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HomeMy WebLinkAbout4745DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 91.26 -1 -28 BOX 36 1 1 IN 11 1 r an Sri 102 Ll #. . T NMI -INA r � N Im � 11112 ` i O 04745 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Norman Anderson, Inc. 152 Barger Street Putnam Valley, NY 10579 October 24, 2007 Dear Mr. Anderson: ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Proposed Well Hamill 7 Agnes Place (T) Putnam Valley A field inspection was conducted on the above referenced lot by Brian Stevens and Mitchell Lee, Public Health Technicians. The application to drill a new well is approved with the following stipulations: 1. The well is to be constructed with a minimum casing length of 100 feet. 2. The proposed well should be survey located by a New York State licensed surveyor. 3. A Well Completion Report (WC -97) shall be submitted no later than 30 days after the well completion by the permittee. Please contact me at (845) 225 -5186 ext.2233 if you have any questions. cc: , l Sincerely, �w D. Mitchell D. Lee Public Health Technician Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 17N i I &VIS 113 1 x'� 5 ; . � � •� � � X11 APPLICATION TO ABANDON A WATER WELL please print or type PCHD PERMIT # I) I q -01 Well➢ Locatnon: Street Address: // TownNiillage Tax Grid # I� -Block 8 41x �h� j';1'� /�' 7 � -Map Lot(s) �JeRR tmeu°: ' Name: �- ✓ILA, �; %1 --1-- Address: C� � �= Weep Type: Drilled Driven Dug Gravel Other Depth Data: Well Depth ft Static Water Level ft Date Measured Use of WeRR. Residential Public Supply Air /Cond/Heat Pump Abandoned I- pnimma>ry Business Farm Test/Observation Other (specify) 2- secondary Industrial Institutional Standby Water Wepp Name: ,,�D 1Q A'I � �/'��� Sd e s: �.52 Comitradtor: P w'iili (/ 1v1 = !v I(i eesolm For Abandonment: s �s1i� I Hi IIDescriptdom of Work To Be Perfformed: �c.. f►c� co o&0-- conc&4 Date: % /U.7 �.. Applicant Signature: "t-- PP g PERMIT This 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 and provided that: Within.30 days of the completion of the abandonment of the water well, the applicant shall submit to the Department a certified statement that the information delineated on the application for this permit has been completed, Date of Issue White copy: HD file; Yellow copy - Building Permit Issuing Form WA -97 ASl0-1 81 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCxHD P rr I Well Location Street Address: Town/Village: Tax Map # L t2l hx � L. Map Block Lot(s) Well Owner: Name: Address. Pkone #: C9 Use of Well: _Residential _Public Supply Air /cond /heat pump _Irrigation 1- Primary Business Farm Test/monitoring —Other(specify) 2- Secondary Industrial Institutional Standby Amount of Use Yield ought 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 JOAC7-IbAl for DrillingCs�ij Z '% Ste' fig- 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 A-04-47d 3 Address: AV /5 w Lot No. ST Water Well Contractor: ,h' 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. �q Date: ! �� Applicant Signature: q 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 Cgbnty. X Date of Issue •-23 -01 Permit I`ss g Offic Date of Expiratio Title: 1 Permit is Non -Tra sferable White copy - HD file; Yellow copy - Building Inspector; Pink copy - 64 copy - Well driller Form WP -97 Rev. 3/06 zv X> FOR ASSESSMENT PURPOSES ONLY NOT TO 13E USED FOR CONVEYANCES DATE DESCRIPTION PREPARED BY JAMES W. SEWALL COMPANY 136 CENTER STREET OLD TOWN MAINE CONVERTED TO ESRI GEODATABASE DIGITAL TAX MAP FORMAT BY WEILER MAPPING. A DIVISION OF JAMES W. SEWALL COMPANY JUNE 2004 , X DNS SPECIAL DISTRICT INFORMATION DATE DESCRIPTION STATE LINE COUNTY LINE TOWN LINE VILLAGE LINE BLOCK LIMIT ORGINAL LOT LINE PROPERTY LINE 55 C13 2 ----------- e -- ------- ------- 26 101.11 24 o 3. ---------------- 71.1f 20 57 ----------- 29 2a n z6 25 42 34 ► 93.96 le 20 Is 59 ---------- - ---- ------------------- 43' 44 7,91 16 61 -------------- 106.41 82 .6 76 10200 61-13 22 81 2 14 63 .9 4.033----- -- - - - -13 -- - ---- \ 23 43-78 P/O 91.34-1-7 80 79 154 % 1 156 iss - --------------- is---- 45 ---- — ----7 ------------- ----------------------- n 56 14 HA-- 'VSON 81-481 - -------- ------- 100.19: 92.83 13 6.5.07 loo. is: STREET 12 42 27 45.89 B8.19 80.19• - - - - - - - - ---- -- 43 ----- - 38 ---- 57 10 44 < 2 ------------- 3 30 32 - - -------- 9 46 4 5 e __.____ -y X 7 9 10 a 46 ------- 13 93.00 92.41 -7- . ;,) ...... 23 ---- ------- --q� 6 7 a 9 10 15 11 14 12 37 7 47 v -I - - — 12 ; 9� -------------------- ------------- per 101.11 : a Z? 48 60 22 :28: ---------- ---- 5 ------------------ ----- --------- 13 16 98.51 -------------------- 5 58 49 21 4 17 et 72.84 ------------- ------------- -- 14 --------- ---- ----------------- --------------- 4 so 130.95 --------- z 33 36 128.46 3 3 51 X Is- 16 - - ------- - - - - - - - - ----------------------------------- 2 -------- 99.03 59 2 X> FOR ASSESSMENT PURPOSES ONLY NOT TO 13E USED FOR CONVEYANCES DATE DESCRIPTION PREPARED BY JAMES W. SEWALL COMPANY 136 CENTER STREET OLD TOWN MAINE CONVERTED TO ESRI GEODATABASE DIGITAL TAX MAP FORMAT BY WEILER MAPPING. A DIVISION OF JAMES W. SEWALL COMPANY JUNE 2004 , X DNS SPECIAL DISTRICT INFORMATION DATE DESCRIPTION STATE LINE COUNTY LINE TOWN LINE VILLAGE LINE BLOCK LIMIT ORGINAL LOT LINE PROPERTY LINE 55 C13 2 ----------- e -- ------- ------- 26 101.11 24 o 22 21 20 LU ---------------- 71.1f 20 57 ----------- 29 2a n z6 25 35 36.40 21 34 ----------- 20 Is 59 ---------- - ---- ------------------- r— 17 so -------------------- ----- -- ----------- - 7,91 16 61 -------------- 106.41 82 .6 0 15 62 0 % 22 81 2 14 63 .9 4.033----- -- - - - -13 -- - ---- \ 23 43-78 P/O 91.34-1-7 80 79 154 % 1 156 iss X> FOR ASSESSMENT PURPOSES ONLY NOT TO 13E USED FOR CONVEYANCES DATE DESCRIPTION PREPARED BY JAMES W. SEWALL COMPANY 136 CENTER STREET OLD TOWN MAINE CONVERTED TO ESRI GEODATABASE DIGITAL TAX MAP FORMAT BY WEILER MAPPING. A DIVISION OF JAMES W. SEWALL COMPANY JUNE 2004 , X DNS SPECIAL DISTRICT INFORMATION DATE DESCRIPTION STATE LINE COUNTY LINE TOWN LINE VILLAGE LINE BLOCK LIMIT ORGINAL LOT LINE PROPERTY LINE R�l v- 0 0 0 OC30 STONE.`. '/0 t :7 ✓ /,Aj Z_ 7_�O. A/C WIV 1A_'14,,E-701V L G7-,S le., /0, A*f 'e>O e_�_3 11 W A Z:>-- _— A-- C-_ k-- Y -IAI 7�Ve5r IC2171-W-1-A-7 C10.1-11V 7- 01_eFoelr� SUR VF ,vey marked with an origin/ of the /0/76f C6, 11fIC011005 hef&017 signify O IhIS survey was prepared In accoroUnco with sew shail be consitivi-vu to be vv/id 15flng Lode of Practice for Lana Surveys odopted by the New ral-tr 5i1cle Assoc- rollons 11 'v 9 y t 1he 1011on of Professional Land Surveyors Sold evrtlfir S 0// run n1 0 Person for whom the survey Is prepared , and on his behalf to the fille company wrnmentcl agency t7na /ending instifutlon listed hereon , ono the assignees of 90 NEW /,V lending institution C81-tiftotions are not transleroble /0 GdYtlonol instItuflors or ��/��I f/ 10 Sj1_tPSegLVj71 Owners SITI, of OCT -18 -2007 10:59AM FROM - ENVIRONMENTAL HEALTH PETER C. ALExANDERSON couAty Executive lo-/) f i 1 L l-- 7 A� "/Ag /"L �o s' -7 6Q24- o y iS L 8452787921 DEPARTMENT OF HEALTH 110 Old Route Six Center, Carmel, New ork 10512 (914) 225 -2294 1 NJx y� � c3 0 T -639 `P- 001/00001 F -4449 il 1 - 1 1 �" ENID L. CAHRUTH, M,P,H• Pdblic Hcaith Director JOHN SIMMONS. M.D. Deputy CommissioAer DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION TO CONSTRUCT A WATER WELL`S �� • `� S, t 000 PCHD PERMIT # WELL LOCATION Street Address Town Villa a City l�44�,e5- LeXE Lam' /LL Tax Grid Number -(44737 /e4 -2- , 6 /3-a1, WELL OWNER Name Mailing Address )Zowr /LL - S'/97"t� ��rivate O Public USE OF WELL 1 - primary 2 - secondary. _JErfiSIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP O ABANDONED 0 BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify ® INDUSTRIAL b INSTITUTIONAL O STAND -BY p AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED /EST. OF DAILY USAGE gal REASON FOR DRILLING fiMPLACE EXISTING SUPPLY ❑ TEST /OBSERVATION ❑ NEW SUPPLY NEW D14ELLINGI 0 DEEPEN EXISTING WELL LI ADDITIONAL SUPPLY DETAILED REASON FOR DRILLING E C iciE " _ A/o / ✓+?Fx /// © ! S7' N /✓ G-z A-gVP `/W71-7- Ali A%r -Oy A-- &Q-1 Ale-Z-4- WELL TYPE DRILLED []DRIVEN []DUG []GRAVEL ❑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: Name A dko f'1+4it( Address: Sj-. /Lj �I9r IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO 3 it M h e'92 %vim NAME OF PUBLIC WATER SUPPLY: L�?c� /�E2rkl�Cl�i� SuhHcS72 � TOWN/VI L /CITY 4(77,11�" /%/17,[,. LS/ DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: r p7 1LE LOCATION SKETCH & RCES OF CONTAMINATION PROVIDED / / 3 ON SEPARATE SHEET (d te) (signature) PERMIT TO CONSTRUCT A WAfCde.EarnL' WLL j This permit to construct one water well as set forth abo is grntedtfiiEr`•t-he.-provi ons of Subpart 5 -2 of Part 5 of the New York State Sanitary t ith i +. thirty (30) days of the completion of water well construction %N 1: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of tUW"*u6amE-96ty Health_ Department attached to this permit. 3. Submit a Well Completion Report on a form provided by thefthlWaWC &GOIIXalth Department. During all well drilling operations, the applicant shal�t� t-,ake a � ���llo o a sure that any and all water or waste products from such well dri].ixg , oft*raad:an:; bsaoC:ontied o this property and in such a manner as not to degrade or otherwise con 9`1'fnate,�sux ,ce�or P undwater. Date of Issue: 19 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 I PETER C. ALEXANDERSON County Executive 7 /t/ig 10L . L�IrE &gcl �rL� �o 5'3 -7 14-E2+t�o� (0'2 0 3 f'�- DEPARTMENT OF HEALTH 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -2294 ®X 1 °0x v"0 = I a Z Emn ENID L. CARRUTH, M.P.H. Public Health Director JOHN SIMMONS, M.D. Deputy Commissioner