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HomeMy WebLinkAbout1317DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.73 -1 -13 BOX 12 01317 'irtc r r�„ e e L. I L L � �� . 81 , , ri I I I . - - 01317 ,• 6 ` ` i 9: 110 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES A@EVPermit WELL COMPLETION REPORT Well Location Street Address: Town/Village: Tax Map # GPS, l; �l_1Lot(s) 350 Lakeshore Drive Patterson Map Block Well Owner: Name: Address: Cartus 40 Apple Ridge Rd., Danbury, CT 06810 Use of Well: X _Residential _Public'Supply Air cond /heat pump _Irrigation 1- Primary Business Farm Test/monitoring —Other(specify) 2- Secondary Industrial Institutional Standby Drilling Equipment Rotary _Cable percussion _Compressed air percussion_Other(specify) Well Type Screened X Open end casing _ Open hole in bedrock _Other Total Length. 62 ft. Materials: X Steel Plastic Other Joints: Welded X Threaded Other Casing Details Length below grade60'9.I Seal: X Cement grout Bentonite Other Diameter 6 in. Drive shoe: X Yes _ No Liner: _Yes No Weight per foot 17 lb/ft Diameter in Slot Size Length ft Dept to Screen ft Develo ed? Screen Details First _Yes _No Second Hours Well Yield Test _Bailed _Pumped _X_ Compressed Air Hours Yield gpm Depth Date Measure from land surface-static specify During yield test Depth of completed well In 2 ft. 200 ft. 325 ft. Well Log Depth From Surface Well Diameter ft. ft. If more detailed Water Bearing. in Formation Description information Land Surface 35 6. Wet sand cobbles. 36 225 6 White & black gmite. descriptions or 226 6 Soft white quartz. sieve analyses are available, please attach. If yield was tested Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity 10 gM at different depths during drilling Depth 200 Model 10CS10 list: Voltage 230 HP 1 Tank Type Aig2blap Volume 62__ Date`INell com leted ',� fi.k WeII Q�tller NY xState #r't� K �rr'� Date "of'Re "ort i "ICh it, FC Certificate# 024 -07 p � i `Yr>< N, �'Y ! r� .. ! dF r� ra +.: +" - Y5:"h- �f' �'d�.f.�r.,y�y F 'C. �i�It� � �' �R�.k W 3'. i5 ' T �'.1l �i i�� S.hsrt ... M1k� �y�u,v��,'ki� �ifJfS j:�. j:'I•al��'�'''.�It. 1'.`��I ��i��4��':n f. 4 r l 1 "` Installer t �- 30 „7/21/08 „ r t Pump PCxCertificafe, #.,003-06 r11. I Driller Nams e { 8 Addr �y� ,ryi �n L ori •r ery : r 11 id 0b : WeA I1'..,: ri t l."! i':j.��1.1•l R. ,i' iE,r'v4 jY'L � , '# 43.�'pk..,.' �'' F '" ,� '! x i '. hN"tt9.. '�'*$�n. ;�x� , Mtaia `1rArI,p V I.I. J ... T� S �,9 u - i i i & 5 ` t4 M� ' i !I ir 1 �t l.PW '?�. Y�t{ ' N M .ri :skrnM .: r. . l . � . . H � S ' � y , Y *1 ! I � A� "r�' - iIMI�'s c . •f � `..,2 I e .r.,M 't' , a I� y. �;'�,. fi.::, `s u� i y�` " *l' IP 'xf i¢ " �. s. M"yy,"e ���q, �� ;t i a J x - v'��✓( � .1:5II� } �� � 1 �. w `���yS:11�. " ° � �. � 5 ,t��pi"$� t • " t Ip , tl N t �s � : � .r . � . � .�S',.�.d. .l e4 ,% r r .s .. au.. .>'.. x.w :� ..",.�..".` � �1lkw ',dh � ,. .x.t M. x..�b� ".l�� a "'.'" 5i�w.�. ��'a , x'iSir•.i:.''�:c` �a v���;",1A � � .5 � � .ut 'dYn.l . .u� `n� . �l i! erxa�'�.,�[� tk o �' �"M 1� wtt fm,.x �. 'rtey. a I' !{.,* P}:4 ni t ' ' x ler -Name&Address N Ah' 5ll � ! . r ! p . 1' I? `^ '.' .' � { ip 4 t F � % � i �� � a+:;{�.x.;bS A 4 !1z •+i � i � "Re' : � �t b �I77 . f , 5I ' !'l.. �( is � �1 'I ki ,.vp ; a 3 , ', t a ra � K i ;b 5 [I M vV� r r I ' r ' t ' . 3 „_7, r I+ �� ' .✓t. �N . �9 � VM . Ci, .,�.1 '' ` 1 .ry�s1 $ � . % k hf d � S y . ..axu. ,.,It,.k.�. .,uk._�i..,..�..,..��s.. ..f ,'..�•.z ...i"nffi,`,�"',,....5„,a. `G .,m.�,.a.: ;M. �".� �Y.a.�x.•5:k?�w�:�.ux. .Px. �. ti.�L.,. a� ..�."'- .sra'... n NOTE: Exact Location of well with distances to at least two permanent landmarks to be providKon a separate sheet/plan. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 DRev. 3/06 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL ABANDONMENT REPORT PCHD Well Abandonment Permit # AW 14-08 please print or type Nell. t4 ®>a ; ^Street Address: TownNillage Tax Grid #25,73 -1 -13 Awe 350 Lakeshore Dr. Patterson Map Block Lot Name: Address: y t r Cartes 40 Apple Ridge Rd., Danbury,CT 06810 Ft� ZIP Aw 1 X Drilled Driven Dug Gravel Other ' Ms �� ti'.�� Depth of Vel➢ !a Well Depth ft Static Water Level 30 ft Date Measured 7/23/08 Nr V 1 yield. ow � yl Abaat➢ ® ®gieetat flDescrip. Wig :mff s ®mp ➢ettcH Wm>r�C Ramove pumping equignent. Install.. 3/8" Bentonite hole plug. , s p ! I, undersigned, hereby certify that the abandoment of the above - referenced water well has been accomplished and completed in accordance with the methods described in Permit # AW 14-08 to abandon said water well. Date: 7/30/08 Signature: Print Name: Russell C. Mill Address: 79 Aittnam AVPrrrrP Brewster, NY 10509 0b :U l-iy1 = w , Form WAR -97 P23 Al PUTNAM COUNTY DEPARTMENT OF HEALTH - ' DIVISION OF ENVIRONMENTAL HEALTH SERVICES 11�' please print or type APPLICATION TO CONSTRUCT A WATER WELL PGH Pe`r'mit# Well Location Street Address: Town/Village: Tax Map # 25.73 -1 -13 350 Lakeshore Drive Patterson Map Block Lot(s) Well Owner: Name: Address: Phone #: Cartus 40 Apple Ridge Road Danbury, Cr 06810 Use of Well: X _Residential _Public Supply Air /cond /heat pump _Irrigation 1- Primary X Business Farm Test/monitoring —Other(specify) 2- Secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily usage gal. X Replace Existing Supply Test/Observation Additional Supply Reason for Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type X Drilled Driven Gravel Other Is well site subject to flooding ?.... .............................................. ............................... Yes _ No - -X- Is well located in a realty subdivision? ........................................... ............................... Yes _ Nom_ Name of subdivision Lot No. Water Well Contractor: M1IL D 1TR T TNT DE. _ Address: 75 Bitam— Aiw- ie -R te­rr,NY Is Public Water Supply available on site? ....................................... ............................... Yes _ No _X_ Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to r separate sheet/plan. Date: -6/1 0/08 Applicant Signatur ; 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 Deoartment. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Departmel 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 app rov d plan requires a new permit. Well to be constructed by a water well driller certified by Putnam Cpunty. Date of Issue lX - `4 Permit I Date of Expiration °' G7 Title:_ Permit is Non -Trans erable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Cif Orange copy - Well driller Form WP -97 Rev. 3/06 P TI NAM COUNTY DEPARTMENT T ®F HEALTH Dff VHSIOT T ®IF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO ABANDON A WATER WELL please print or type PCHD PERMIT # Ali✓ Well L ®eats ®», Street Address: TownNillage Tax Grid # • 25.73 -1 -13 350 Lakeshore Drive Patterson Map Block Lot(s) Well caner: Name: Address: Cartus 40 Apple Ridge Road Danbury, Cr 06810 Y�eDR Type: Drilled Driven Dug X Gravel Other )I➢. pth Data: Well Depth 40 ft Static Water Level ft Date Measured. 5/1/08 e of. well: x Residential Public Supply irn>mnary VV Business Farm lee®nndary Industrial Institutional Air /Cond/Heat Pump Test/Observation Standby Well Name: Address: ietor: Mill Drilling, Inc. 75 Putnam Avenue Brewster, NY 10509 ason For very low yield = 40 feet deep Iandonment: sernnntnon of Work To Be Performed: Abandoned . Other (specify) Ill fran bottan to top with hole plug (bentonite).. U [��� fn �.ri' f (A,� com or\e A Vo ©v co Date: 6/10/08 Applicant Signature: ICE 1T !.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. I I kc Date of Issue Permit Issuing 0 cial tle White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well dr 1 er Form WA -97 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health - LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Russ Mill 75 Putnam Ave. Brewster, NY 10509 June 30, 2008 Dear Mr. Mill: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Proposed Well Cartus 350 Lakeshore Dr. (T) Patterson A field inspection was conducted at the above referenced lot by Mitchell Lee, Public Health Technician. The application to drill a new well is approved with the following stipulations: 1. The well pump and all electrical components are to be removed from the existing well once it is abandoned. . a ............... _ _.__ -2. A Nell Completion Report (WC -97) shajL 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: Q le S' ay, b, L 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 76678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648