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HomeMy WebLinkAbout4768DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 91.26 -1 -70 BOX 36 iq I yti r F I 6 11f . my r izij; 144 PU1NAh1 YAl1E1 -. TOWN HALL PUTftA, M VAl,t;fYr N:Y; . MAHVIN O'DELL Inspector ` y F (914) 526 2377 ��Gun Ito✓` TOWN OF PUTNAM VALLEY BUILDING, ZONING, AND SANITARY DEPARTMENT November 16, 1989 a'?' Putnam County Health Dept. 110 Old Route Six Center Carmel, N.Y. 10512 Att: Win. Hedges, health Sanitarian Re: BTMW3 &2R1 ner Dear Mr. Hedges: T'_ie proposal to relocate a water we 7 on the above - "- noted property has been reviewed and approved by this department.. a '... Very truly - yours;' -� I/ MARVIN 0 DELL Building &.Zoning Inspector MO'D:es �..,.o`. .� d ._. - ,.... ". � � .. C� .. a r.. '' �� rb xT�,o. .. ae-'� 1:. 1. �, ;�. .�: .,s: ,�P �: .., �n.��. �. �� 'i I 1 DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 ` _AVPLICATYON' TO. ~CONSTA CT A WATER WELL 4 PCHD PERMIT WELL LOCATION Street Address,,.) Town/Village/City Tax Grid Number WELL OWNER N Ma "UrWj Address. _ ' L ' U�� o_taip �f v�C / �.� >�79j :11_ C .,l,s, ,Private Public USE OF WELL 1 - primary 2 - secondary tRESIDENTIAL OPUBLIC SUPPLY QAIR /COND /HEAT PUMP 0 BUSINESS O FARM O TEST /OBSERVATION 0 INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY D.ABANDONED O OTHER (specify O AMOUNT OF USE YIELD, SOUGHT gpm /# wffREPLACE EXISTING SUPPLY O NEW SUPPLY NEW DWEL IN PEOPLE SERVED /EST. OF DAILY USAGE -,10 gal O TEST /OBSERVATION GI ADDITIONAL SUPPLY 13 DEEPEN EXISTING ` ELL REASON FOR DRILLING DETAILED REASON FOR DRILLING &J;A V Aligzs _ WELL TYPE DRILLED DRIVEN ODUG OGRAVEL OOTHER 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 Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: ✓ . YES NO NAME OF PUBLIC WATER SUPPLY: '�GV TOWN /VIL /CITY &,,,& . DYST�iNCE;` TO; PROPERTS':'FRO'�.NEAVST`. F�ATER',MAIN.._ LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED yt O ON SEPARATE SHEET lli r9 p f 9ZO& -- (date) __._ (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirt3! (30) days of the completion of water well construction, the applicant 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 attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department.. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or 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. Date of Issue: , 1A 19 Date of Expiration 19 Permit Issuing Offic Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller DEPARTMENT OF HEALTH Division of Environmental Health Services cvrC - SY� - ?ssS 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 nn APPLICATION TO CONSTRUCT A WATER WELL (� r o.f Ve PCHD PERMIT 6 1 -'A' WELL LOCATION Street Address ) Town/Village/City Tax Grid Number WELL OWNER Nam i" Ma�ling. Address. •� � IMPrivate - f Public USE OF WELL RESIDENTIAL 0 PUBLIC SUPPLY 0 AIR /COND /HEAT. PUMPI ® ABANDONED . 1 - primary 0 BUSINESS 0 FARM 0 TEST /OBSERVATION 0 OTHER (specify, 2 - secondary 0 INDUSTRIAL b INSTITUTIONAL 0 STAND -BY AMOUNT OF USE YIELD SOUGHT gpm /# REPLACE EXISTING SUPPLY PEOPLE SERVED /EST. OF DAILY USAGE c gal ® TEST /OBSERVATION 13-ADDITIONAL SUPPLY REASON FOR DRILLING 0 NEW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL DETAILED�� iii iL��.. = �` AJr,� +�'<�i «�% i� ♦,;.v: jJ,^Z! �-.1 > G ` / !;-► c REASON FOR DRILLING WELL TYPE MDRILLED ®DRIVEN ®DUG ® GRAVEL U OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: I Lot No. WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: ✓ YES NO PnL1.,7",X__, NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY LK 45'eL_ . DISTANCE _TO .PkOPER'Y,FROM NEAR.►:ST_ WATER WN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ®ON SEPARATE SHEET ie/aa If (date) / (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions. if Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within hirtr (30) days of the completion of water well construction, the applicant 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 attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. )wring all well drilling operations, the applicant shall take appropriate action to assure that my and all water or waste products from such well drilling operations be contained on this roperty and in such a manner as not to degrade or otherwise contaminate surface or groundwater. ate of Issue: 19 ate of Expiration 19 Permit Issuing Official ermit is Non - Transferrable White copy: HD File Pink copy: Owner /89 Yellow copy: Bldg. Insp. Orange copy: Well Driller John M. Simmons, M.D. PUTNAM COUNTY HEALTH DEPARTMENT -_ DIVISION OF ENVIRONMENTAL HEALTH SERVICES Deputy Commissioner of Health - FIELD ACTIVITY REPORT - Sheet of INSPECTION NAME J 1 CJS�' `�Y Orig. Routine / Orig. Complain ADDRESS ? j �, g el' 17 S 4 Orig. Request No. Street Town TM No. — Compliance Complaint Camp MAILING ADDRESS Final P.O. -Box Post Office Zip Code Group Illness _ Construction TELEPHONE _ Reinspection PERSON IN CHARGE Field, Sampling Only OR INTERVIEWED Field Conference Name and Title � Other DATE 7 TYPE FACILITY TIME ARRIVED ��� TIME LEFT �� Explain FINDINGS: INSPECTOR: Signature anti 'title PERSON IN CHARGE OR INTERVIEWED: I acknowledge this Field Activity Report. SIGNATURE: 6/86 TITLE: TELEPHONE: COPIES OF THIS SURVEY MAP NOT HEARING TF!E LANn INKED SEAL OR EMBOSSED SEAL.SHALL 'JOT Of CON$10EWE0 TU Bt. A. VALID TRUE CMPY GUARANTEES OR CERTIF!i.AriONS iP.F: ^ATEO HEREON :HALL FUN ONLY TO THE PERSON FOR WHOM THE GJRL%EY is PREPARED. AND ON HIS BEHALF TO THE TITLE C01"FAt1Y, 1i0YERNNENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON, AND IT) THE ASSIGN EES OF THE LENDING INSTITUTION. GUARANTEES OR CERTIF!C'A.. TIONS ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS. UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY MAP IS A VIOLATION OF SOCTION 7209. PARAGRAPH 2. OF THE NEW YORK STATE EDUCATION LAW. LOT N? 110 2 F- Pr`TC. 0LII� WF=LL TS�.. LAND SURVEY MAP � PREPARED FOR II II LYNNE BURKE t ALAN R05NER SITUATE IN THE TOWN OF PUTNAM VALLEY PUTNAM COUNTY mrw YORK * '