N.28° 091E 85.85 feet to a point of curve; thence on a curve r-ad:ius. of-1-40- -"eet--and-.a :length; Qf= 1 0; 3 , feet, with a central angle of 11° 42128" to a point on the easterly line of Mill Street as it now exists; thence along the easterly line of Mill Street as it now exists, S.1° 151W 18.00 feet, 5.12° 241W 40.30 feet, S.230 391W 14.50 feet, 5.160 131W 38.00 feet, -S.270 181W 65.00 feet, S.320 541W 20.00 feet to a point, said point being the southwest corner of Marion M. Brunke; thence along to prolongation of the division line between Marion M. Brunke and Herman and Charles Brunke, N.75° 4412611W 16.46 feet to the point or place of beginning. Containing an area of .2,452 square feet. x I[l 1j WtljL UU1v1rLJ111Va ALLrVal DEPARTMENT OF HEALTH y 'gr.v Division Of En jizqi�np�t_a�&q PUTNAM COUNTY DEPARTMENT OF HEALTH office Use Only WELL LOCATION ,, 51R4T ADDRESS: WN/V1LLAC4/CIF): TAX GRID NUMBER: WELL OWNER ME: AooREsSa S P81VATE 0 PUBLIC USE OF WELL 1 - primary 2 : secondary fia-RESIDENTIAL 0 PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED 0 BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL 0 STAND-BY ❑ AMOUNT OF USE - YIELD SOUGHT gpm.INO. PEOPLE SERVED EST. OF DAILY USAGE 1�00 gal. REASON FOR DRILLING C _(�,NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY 0, TEST/OBSERVATION 0 REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH ft. WATER LEVEL --:90—ft.] DATE MEASURED DRILLING EQUIPMENT &-ROTARY ❑ COMPRESSED AIR PERCUSSION 0 DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING. 49 OPEN HOLE IN BEDROCK ❑ OTHER CASING 4 TOTAL LENGTH .2 tL r MATERIALS: ,STEEL 0 PLASTIC ❑ OTHER LENGTH.BELOW GRADE t9 ft. JOINTS: - ❑ WELDED 0 THREADED ❑ OTHER DETAILS.. DIAMETER in. SEAL: 5nEMENT GROUT ❑ BENTONITE 0 OTHER WEIGHT PER FOOT Ib./ft. DRIVE SHOE: 9YES_ ONO I LINE'R:'D YES nNO SCREEN DETAILS DIAMETER (in) -SLOT SIZE LENGTH (it) DEPTH TO SCREEN (I ) DEVELOPED? FIRST HOURS -SECO—NO GRAVEL PACK ❑ YES 0 NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM OEM it. WELL YIELD TEST If detailed pumping METHOD:. 0 PUMPED tests were done is in- att OCOMPRESSED AIR formation ached? 0 BAILED ❑ OTHER ❑ YES 0 NO If more detailed formation descriptions or sieve analyses WELL LOG are available, please attach. rEPTH FROM DSURFACE Water Bear- ing Well Dia- mete In FORMATION DESCRIPTION ft. WELL OEM ft. DURATION hr. min. DRAWOOWN ft. YIELD . gpm. nd Ce lauria j // a00 , U WATER I&CLEAR TEMP. QUALITY 0 CLOUDY HARDNESS 0 COLORED ANALYZED? 0 YES ❑ Wo ANALYSIS ATTACHED? 0 YES 0 NO STORAGE TANK: TYPE CAPACITY I Y4 GAL. PUMP IXFGHMATION TYPE CAPACITY MAKER DEPTH d MODEL VOLTAG§!3P— HP WILL 1RILLFJ1NAM1-x��ax44WV--.&-0_ ADDRESS SOMME A j °JV /A Xl�z �\ev Ir CC 660, ok Beroc 141,EQA�-41V I......... Scene I J , -� N. y,E N36° S 7RE6 r So. p. 23E y. 33.3pJ �.,9j3. 119 09'E . 026 Now or s� Fo�'mer /1J y , yerrnor7 Cho, /es Bi urn Fe s 'h (Y s. Surveyed k`prepored by SUNNEY ,ASSOCIATES Lond ,Surveyors Quro/ Route # Fie /ds Lane VOrlb So%rn, Nzw York 10560 ;}r • t; ..4 t; .r i; e5.;e5, 172.57' A: 4040 = 1/0 reo 18.0 2o p 2 °24 E. 46.30 'V.27'1 B 0' 3 3E 38.0N?9 .1 6500' A1.16 °13'E 4.50 y� Alow 0, Former /,y ' TO be deeded Born fhe Coui ' Morion M. Brunke ,I t ®ice Ahc .w i; og 73 UP nki X,31 P� 7