Loading...
HomeMy WebLinkAbout4747DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 91.26-1-30 BOX 36 91 r IN Nj- I III -& 1 1OW , 19 04747 SHERLITA AML.ER, MD, MS, FAAP Commissioner of HealthA L;O TTA MOLINARI, R1V, IVMN- r�..w�•. . Associate Commissioner of Health ROBERT 1, HINDI County Executive July 6, 2005 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Michael Siegel 8278 Roosevelt Avenue Jackson Heights, NY 11372 Re: Well Permit Application for Siegel Property 11 Agnes Place (T) Putnam Valley Dear Mr. Siegel: This Department has approved the well permit for Well #W44 -05 at the above referenced site. Please be advised that if site conditions and/or site plans change and/or are revised, thereby compromising the approved separation distances, siting approval of the well must be re- approved by this Department. This letter shall serve as record of approval and by initiating construction of the well covered by this approval of plans, the applicant accepts and agrees to abide by and conform to the following: 1. The well location shall be survey located and staked prior to drilling. 2. The proposed well is approved 50 feet from on- site.and/or adjacent subsurface sewage treatment system areas. _ .. 3. The -well shall -.be in.stal:led ,.vitb a minimum-of -8 ?- feet of casir b w. 4. An ultra- violet light disinfection unit shall be installed on the incoming well line to the dwelling. 5. A water sample shall be collected and analyzed for coliform bacteria after the well is drilled. The sample result is to be submitted to this Department along with the well completion report within 30 days of completion of the water well. 6. All necessary Town permits for the installation of the well are required to be issued prior to well construction. Should you have any questions, please contact this office. Michael J. Director of MJB:cw cc: C. Santos, (T) Putnam Valley Insite Engineering . Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 CK. tF 63®� P UTNAM COUNTY DEPARTMENT 01F HEALTH DIVISIO N OF ENVIRONMENTAL HEALTH SERVICES APPLICATRON TO CONSTRUCT A WATER WELL .::: .'.... .,,. Pte WeRR Location: Street Address: Town/Village Tax Grid # Map - A- Block Lot(s) 3 0 WeRR Owneire Name: Address: �G r� q Use of Welk � Residential Public Supply Air Cond/Heat Pump Irrigation I- Primarry Business Farm Test/Monitoring Other (specify) 2- secondairy Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily Usage al. Reason ffoir JL Replace Existing Supply Test/Observation Additional Supply ➢Drifling New Supply (new dwelling) Deepen Existing Well Detailed Reason . ffolr IIDAffinflg WeRR 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 : Ad dress: Is Public Water Supply available to site? :................................. ............................... Yes Na, ' Name -of Public Water Supply,:. Town/Village : �C= Distance to property from nearest water mam ,- Proposed well' location &--sources =of coii ination_to'be provided on separate- sheet/plan - 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 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. I a ^ /t, , Date of Issue — -� Date of Expiration Peirmit is Non- Turaisff&irzbIl Permi Title: White copy - HD file; Yellow copy - Building Inspector; Form WP -97 3 2 .ir1 W a -1y 1 f r, K '�s+l'x ^2ra�tR J • i } SyyV r 5���ft �I Tilt _ '' X r l \V ti59! from Fk'i .. Jut �. 70 L 8 8 10 p tk ®� t, rim FOUPIV I - _ _ Alve 5' 5 '00" W. of rumve R- 15.00' I°— 22.741 - v, �0 Palta— 86' 5240 1I a F.15 PLA, i } CK. tk & 308' ® DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL Well Location: Street Address: TownNillage Tax Grid # Map Block Lots) 3 0 WeH Owner: Name: Ad ess: Use of WeIIe Residential Public Supply Air ond/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 6M al. Reason for J Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason LAd SA for IDriWmg 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./ Address Is Public Water Supply available to site? .................................. ............................... Yes Name of:Public Water Supply:' : Town/Village c Distance toTroperty from nearest water. main Proposed well location sources of c ©ntaininatioiit�: be povidetl oh separateheetfplan Signature: Date: _ Applicant - PELT TO CONSTRUCT A WATER WELL N 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. I A n /_\ A 4 Date of Issue Permit Iss ' g 0 ial: Date of Expiration Title: Permit is Non- Transferrabl . White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; flange copy LWell driller Form WP -97 i PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES .�. ' °� ::�` q.,;,r`i.. k_ R_.•fie.. �'•.�. .y.„p.�'a+a. =i ... _ ;•�eo... '��'•. :�.'a. .. •..,: <.a 3: .i;. :::Q'„nr:n PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR SITE LOCATION OWNER'S NAME MAILING ADDRESS OFFICIAL USE ONLY J-0 2- PHONE PERSON INTERVIEWED PCHD Complaint # Name & Relationship i.e., owner, tenant, etc. ` DATE TYPE FACILITY Mt 0 £N i tll L PROPOSED INSTALLER ADDRESS PHONE &L- G35 %t o j REGISTRATION# Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system .Different location may require submittal of proposal from licensed professional engineer or registered architect. qOX S'C! TITLE �k* ( F-fl- Propos_ as 1 approved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name .�s V b. Site Street Name, Town and Tax Map number. C. Location of installed components tied to two fixed points (e.g.,house comers). d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6' deep e. Installers' name and number. 3. System repair to be performed in accordance with the above proposal and conditions. Proposal appro d Inspector's Signature & Title ATE COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99ML LICENSED- TC)Wf',!.- POUGHKEEPSIE MR. ROOTER PLUMBING - CITIC§ - POUGHKEEPSIE, P.O. BOX 1740 KIN(;GTON, BEACON PLEASANT VALLEY, NY 12569' 1-800-795-9003 COUNTIES - PUTNAM, WESTCHESTER, ROCKLAND CONTRACT/RETAIL INSTALLMENT 2r DATE: -? / ( `/ / -) 3" 7/ 0; iypew-witnoui notice ot canceiiation 24 Hours a Day o 7 Days a Week... Nevee, mrnn rtpw-nn�n n Overtime Charcue! wwww- Ix a I ✓ q CUST0ftR NAME: e- 7ADDREoS CUSTOMER NAME: rlj�6 /V J' e 3, � i ADDRESS: 0 ST ZIP JpBPHONE CITY ST ZIP OTHER PHONE SERVICE PREV MAINT EMA, ` TECHNICIAN (S) Kee V", CONTACT CPP MEMBER n Nu e Lr-�ll 411 MUNKMAk ESTIMATE ❑ CASH (CHECK BILLED' Eg Rg [E] EE] CREDIT EXP ALITH I CARD # DATE CODE H/ SCRUB (SMALL) H/ SCRUB (TRAILER) E-71 CAMERA OPPORTUNITY CALL — ° MRMDD�� Fl AGREETHAT INITIAL PRICE QUOTED PRIORTO START OF WORK DOES NOT INCLUDE ANY ADDITIONAL OR UNFORESEEN TASKS, OWNER paq NOR MATERIALS D TO BE NECESSARY TO COMPLETE REPAIRS OR REPLACEMENTS. it ALSO AGREE TO HOLD MR. ROOTER OR ITS ASSIGNS HARM- PARTS DEEMED MAY BE FOUND LESS FOR CORRODED, UNUSABLE OR UNRELIABLE FOR COMPLETION OF STATED WORK TO BE DONE. I HERtrw AUTHORIZE MR. ROOTER TO PERFORM r -- I PIPE LOCATOR = CABLE MACHINE TENANT PROPOSED WORK AND.AGREETO ALL AGREEMENT CONDITIONS AS DISPLAYED ON THE FACE AND REVER E "SI ES-1 S D-C)CUMENT AND FURTHER ACKNOWLEDGE C-1 BACKHOE RESIDENTIAL THATTHIS INVOICk:IS DUE UPON RECEIPT. C-1 TRENCHLESS An Independently Owned and Operatedfranchise $311o.2s C=I OTHER COMMERCIAL yr M W 19 W .4 I -V C) CI MIA Ad VC A J , I '21-\ s- 7. a C i-cs- LL-e A 'o- L;f AA. cl. s. CPP ❑ APPROVED ❑ DECLINED APPROVED ❑ DECLINFb ❑ APPROVED C];D�60NED o ACCEPTANCE OF WORK'PERFORIVIED: I FINE) THE SERVICE AND MATERIALS PERFORMED AND INSTALLED HAVE BEEN COMPLETED IN ACCORDANCE WITH THIS AGREEMENT. I AGREE TO @QR§P� PA*AEASONAdtjE ATTORNEY FEES, COLLECTION FEES AND COURT COSTS IN THE EVENT OF LEGAL ACTION PURSUANT TO COLLECTION OF AMOUNT UE... x. I DO HEREBY STA*THAT THE ABOVE WORK HAS BEEN DONE IN A WORKMANLIKE MANNER AND TO APPLICABLE CODES. T192=90MIN99MM x dr4A 7/ 0; iypew-witnoui notice ot canceiiation 24 Hours a Day o 7 Days a Week... Nevee, mrnn rtpw-nn�n n Overtime Charcue! wwww- Ix a I ✓ q at TECH 'CAUL T.ICKE,'Irf PROMISED: 07/14/02 03:35P -05:35 CUSTOMER NAME: Call Taken By SI RGEL,MICHAEL Map Code: DF ?LACE- ��'- �.= ;`c�.;�• st 3 D10 LAKE PEEKSKILL NY 10537 SWO Number C Phone 917 - 287 -5204 Job Description: KEITH TO GO BACK TO INSTALL INFULTRATERS AS PER EST CALL CUSTOMER ON MONDAY TO SCHEDULE + ESCAVATOR Comments: AHANSEN AVE+ HOLLOWBROOK RD's[ *Y =019] Inv #: Amount: Trip Charge: Mr. Rooter Plumbing 04 JOB# 07 -14 -007 Time Taken DISPATCHED HOURS 02:32P Collect Fee Source: - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 6AJ CA Y) bv, A -) � 4 _. -. ' a • w ....- . 5 •..�;': Y .. . � .. .� .... _- . - .... o�c- .y. ��.-�, .._- -,� -.� � .. ...��. -••-• �"-V ••.__ �^° .p., ..;�. ..o.....t.. .. ..- .-. --..7t a .... ,. �.o..ir....ys; ; ..o o . w sue, (je-n 0A 0- LN" 7 Wke 4EL NO 7F., these sketches am based an Now York State High Resolution LEGEND Approx. Location Existing ft/1 Q Statewide Digital Orthokmagwy Program (2000 P#ot —Present) and d1g1tat tax map intannotion ham Putnam ountK them sketches are intended to show Subject Property Approx. Location Proposed Well OPPMAMate, property 11neA =dweilings. and septic systems f" use in assessing possible waff locations WIY. These sketches " not intended far my other Approx. Location Direction Of Ground Slope SLOPE purpose and are not intended to be scoled. Prior to "Ing any proposed Existing SSTS K9 Arrow Points Downhill wall, the appmprkto surveys, designs, and permits must be obtained. DA M' LAKE PEEKSKILL "`""M°°" N S / T E 10-11-04 acae WATER S YS TEM SHUTDOWN ENGINEERING, SURVEYING E PRA"r No: 04M.i00 CRAMPM LANDSCAPEARCHITEC77JR& P.C. PLOT PLAN' 3 Garrett Place - Co r a/. Now York 10512 r" s 'I 11 AGNES PL. Ph—* ,45) 22,—,,,,T. . (,,,) 225-9717 91.26-1-30 j T `AIf' J 1=801 i NE' -,'. I ' 1 21 41 9L BM9um 6CAIL O1 t /IO0FAtl 1A0N Iwo: �TTP% B3.B2T �-FT Wra. 1 rtr TT— T.T.Tr: �•:.T �� ''�.. - ,'Z�\ \ #�`_� 73 H_ 185 B I I I IG I I I: i- 1 5�� ♦ ♦ n\ /on \'\ o IR I I I I I I I I I I I. I I I I �\ \ •. n♦\ 72\ `�G1'gpAr 1 I i ; _ I I I I I IAV,AA •e \ \♦ �\ u ° 8 a\ \ /a '� .' \ 71\ ♦S. 76 3 I 1 1 ! 1 ! CAro � �wV \ \ \� \ \n rY♦ \� \ \\ JTo. 1 \ \\ 77 V\ \\ p \ 1,/, \;m 70\ I 1 ! 1 I 1 1 1 1 11 B gl 1 V \ N\ ) /n \ ♦ '� / p' x I A I I 1 f II g I f I I I I 1 1 796 T11. \\ \rro \\ ♦\ / _ I I p f r/ I 1 ! f I l 1 BI F 1 1 �• \ N\ \ A.Ar '1 x7 n l �H 1. 1 1 1 1 I I I a a l 7 1 ur"°•\ 1 � \69 ♦ J \ •` r /ul a V /r1 / 1 wl IAm feel l 1 1 1 l y l a Ices Lye>. V' arl till nr 1 1 /A 1 r I p 1 /a 1 1 1 68 1 1 \ /•v \ \ I 1 a/1/A� /A1 JJ/IJA 1 I I �. Anw 1 X11 /r /1 !x 1 1 \' 1 1 \ \ Off. 1 1 I 69 1 I 1 f tv r• O l l l 1� V 67 9 \ V t \ 1 \ kor "Al 66 i 1 1 1• M 1,� \I 1 1 1s• °s '' � � f I I r 1 1 1 g 1 1 65�f +mt f 1 f I � 1 I I. 11 � I \V V yIn Au+LI I• I � ~_ ____ MA, I 1 1 �� I 1 . ti 11 531 • 1 1 a 1 I j I A IIT • -- rr IIIH u 1 wt _ _ _ _ _ _ — _ .Mr j A —g y — - - - -- 6 x - - - - -- 8 E If A jy _ g 56 to 9 ro — — iJ a - - — — — — — ---- -- -- /r v IO2W lets >d a 61 --'r1e -- — - — — — — - — — — ,. ya _ _ — _ — _ _ _ _ — _ _ I9 01 N 60 ___ 20 ° • �i 29 �r _ y I _ _ _ _ _ S 101.11 p V I p 1 al I ° 135 1 I s \ ♦ ` I I .1 ru ' \ io /e x 25 p Y L _ _ 1 34 1 I I I 'r / \ 21 \ .. - - — — -- — — — `5 \�/N� I I I I n1.s. \ \ \ \ \ H IA•nl \\ t\ t 11 3 \ \\ \\ \ A� \.\ /!° ?r \ ♦ a 1 \' \� a o S ! \ � a L _ — — _I _ � 44, \ 1 \22\ \ ' \ ' \ 4\ \ H \ _ Z _H b i � NL9f \ \ t $ 1 \ � \ 1 �1f � ♦ Jx \ . \ \ \�� \ o. __ �___ �' a 23 / •ar \ \ \' 1 1 If .1 \ 1a\ o \ \ .1 \/a\ \�\ /O _91j34_*_ P4 91.19.1• FOR ASSESSMENT PURPOSES ONLY "REVISIONS. SPECIAL DISTRICT INFORMATION NOT TO u -r rtl LMAN/. rMI rM_• • e.rn•rwn Inn w SL190. •001• pjTpetl, '0 10100. plegl9l, ••. VM STIR LIK pit Aew BE USED-FOR CONVEYANCES ••• n, w Y u• w.,va ...n w A n room uK C007IIAMD ANM,VAtr woo n i e rMF i• NANM VLIFA rl IANFCIIR OlOrwtl _ -• .RNA LINE A010 RO.M. JAMES W. SEWALL COMPANY R W Rr.M rr 1.• n ., �, . M.r A ""AM LIME -- -- F71VNWATMINE 107 CENTER STREET, OLD TOWN, MAINE • • yyp'rM r.rau...r u M.N >MR'A ACK LIMIT — — RMOM LIK . RECIL 0137 19 LIN ' i9001 01=10 LIM ' I: .. r L 010011.E - -- LIK M. - INQ M_ 246