The URL can be used to link to this page

Home My WebLink About4730DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 91.25 -2 -31 BOX 35 mr J6. �, r �, ti , j IL r r r NI-6 r 04730 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL _ ..y..•,. :1n: �-.� :c5c't �:9.•:�'. t': Fl.: S "Y.'.'�JM' -�. •.-... s.' .", °-. .�"'Q. �:i'. _ ....... ': w. .'p.. �d:�iiiAnRlii -F•�i � .�'ti• L.it•: ��.� ^r ^�YK. Well Location: Street ddress: Town/Village Tax Grid # I., � h ap ��,L�Block ?j Lot(s)3/ Well Owner: ��ame: Address: &44 f1 Use of Well: Residential Public Supply Ai t /Con eat Pump Irriga on 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yiel ought gpm # People Served Est. of Daily Usage gal. Reason for V Replace Existing Supply T Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reaso . r for Drilling 2i 6 r ,r �„/C P Well Type Drilled Driven Gravel Other lor Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty 1 u vision? ...................................... ............................... Yeso Name of subdivision A Lot No. Water Well Contractor: (7�' Address: Is Public Water Supply available to site? .................................. ............................... es V No Name of Public Water Supply: -Ai d' Town/Village — �i,u�'(�j% Distance to property from nearest water main: &h 1AMAL I Proposed well location & sources of contamination to be provided on separat she Ian. Date: 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 nw�nte � surface urface c o gro�u2ndw' ao t IcOcN�: SiT✓l � a PP roya l expire e two yea rs e s om tf he date i�s� sMU6 ' o PROVD OR Jedv unless 1 J l�v1 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 wat well driller certified by Putnam County. Date of Issue �� -(�2- Permit Is ng Official: Date of Expiration Ti---- Permit is Non-Trans terrible White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Nblvl << h BRUCE R. FOLEY Public Health Director DEPARTMENT OF BEALTH I Geneva Road Brewster, New York 10509 LORETTA MOLINARI R.N., M.S.N. 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 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 Norman Anderson, Inc. 152 Barger Street Putnam Valley, NY 10579 Re: Proposed Well Schullman 20 Pine Street 91.25-2-31 (T) Putnam Valley April 17, 2002 Deu Mr. Beal: On February 27, 2002, a field inspection was conducted on the above referenced lot by Daniel HaddeA Public Health Technician. The application to replace an existing well is approved 111fo following stipulation: p - I - A minimum of 72 feet of casing must be provided for well protection. As-built plan, Well Completion Report (WC-97), Well abandonment, if applicable, and water quality analysis shall be submitted no later than 30 days after the. well completion by the permittee. Please contact the writer at (845)278-6130 ext.2235 if you have any questions. Very truly yours, Daniel Hadden Public Health Technician cc: MJB, file PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES please orint or tvoe A]�AI�iI1i °�rv'A °WATkit''W'FL PCHD PERMIT # W_f�7 Well Location: Street Address: TownNillage, �l o - ,, Tax Grid # ; Z 3 Map Block Lots) t Well Owner: Nam :, Address: Well Type: Drilled Driven Dug Gravel Other Depth Data: Well Depth D 0 ft Static Water Level ft Date Measured Use of Well: Residential Public Supply Air /Cond/Heat Pump Abandoned 1- primary Business Farm Test/Observation Other ('specify) 2- secondary Industrial Institutional Standby Water Well Contractor: Name: Address: Reason For Abandonment: eo VI/ ed I l�S . Description of Work To Be Performed: w ' av-r' t . � •. - Li�i�R��e� -.-. .�.- .e p,�S /�_ ^.��- ,r�..y..y... -.o. •. +.. �.a;.-.. .... ... ..... w -. r. .. j� �/O Z Applicant Signature: Dae: 1/� - PERMIT Th's 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 ani provided that: Within 30 days of the completion of the abandonment of the water well, the applicant shall su)mit to the Department a certified statement that the information delineated on the application for this pomit has been completed. Dae of Issue Permit Issui Offi ial Titl Wlite copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -97 m 1 FROM :ASSESSOR FAX NO. 17, 415261077 Jan. 18 2002 01:4eAM P3 R.- L em, I VAZKNQW� vhQl4wc(* kv Z AL Nr 44 0 e, c 40avuv� c AP il V% V i A f p -64P W. MKS P I- T\ M A N SCI Lff r= a 1 4 Le. d t die LE P SrriL-S«.ALL \,v }-O R.K. chc6ecO. *Gr,;ng I.fie 6coit L $oa no. T H E C, v C,' -'J'R* Grow,hg no. ;SQC!ATES a r c h i t s t inning co r, s u I t a n t s KATONAH VEW YORK 814- 2 3 2-5033 FROM :LAW OFFICE OF M.SCHULMAN FAX NO. -.'712 898 4573 Jan. 27 2002 10:11AM P2 01/21/20 @2 11;00 9145264952 TENDY AND ZARCOW PACE M2 $a! 4W" 417"; A3 Idw,-Vw� ORO). as. 64 5SC&T 0j, 6c• 16 "i I . cm *-fosimep, So, i's 01 d VABW%OCD w I* Qeflf� a � IPFU " 0 IS-A N Jr -MEW- 140 Ai a a cl 1p W v^0 -'via CM4 4_39OCIAT93 drove n9 pY*71 *,In! iry @ c r. s u It a n 9 s KATONAW • NlrW YoAg 0 914- 2 3 2-00s* off. �:.•• EAVVt:� 14 •Fot. 't' Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 L iWfrA MOLINA1tI R.N., M.S:N::�t ;- 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 Norman Anderson preschool (845) 228 - 5912 Fax (845) 228 - 6113 Barger Street Putnam Valley, NY 10579 February 6, 2002 Re: Proposed Well: Shulman 20 Pine Street (T) Putnam Valley Dear Mr. Anderson: Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. The application to construct a water well was unclear wether it was to replace an existing supply or deepen an existing well. Comments are offered. as follows: 1. Site plan (or tan map) of property showing locations of proposed well, existing septic system and house'. The well shall be dimensioned from two fxed points. 71 : = 2. The situ plan is1 alsdinclude 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....) 3. Neighbor notification documentation — Neighbor notification form signed by property owner or returned certified return receipt requested from the U.S. Postal Service. (Not required for deepening of an existing well or replacing existing supply within 5 feet of existing well.) 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. IR Very truly yours, ZIMA-d •o*" Daniel Hadden Public Health Technician