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Home My WebLink About1087DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.54 -2 -11 BOX 11 01087 Ji. on f _ � ♦ , - _. 01087 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL t / - .pleaseprint.or type. .. _ _ _ . ..- ....- ._.._.- ...: -.: .. PCHD Permit # Well Location: Street Address: Town/Village Tax Grid # 9' MapZs, s " Block '2 Lot(s) 1 Well Owner: Name: je5a/�h /�'p� dress: $I)A,t = �7 arLnr,� N�i2 Q Use of Well: _ Residential Public upply Air /Con eat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served _5; Est. of Daily Usage al. Reason for ,ke Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new. dwelling) Deepen Existing Well Detailed Reason LoL-) V, 4 k for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................... ............................... .............................. Yes No .,X Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision Lot No. Water Well Contractor: i eP, Address./P,oq X.,7,6� � l,Lo A /zQ Is Public Water Supply available to site? .................................. ............................... Yes No Name.of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed we /Io a tion & sources of contamination to be provided on eparate 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. F. 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. revision or alteration of the approved plan requires a new permit. Well to be constructed by a water e 1 iller Wrtified by Putnam County. Date of Issue 0 Permit Issuin ic' Date of Expiration I a Title: Permit is Non- Transfeirra e White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller . . !�?'/'l r;i w/'a GA� , n A !�-' 1441 Forth wP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO ABANDON A WATER WELL please print or type PCHD PERMIT # ell Location: Address: TownNillage Tax Grid # • � % /1/�W�jr�� A "/ MaQOBlock Z Lot(s) 0 ell Owner: Name: ell Type: 1 4 Drilled Driven Dug Gravel Other Depth Data: Well Depth ft I Static Water Level ft jDate 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 Name: ``� , Address: 41� _ Contractor: A9111.,* Ass i/�t! J.a f / Aoo/ �r, // /^ /_ j L d --se /1 A _.. ZAZ1 . j % / J e /_ J,111 Reason For Abandonment: Description of Work To Be Performed: 1,74 �� /L) tj `� Applicant Signature: 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 in f rma ion delineated on the application for this permit has been completed. 0 r Date of Issue Permit Issuing Official Title White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -97 )%zm,r,e M4fZ -td /4 61. i .t i f' Boyd Artesian Well Co., Inc. _.._ _1054 Rte:._.5.2_.. Carmel, N.Y. 10512 (845) 225 -3196 Fax (845) 225 -8420 h 241COW will Oh _ �I UN110 I ti F] Ll PAS!' LI ! rxy i t�Hbr .'x;.45(. s-ir�j; Its R I L .. I' I I r� Y ' - - --- •... vv�n UH PRESS N - - -�� ERE -RED Ih1AGE DISAppEp 1:021906110,91: . ■ ■ • M .R { :j LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6,130 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 Boyd Artesian Well Co., Inc. 1054 Route 52 Carmel, NY 10512 July 21, 2004 Dear Mr. Boyd: ROBERT J. BONDI County Executive Re: Proposed Well Zakon 47 Newburgh Street (T) Patterson 25.54 -2 -11 A field inspection was conducted on the above referenced lot by Brian Stevens, Public Health Technician. The application to replace the existing well is approved with the following stipulations: 1. A minimum casing depth of 60 feet is required. 2. The existing well is to be abandoned once the new well construction is complete. Please provide notice to this Department five days prior to abandoning the existing well so that this Department may witness it. A Well Completion Report (WC-'97) 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. Sincerely, Brian R. Stevens Public Health Technician ,cc: RM, file Arm 0 Cie �4 W W o• : 0 O ()N CZ co O0�C, oy z �!► O i Ro RPy� g v+rvv rUKMERLY PAUL L. BATCHIE \ ' FORMERLY LOT2 A$ SHOWN OF FILED MAP N.. flag LOT1 AS SHOWN ON FILED MAP No. 1425 (` N37 °4G'2 I T 2G 1.52' NO PHYSICAL BOUNDS WOOD DECK N * AT GRADE WALL I STORY Cn W STEPS (Na lei m U1 2 m a I Y2 STORY o z FRAME 0 �. o d DWELLING cc) N ' o Z } a _ of 49.3'1 a = w 112 STORY u' o PRAMS AND GLOM w Z GARAGE z g s ! ELEC 0 3 SERVICE W REi 01YE 0 LOT / AS SHOWN ON FILED MA, 0 /W9 AREA / \ O, A5 PER A55UMED RgADLINE 2.3604 ACER5 = 102.817 5ct. 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