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Home My WebLink About4522DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85. -1 -23 BOX 34 04522 44 or „_. } 091, m 04522 a�Y�3goa89� PUTNAM COUNTY DEPARTMENT OF HEALTH ' ED DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type CHD-1:, K, Well Location Street Address: TovAnNlllage: Tax Map # kf h a m Ui I e �'tc i 14, o Map Block Lot(s) Well Owner: N e: W JA dress: a�` c Phone M � f Use of Well: A4esidential _Public Supply Air /co /heat pu p _Irrigation 1- Primary Business Farm Test/monitoring _Other(specify) 2- Secondary Industrial Institutional Standby Amount of use Yield Sought S gpm #People Served Est. of Daily usage gal. Replace Existing Supply Test/Observation I- Additional Supply Reason for Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason Y for Drilling u +ev Well Type Drilled Dr' en Gravel Other Is well site subject to flooding?... .... _ .................................... ............................... Yes No Is well located in a realty subdiviion? ........................:.................. ............................... Yes _ No Name of subdivision Lot No. Water Well Contractor: o Address: As Is Public Water Supply available on 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. [safe: 1 z App!l�artt Sgnatare; ?.��*'�''y> rCKIY11 I I U VUNO I KUIi I A YYA I tK YYtLL 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 by the Putnam County Health Deaartmer 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 maybe 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 County. Date of Issue Permit Issuing Official: Date -of Expiration Title: Permit is Non - Transferable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Rev. 3/06 6 ri �aa � p � ' e. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type � „��.,,,,:«� , : � �'...• �H� � a� Well Location Street Address: Town/Village: Tax Map # V�C� \ h ►�� 1� ? U+ V%W% VC "�1Map 95 ! Z 3 I Block Lot(s) Well Owner: Name: Address: Phone #: .te1,41 / `�/ �¢�o¢ -�, �� 1^�@�a h ; I 1 h,oc X4&4 MVIll e , Use of Well: Residential Public Supply Air /coed /heat pump_ Irrigation 1- primary X Business Farm Test/monitoring _Other(specify) 2- Secondary Industrial Institutional Standby Amount of Use Yield Sought s -ro gpm. # People Served �dJ Est. of Daily usage COO gal. Replace Existing Supply test/Observation Additional Supply Reason for Drilling New Supply (new dwelling) _ Deepen Existing Well Detailed Reason LOW for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ....................................................... ............................... Yes _ No X Is well located in a realty subdivision? ........................................... ............................... Yes No X Name of subdivision Lot No. Water Well Contractor: D,� Address: Is Public Water Supply available on site? ....................................... ........6...................... 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. Hate: -- °1 L-6 %i�' ::_.. = applicant vignature 15� 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 by the Putnam County Health Departmei 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 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 County. Date of Issue It /1� Date'of Expirationr�f /i-- Permit is Non - Transferable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Rev. 3/06 A • y" `- / f ( 06,A 80N ONL Y,' SEE NO TL) •• r.'hiir+. + t 1,. 1 cvncr�fcr.,;e /cb . ,•'�:� W s vop ` I c'oncreta' polio i. "Illy 1, 1 t DOIi� SE�� icTK I o ` cuncrate violi , lundinp and steps IO'Dg AvA k4iLl -A 5 FJT rJA V\ 'J ALA-VE'l S C"k L. E 1 " 1�1C—T J p.-." ,-1-ka.o� 13 1000 cl. ,c Q conc. ��. ; 1� <.'app0d y' I rr c pr pc' - conr:r0tct t � �T3 LXJ _....... .a i r R T +ole�` , �• X1. •o oorty defined C� p ' "•fie'% � ___. dirt and grove/ ovNl t ' ? ekl 1 4, p, :.r `� � a•t,•. to .. .,'n!r.;• f�i � r�� Oor -inq or'en I I V t ! coverod corlocr. .stoop _.. ivrr // . iand pump 1 a• .• lo 7'ql' ►7 pole hryc_ �• i Iu/°41 1 n..... r,` 133x. l? t i t � i fi r 39,3 e ;. 22 aq% 9. rr 3 92.25 AC. CAL. 5.0 a 4 A , 62� 33 # fix R 0A � IjILL ■ 1 5 _ K 1 EXEMPT LANG CEM.ETERY t , � 32, 13.32 AC. CAL. ' 'i. $ AC. -tom ... a Property Details - Image Mate Online Putnam County *6G Image Mate Online Page I of 2 i Navigationj GIS Map FTax Maps ORPS Links Assessment Info^ ; Help Log In Residential Property Info Owner /Sales lnvento,ry,,-,,.,.Ij Improvements Tax Info .... Report......... Comparables Res. Sites ❑� 1 'I Municipality of Putnam Valley, Town of SWIS: 1 372800 Tax ID: 1 85. -1 -23 Tax Map ID / Property Data Status: Active Roll Section: Taxable Address: 22 Indian Hill Rd Property 281 - Site 230-3 Class: Multiple Property Family Res res Class: Site: Res 1 In Agi. No Zoning Code: R1 - Bldg. Style: Old style Neighborhood: 28140- School Lakeland - District: Legal Property 12000000030130000000 00628.0000000000000500 120 -3- Description: 13 2013- Total 5.00 Equalization 100.00% Acreage /Size: Rate: 2012- 100.00% 2013- 2013- Land $268,900 Total $792,000 Assessment: 2012- Assessment: 2012- $219,800 $814,000 2013- Full Market $792,000 Value: 2012- $814,000 Deed Book: 1032 Deed Page: 40 Grid East: 683174 Grid North: 914689 Photographs No Photo Available Ma Pin Property on GIS Map View in Google Maps View in Yahoo! Maps View in Bing Maps Map Disclaimer http: / /putnam. sdgnys. comlpropdetail.aspx ?swis= 372800 &printkey = 08500000010230000000 12/3/2013 Property Details - Image Mate Online Special Districts for 2013 Description Units Percent Type Value Fire district 10 0% L 0 Special Districts for 2012 Description Units I Percent Type Value Fire district 10 0% 0 Land Types Type Size Primary. 1.00 acres Residual 3.98 acres Page 2 of 2 http: / /putnam. sdgnys.comlpropdetail.aspx ?swis= 372800 &printkey = 08500000010230000000 12/3/2013 Property Details - Image Mate Online Q,....... Putnam county Image Mate Online Page 1 of 2 { Navigation GIS Map I Tax Maps il} ORPS Links Assessment Info i Help i Log In 1 372800 Tax ID: 1 85.4-23 Residential Property Info Owner /Sales Inventory, Improvements Tax Info Report Comparables ' Res. Sites r<] 2 Municipality of Putnam Valley, Town of SWIS: 1 372800 Tax ID: 1 85.4-23 Tax Map ID / Property Data Status:,_ Active Roll Section: Taxable Address: 22 Indian Hill Rd Property 281 - Site 230-3 Class: Multiple Property Family Res res Class: Site: Res 2 In Agi. No Zoning Code: R1 - Bldg. Style: Old style Neighborhood: 281.40-, School Lakeland. - - . 12000000030130000000 Legal Property 006280000000000000500 120 -3- Description: 13 2013- Total 5.00 Equalization 100.00% Acreage /Size: Rate: 2012- 100.00% 2013 - 2013- Land $268,900 Total $792,000 Assessment: 2012- Assessment: 2012- $219,800 $814,000 2013- Full Market $792,000 Value: 2012- $814,000 Deed Book: 1032 Deed Page: 40 Grid East: 683174 Grid North: 914689 hs No Photo Available. Ma Pin Property on GIS Map View in Google Maps View in Yahoo! Maps View in Bing Maps Map Disclaimer http: / /putnam. sdgnys. conVpropdetail. aspx? swis= 372800 &printkey = 0850000001023 0000000 12/3/2013 Property Details - Image Mate Online Special Districts for 2013 Description Units Percent Type Value Fire district 0 0% 10 Special Districts for 2012 Description Units Percent Type Value Fire district 0 10% 10 Land Types Type Size Secondary 0.01 acres Page 2 of 2 http://putnam.sdgnys.conVpropdetail.aspx?swis=372800&printkey=0850000001023000O000 12/3/2013 Property Details - Image Mate Online Putnam -County-'r- Image Mate Online Page 1 of 2 Navigation GIS Map Tax Maps ill ()RPS Links I Assessment Info i Help � Log In I Residential I Tax Info LqqTpa !�a Res. Sites 3 Municipality -of Putnam Valley, Town of SWIS: 1 372800 ITax ID: —T-85.-1 -23 Tax Map ID / Property Data Status: Active lRoll Section: Taxable Address: 22 Indian Hill Rd Property 281- Site 220-2 Class: Multiple Property Family Res res Class: Site: Res 3 In Ag. No Di stri ct: Zoning Code: R1 - Bldg. Style: Old style Nejghborhood:.2a140,.- School Lakeland- 12000000030130000000 Legal Property. 006280000000000000500 120-3- Description: 13 2013 - Tota 1 Equalization 100.00% Acreage/Siie: 5.00 Rate: 2012 - 100.00% 2013- 2013 - Land $268,900 Total $792,000 Assessment: 2012- Assessment: 2012 - $219,800 $814,000 2013 - Full Market $792,000 Value: 2012- $814,000 Deed Book: 1032 Deed Page: 40 Grid East: 683174 Grid North: 914689 I PhotoaraDhs I No Photo Available Maps Pin Property on GIS Map View in Google Maps View in Yahoo! Maps View in Bing Maps Map Disclaimer http://Putnam.sdgnys.conVpropdetail.aspx?swis=372800&printkey=0850000001023000O000 12/3/2013 Property Details - Image Mate Online Special Districts for 2013 Description Units Percent Type Value Fire district 10 00% 1 0 Special Districts for 2012 Description Units I Percent Type I Value Fire district. 10 00/0 0 Land Types Type Size Secondary 0.01 acres Page 2 of 2 http: / /putnam. sdgnys.comlpropdetail. aspx ?swis= 372800 &printkey = 08500000010230000000 12/3/2013 r .6 22 ,92.26 AC. CAL. 0. JK V4 ...-j 4*� 4F) Ap ■.08 AG. 33 !:11) t � tf 23 6.O AC. HILL 24 M 39,3 ■ low ROAD 31 3..EXEMPT LANG CEMETERYS 13.32 AO., L. --Pr Z ;L at O k WET AREA GENERAL LOCH 7701V ONLY,' SEE NOTE Ik4 I I rernoms Of NO soling house S 51.44 T . stone wail zsl t. Aectznq this property, if any, hod the :tjme of this survey and, therefore, in; as noted and limited below, only to: HILL APTS., INC. Z chlm 7� i 4t Z oop C- C L Concrete- *alk, it :1.ndIng . and vt!Ps capped PM PIP&- - 7 stoop L &: A, 4� "AP ' -W , f C , . ', 54 stoop q� jo. )oorty defin N% dirt and parking area' 1 0 5- A, Ij z c.-red. yr it; N 80*57'30 rx J 0 82'10'40" W S 51.44 T . 0 o, n P—.0 anamoer 111 N� 85' 002 47-63 ole*��...N 76'41'10" -#1 Aectznq this property, if any, hod the :tjme of this survey and, therefore, in; as noted and limited below, only to: HILL APTS., INC. Z chlm 7� i 4t Z oop C- C L Concrete- *alk, it :1.ndIng . and vt!Ps capped PM PIP&- - 7 stoop L &: A, 4� "AP ' -W , f C , . ', 54 stoop q� jo. )oorty defin N% dirt and parking area' 1 0 5- A, Ij z c.-red. yr it; N 80*57'30 rx J 0