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HomeMy WebLinkAbout4719DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 91.25 -1 -75 BOX 35 ru No L I , ■ I No No IN 11 No 'TI ' 1 ' ` . or INN No I r Ift, r I 04719 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL iA�. . +sr.:::.iG �': :�. .-.� .. ,,;.,plaa�se prinGur type, -�; ..,; ;� >�.s,,.- ..�� �.:..;,,. '• . �:;Q -: ;;:; ..... -.:-PGI=ID Perm'it " #� Well Location: Street Address - T/own��/(vill�e Tax Grid # /MapqJ.-2-S ,f rjOru /�dV¢` �LUte fee,%6 I` i l Block I Lot(s)r7 Well Owner: Name: fi K &A Ir Address: IV Ze;il�e Aek;,elll F Use of Well: t// Residential Public Supply Air /Cond/Heat Pump Irrigation %4. 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily Usage gal. Reason for Replace Existing Supply est/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason It 41441 for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ......................... .... ................. . .j............................. Yes No .. Is well located in a realty subdivision? ... .A. ? % l'. /. ............................ Yes A . No Name of subdivision Lot No. Water Well Contractor:' Address: Is Public Water Supply available to site? .................... ......................... Yes No v........... Name of Public Water Supply: � ,0,0'A r' � -° � own/Village Distance to property from nearest water main: Proposed well location & sources of contamination* be provided-on sep ate sheet/plan. Date: at ' .90 0 .5- Applicant Signature: _ _ ...� �.0 w -. .. r _ � . _.r...+ -w -. �. T . .r _a... � � �. ... .� ... r. r ... ....fir �� • ..... -.. v .T. .... 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 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. /'2�.= �,tu•� 6 l �j X05 4- AIROVED 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. . /I. I _ AX J_ Date of Issue 3 Date of Expiration `?5 14A -C2 Permit is Non - Transferrable Permi Title: White copy - HD file; Yellow copy -Building Inspector; Form WP -97 )-&-,I IFUTNAM (COUNTY DEPARTMENT OIF HEALTH H DIVISION OF ENVIRONMENTAL ONMEE? TAEL HEAILTH SERVICE'S APPLICATION TO CONSTRUCT A WATER WELL ...:Qei��.:,esm�' ='e:.- - :- �. Z6 :=w6ysi38SC�fIt1Y'OF�{�1C°'°'• ._�. . -... ._.� -;_S� .- +�3�:- ...:+e.:.voae���Llll� tf' -... ........._ .� =.= WeIR Location: Street Addres : T wn/Villa e Tax Grid # . ✓� S Block Lot(s) WeRlOwner: Nre: Address: , Use of WeR Residential Public Supply Air /Cond/Heat Pump Irrigation I- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served / Est. of Daily Usage gal. ]reason for Replace Existing Supply Test/Observation Additional Supply IIDriMug New Supply (new dwelling) Deepen Existing Well Detailed Reason K i 6? for IlDrMing Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes - No Name of subdivision Lot No. Wi tef 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 t�or be provided on separate sheet/plan. Date: J (? 02- 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 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. Date of Issue Date of Expiration Permit is Non- TransfferrabRe Permit Issuing Official: Title: White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 "'V Department. of Health J s..:..- _...�.c+- '..,P, -., .-.: ::.., ,"_� ;.... :.:. •�..: Y:.. 'r.d ^. : »::•lb';.,_.r:�•i.w, .. .: SV��ca�K R.,'.. .. -.: -�.. .. .- ts2�;'_s:; ,:1�:..:.: si':�; v}%; 4 County, New York 10509 Marie A. Mechura has been residing at 2 Avon Road Lake Peekskill, New York 10537 for 59 years. Marie's water source is an existing hand dug well located on the above property. Flowing into this well was a stream from a lake located approximately 200 feet from the property. The town of Putnam Valley diverted the steady stream of water from this lake into a storm drain, cutting off the water supply to Marie Mechura's house. As a result of the towns actions Marie Mechura only water source went dry. The existing water is unsanitary which resulted in Marie Mechura becoming critically ill and near death from a bacterial infection in December 2001. Having no water source she melts snow and ice for water. It is imperative this issue is resolved and a well permit issued immediately. Thy you, Patricia E. Gilman Daughter of Marie A. Mechura aoo3 G �L Lynn A. Minard Notary Public - State of New York 01 M 16076915 Qua i �'e 1. b d! Jif Dutche _� _:.. u • „ ..� .. „ _ r- W Commission Expires My 1, 0.7 76.59 �0 i 27.98 • .tih�a \ \ 47 s 1 48 \ ° 42. � m 99.85 46 0 C) 46 0 u .1 95.74 48 45 0 99 ° a — — —Q "fa rO�n/inj {� R 4� 1 , NiW HES 100.46 ua! ;HANSO N o 44.31 125.09 titi0� I I 1 I I I I I 1 1 361 1 1 o I 1 l l v- IQ- p° 1 1 I 35 1 N m JL m ( 1 93 1 36 1 9 39 1 q0 I 4/ 140.00 160.00 100.00 J/ 100.00 a2 a, ° CD - - — — — — M o 34 ° ° ° CD 29 qq �I R ' I I j 01—. E{ 0; a; I /26 ti ?; m X37 1 7{ I I j9 J. 26 if q {. 0--b w-: July 2, 2002 Town of Putnam Valley Putnam County Department of Health . Division of Environmental Health Services Carmel, New York Mr. Dan Hadden Dear Mr. Hadden: RE: Application to Construct a Water Well 2 ' Avon Road Lake Peekskill, New York As a member of the Putnam Valley Town Board who serves as the liaison to the Lake Peekskill community I. am asking the County's support in issuing a well permit for the . above applicant•: The seasonal water system in Lake Peekskill as you know has been determined not to be in compliance with the Surface Water Treatment Rule (SWTR) by the New York State Department of Health (NYSDOH). As directed, the Town must submit a plan of correction by September 1, 2002. Although the Town Board has as of this date not publicly stated it's. intent, it is the view, of'the entire Town Board. that the system will l?e 1. V permanently'shut,down °I estimate rliat Phis acU6 Will"tie'announced publicly at my district meeting scheduled for Saturday July 20�'. It is my understanding that the County is waiting for the Town's decision before they will consider any variance to the requirements to drill new wells. In the spirit of time I am asking that special consideration be given to this applicant, Mrs. Marie Merchura a senior citizen. Respectfully: 265 Oscawana Lake Road • Putnam Valley, New York 10579 • (845) 526 -2121 • Fax (845) 526 -2130 PUTNAM COUNTY DEPARTMENT OF HEALTH DWISItON OF ENVIRONMENTAL HEALTH S]ERVK ES APPLffC�'I"ff0 SWtOMTkkT�A�WATER WELL r_ vlease vrint or type PCHD Permit # Well ]Location: Street Addres : T wnNilla e Tax Grid # ✓p t'j S Block Lot(s) Well Owner: Nagie, her Address: ffla �l Use of Well:.. Residential Public Supply Air /Cond/Heat Pump Irrigation I- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served / Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason T Q for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No 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. _ Date,;. ::0 - .pplieant Signat�u1e: 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: l) 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. AI?PROVED.IFOR 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. Date of Issue Date of Expiration Permit is Non- Transfferrable Permit Issuing Official: Title: White copy - ID file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Y Fs Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Associate Public Health Director Director of Patient Services Environmental Health (845)278-6130 Fax(845)278-7921 Nursing Services (845)278-6558 WIC (845)278-6678 Fax(845)278-6085 Early Intervention (845)278-6014 Fax (845) 278.6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Patricia Gilman 49 Park Hill Drive Hopewell Junction, NY 12533 February 5, 2002 Re: Proposed Well: Mechura 2 Avon Road (T) Putnam Valley Dear Mrs. Gilman: Review of plans and other supporting documents submitted at this time relative to the above regarded project has been.completed. Comments are offered as follows: 1. Site plan (or tax map) of property showing locations of proposed well, existing,segti� systel.and house. 'the -well shall ber dimensioned from;two. -fixed- DbInu." 2. The site plan is to also include location of all existing septic systems and wells within 200 feet of the proposed well as well as all possible sources of contamination within 200 feet (i.e.< salt storage, oil tanks, land fills....) If there are any questions please contact the writer at (845)278 -6130 ext. 2235. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. cc: MB Very truly yours, �w� Daniel Hadden Public Health Technician BRUCE IL PMEY -- Public. DEPARTMENT OF BEALTH I BWWS W, New York Dow May 6, 2002 Wen.. 2 Avm Amd 91.E -1 -75 (T) Fumm Whey r, Cf plan" SWvkW Review of pleas ud other mpporting doh mbmkW at ft dw relative to to above rqpww Fged has bees complow. Comments am oftw as Ibnowa: 1. A well parmit applicatot ( 97) is to be ubminei 2. Certified Check or Money Order in to anwa t of $100.00. vWfic system Wd hmm. 4. The site plot is to do include locigim of aff adgft septic sygWms and wens within 200 fed of dw proposed wet@ as wd a all pmibie wurou of coftunination whbin 200 Led (i.a, salt A=M ail tudM kW fa19a....D If dxn are way quesdons plase gonad tk writer at Q845 130 w. 2235.