Loading...
HomeMy WebLinkAbout4742DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 91.26 -1 -18 BOX 36 04742 CD ® PUTNAM COUNTY DEPARTMENT OF HEALTH 0 DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION'TO'CONSTRUCT A WATER' WELL f please print or type 0I MUSEUM Well Location S et Address: TownNillage: Tax Map # L �,(IAap/ Block Lot(s) Well Owner: Name: 00664 r Address. Phone #. Use of Well: Residential _Public Supply Air /cond /heat pump _Irrigation 1- Primary Business Farm Test/monitoring j,--Other(specify) 2- Secondary Industrial Institutional Standby . &/( ,4124.46GuA Amount of Use Yield Sought gpm # People Served Est. of Daily usage gal. Replace Existing Supply Test/Observation _Additional Supply Reason for Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling 4-OD f Qr o..ble e I h • c� ' Ica: e ,/ p SJ fit' (A, 04. _ C o We I( k'r Wwfie Well Type rilled Driven Gr vel 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: D " w c.r. , '-A" Address:_ /,<-,I )g a v- a oe -,St & -A ¢. � fil14 p Is Public Water Supply available on site? .......... ............................... ... Yes _ N.qr- 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 _ _.. Applicant Signature�M/hlah� 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. 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 7 �`� Permit Issui Date -of Expiration Title: Permit is Non- Transf rable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 80 " 0� C 0. "Iis rev re Rev. 3/06 b7"" i-T C, (� le C-6 K Q � C, a--c A. O 9. • V Y 15 - -- -- - -- N: 100 39 - - - ------------------- - - - - -- 120.93 250.93 130 q 40 99 ___ - - -- Go- ------------------ 9 131. - - -- - - - - -- - - ___ -- 98 41 - • N = --- --- " -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - C'4 - -- - - - - - -- 97 132 42 267.43 139.0 103.39 133 ^ 43 N -- - - - - - - - - - - - - - - - - - - - - - - - - - - --- - - -- -- IN 134 44 61 95 I�- - -------- - - ° Co ;. - -- 45 ---- - - - -^- �• - _ - - - -- 135 94 1: �h - - - -- ____ - - --- _ - -- .- 46 - -___ -- - - -- 93 a ti� 136 153.7 92.41 - 135.86 ` 137 e 47 - - - - - - - - - - -- ------------ - - - - -- 19 92 ocO 138 7 �. 48 60 - =` - -� ^y - - -- o ;. --------------------- - - - - -- ------------------=---- - ^. 91 49 - - - - - -- --- 139 72.84 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 140 +` 0 r a G)-es d` r4 DLI I-Ir- 1)0 F� -� t --------------------- ------------ 1'9 92 -- - - - - - - - - - - - - - - -=• 91 --- - - - - - -- L -t r3 137 ----------------------- o`O 138 7 lry. 139 7 T 3 •! 37 -- - - - - - - - - - - - - - - - - - - - - - - .. __ -- - _ -- - -- 128 127.00 38 - -- 17 : 101 0 10 -- - - - - - - - - - - - - - - - - - - - - - c`6 ___--- -- - --' "- N 129 130.00 ___-- --- " 100 0 39 -- - - - - - - 120.93 `4 250.93 i 130 - -- - - - - - - - - - - - - - - - 99 - - - -- ----- --- o 40 ;_ -- - - o -- - - - - - - - - - - - - - - - - - - - - - 98 9 131 _ -_ -- 41 ' = ---- - - -- -- - _ O 97 ' 132 42 - - -" 267.43 139.00 103.39 133 -- -- -- -" "c 43 96 -- - - - - - - - - - - - - - - - - - - `f ___-- - - - - -- N 134 ___ - - -- 4 61 -_- _ - -- -- - -- 18 95 ifl __---- - - -- -- - - --" "" o __ -- __ co. ---- 135 __- oh' - --- _ -- -- - - -- ----- - - - - -- -- "- 93 ti 136 153 -73 92.41 ___- - - 135.86 M --------------------- ------------ 1'9 92 -- - - - - - - - - - - - - - - -=• 91 --- - - - - - -- L -t r3 137 ----------------------- o`O 138 7 lry. 139 7