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Home My WebLink About1249DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.64 -133 BOX 12 1 r I,yL ,., ,. 1 i . , Oki ' T Xo IN V} TIC '.4 ■�� 616 �' �'' I } UL 01249 DEPARTMENT OF HEALTH Division of Environmental Health Services TWO NTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL #. L1sz.12 Prwn PRRMTT WELL LOCATION Street Address Town Village City Tax Interlaken Rd. Pa,tterson,NY Grid Number WELL OWNER Name Mailing Address (aPrivate Dominic & Laura DiSanto, Interlaken Rd., Patterson ,NY OPublic USE OF WELL 1`- primary - secondary ® RESIDENTIAL Q BUSINESS 0 INDUSTRIAL ❑PUBLIC SUPPLY OAIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION O INSTITUTIONAL O STAND -BY 0ABANDONED 0 OTHER (specify Q AMOUNT OF USE YIELD SOUGHT 5 gpm /# PFOPLE SERVED /EST. OF DAILY USAGE gal REASON FOR DRILLING NEW SUPPLY O PROVIDE ADDITIONAL SUPPLY ®REPLACE EXISTING SUPPLY ❑DEEPEN EXISTING WELL ❑ TEST OBSERVATION DETAILED REASON FOR DRILLING .- 4 "-o G e• X OO �' 'S rw r / - 7 WELL-TYPE, DRILLED DRIVEN DDUG ®GRAVEL ®OTHER IS WELL SITE SUBJECT'TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR:. Name P.F. Beal & Sons , Inc . Address: PO Box B. , Brews ter, NY IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE" TO- PRO?ERTY'.PROW NEAREST` WATER 'MAIN'i....... + :_.._ _ ._....._..... _.e,__ _. r_...__... - .•......_ ._ _........_. __....._. __ ...:,.. _.._. LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED j&N REAR OF THIS APPLICATION ! ®0 SEPARATE EE D (date) (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to 'construct one water well as set forth above is gran-%:d under the provision's of 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, s.hall: 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. Date of Issue; 19 Date of Expiration: 19 `d� wit min- g�ffici Permit is Non- Transferrable White copy: H.D. File Yellow copy: Building Inspector 2/87 Pink Copy: Owner Orange copy: Well Driller LORETTA MOLINARI Public Health Director DEPARTMENT ®F' HEALTH I Geneva Road,' Brewster, New York 10509 Environmental Health (845)278-6130 Fax(845)278-7921 ]Nursing Services (845)278.-6558 WIC (845)278-6679 Fax(845)278-6095 Early Interventlon/Preschool (845)278-6014 Fax(845)278-6648 Albert M. Hyatt & Sons Rte. 311 Patterson, NY 12563 October 4, 2004 Dear Mr. Hyatt: ROBERT J. BONDI County Executive Re: Proposed Well Wert 23 Interlaken Road (T) Patterson 25.64 -1 -33 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: 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) 27 8-6130 ext.2235 if you have any questions. Sincerely, Brian R. Stevens Public Health Technician cc: RK file Page 1 of 1 Free @rice *:... _ __ ._._. -.._.- _.__ _. PRINTO_UT.TITLrE.-- Town Lines ' Parcels Old Parcel Lines Streams 0 Lakes and Ponds Wetlands Carmel Road Kent Road Names Patterson Road Names Philipstown Road _ Names l Putnam Valley Road w Names r w IF Southeast Road Names 4- 0 11 : f A r I IT ,ter" ,�k`� ./ "� � ✓�, �, % r � i i r � Disclaimer: httpl /imsserver. .com/Freeance/ Client /LandRecords /printFrame.html �l33 9/29/2004 ® PUTNAM COUNTY DEPARTMENT OF HEALTH 4 DIVISION OF ENVIRONMENTAL HEALTH SERVICES ® APPLICATION TO CONSTRUCT A WATER WELL _ ..... .... -- - �_d�C please print or type T - - _ - - PCHD Permit # Well Location: Street Address: Town/Village Tax Grid #/' �-1 A ",g, �w�N � b p�7&,,C50 4,1 Map d�, Block Lot(s)33 Well Owner: Name: Address: Use of Well: I 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 Sought S gpm # People Served l Est. of Daily Usage _ J�gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to! flooding? ................................................. ............................... Yes No Is well located re a in ' realty subdivisio ? ............:......................... ............................... Yes No ✓ Name of subdivision Lot No. Water Well Contractor: AI&AZ7 S y,� Address: Ar Jr-17 � 2' Is Public Water Supply available to site? .................................: ............................... Yes No ✓ Name of Public Water Supply. ,P✓ /} Town/Village Distance to property from nearest water main: ivN Proposed well location& sources of contamination 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. y revision or alteration of the approved plan requires a new permit. Well to be constructed by a wate el driller ertified by Putnam County. Date of Issue � � . Permit Iss n O cial: Date of Expiration Title: Permit is Non- Transferr ble White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller A k-4 A' C, 1 i, A // f = a FOrtn w r -97 �5 - i k -f i t r"Ze 1A t twA CAS/ P T NAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL TAIL H EAILTH SERVICES APPL)<CATION TO ABANDON A WATER WELL please print or type PCHD PERMIT # Well Location: Street Address: TownNillage Tax Grid # 3 %AV 7K)0'tl9*wAl AD PP-7- r1 ;5AS01V MaO5,`�Block i Lot(s) :5'3 Well Owner: Name: Address: Well Type: ,"Drilled Driven Dug Gravel Other Depth Data: Well Depth _Li 0 ft Static Water Level _ ft Date Measured O Use of Well: Residential Public Supply Air /Cond/Heat Pump Abandoned I- primary Business Farm Test/Observation Other (specify) 2- seco>ndai y Industrial Institutional Standby Water Well Name: Address: Contractor: L�'�'� % /0' /�/ ,1i77 � �,�� X7- 3 11 Reason For Abandonment: diVH L L � ►� %,t�lj er � �Y /V EW M-7 C-Lr Description of Work To Be Performed: Date: /`�'�l by Applicant Signature: PEI's 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 donment of the water well, the applicant shall submit to the Department a certified statement that the i orma ion delineated on the application for this permit TO been completed. o l 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 CGS th I 2 c? "'d I s 'p. 0OV4 :POIGjaujo, AomnS lie opien! PA?q j u jI pong AW 'JNNV 57,0, ;-Z C,� '40 rz, Cr ..4 OZ ;hrc a n,,AOA.T)S GAe4j 10111 AIIIJ90 01 $1 St41 Td WdEIT :VO, tOCI-t' C-T -dzIS '01-4 C9TZ-8L'8—SV8—T 3DIJAC-1 MU-1:. WMij FINDINGS: