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Home My WebLink About1375DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.79 -1 -60 BOX 13 01375 ru m. ki - f , � r - 16� , r`� - , , T { -. . j� . go �. ' i 1 01375 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Ms. Eileen Gilsenan 200 Haviland Drive Patterson, NY 12563 November 15, 2006 Dear Ms. Gilsenan: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive :.... ...- R- t....._.... _.. ROBERT MORRIS, PE Director of Environmental Health Re: Proposed Well Gilsenan (T) Patterson 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 two days prior to abandoning the existing well so that this Department may witness it. A well abandonment report form (WAR -97) is included for your use, and must be submitted within thirty days of the abandonment of the old well. 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) 225 -5186 ext.2235 if you have any questions. cc: file(2) Sincerely, Brian R. Stevens 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 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 CK� PUTNAM COUNT 77 Y DEPARTMENT OF HEALTH q 7 [� DIVISION OF ENVIRONMENTAL HEALTH SERVICES 9 rO -/ c� J 3 . eoai tr-eTinN Tn CONSTRUCT A WATER WELL er�,lDl� please print or type Well Location Street Address: Town/Village: Tax Map # j��r,,400 Q / 100 r a ✓,1a�1t P9_ I m- J'^— k, Map Block Lot(s) Well Owner: � Address: moo hr- -- W fjrL / Phon e # : r" �v 11-343 f A 2 ?:g Z .� v Use of Well: Residential _Public Supply Air /cond /heat pump _Irrigation - rima Business Farm Test/monitoring —Other(specify) 2- Secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily usage gal. Replace Existing Supply Test/Observation' Additional Supply Reason for Dril ling New Supply (new dwelling) Deepen Existing Well Detailed Reason 6 777 t e il + for Drilling Well Type Drilled Driven Gravel Othe Is well site subject to flooding? ....................................................... ............................... Yes _ No Is well located in a realty subdivision? ........................................... ............................... Yes _ No Name of subdivision Lot All C, Address ,/ fd- ✓ Water Well Contractor: Yes No� Is Public Water Supply available on site? ....................................... ............................... Name of Public Water Supply: Tnwn/Viva ®p __ .- Distance to property from nearest water main: Proposed well location & sources of contamination to be pro 'd on se arate sheet/plan. bate t.() 1-2, A2=L-- A Uicznt -Si nature: - -; 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 cleat. 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 > '7 .. 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 ap roved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue l Permit suing Date of Expiration. Title: Permit is No White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 ))__ Rev. 3/06 7L PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO ABANDON A WATER WELL please print or type PCHD PERMIT #AW9 -V Well Location: Street Add ss: TownNillage ,fi�j? Tax Grid #�2y043 f� �a O�- ��-� -�-'� Map Block Lot(s) Well Owner: Name: e *J4& f e7; Address:.2_0 Well Type: Drilled Driven Dug Gravel Other Depth Data: f� Well Depth /, ft Static Water Level ft Date Measured Use of Well: Residential Public Supply Air /Cond/Heat Pump Abandoned 1- rima Business Farm Test/Observation Other (specify) 2- secondary Industrial Institutional Standby Water Well Name. Address: �" /1v7- Contractor: �Y--- . 4-.-vl Reason Fori� =�ju Abandonment: /' Description of Work To Be Performed: �o tin. old W .l Date: v 2- �!./ Applicant Signature: I Ir 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 information delineated on the applicati n for this permit has been completed. ,( \ _ Date of Issue Permit I ial -Y Ti White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -97 r E � , , , N i 4 i 1 i 1 of i 1 � � I 1 ' qi a II, CCO4 P�q Im ci .......... ...... C%l Co J., co tn dA CV coj�e 21, ci Uil LO 100. 47• 1.4, QA I eo LO 281, -oz C6 A di CY C&