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HomeMy WebLinkAbout1404DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 33. -2 -26 BOX 13 01404 - :: is � .. T 1.6 mir L Ild r IBM as g . I , 01404 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH. SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # Well Location: Street Address: Town/Village Tax Grid # 372400 630 Fair Street Carmel Map 33 Block 2 Lot(s) 26 Well Owner: Name: Address: John Klett 630 Fair Street - Carmel, NY 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 Amount of Use Yield Sought 5 gpm # People Served Est. of Daily Usage gal. Reason for y Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason Low yielding well 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 No X Name of subdivision Lot No. Water Well Contractor: Mill Drilling Inc. Address: - 75 R,rnam Ave Brewster, 2 Is Public Water Supply available to 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 be rovided on separate sheet /plan. Date: 5/7/n7 APPli.cant. 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. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putni -im County. Date of Issue Date of Expiration Permit is Non - Transferrable Permit Issuing Official: 41 -(0 I q Title: White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form "T -97 V 0 'y 0 6?� �o� 03 L rr N 4 'jj rr N 4 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEAL'T'H SERVICES _ APPLICATION TO ABANDON A WATER WELL ell Location: ell Owner: please print or type PCHD PERMIT #.A tv 630 Fair Street Carmel Map 33 Block 2372400 26 dame: Address: John Klett 630 Fair Street Carmel, NY 10512 Well Type: x_ Drilled Driven Dug Gravel Other Depth Data: Well Depth N/A ' ft IStatic Water Level ft Date Measured Use of Well: X Residential Public Supply Air /Cond/Heat Pump Abandoned 1- primary XXX Business Farm Test/Observation Other (specify) 2- secondary Industrial Institutional Standby Well For Mi11 Drilling, Inc. 75 Putnam Ave., Brewster, nY 10509 no water - no yield Description of Work To Be Performed: FILL CONC1tEIF FRCM BOTRM TO UP 7/13/07 Applicant Signature: 434107-1 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.. Date of Issue White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -97 CyC, 3 �F / PUTNAM COUNTY DEPARTMENT OF HEALTH ® ® o D DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # — Q Well Location: Street Address: Town/Village Tax Grid # 372400 630 Fair Street Carmel Map 33 Block 2 Lot(s) 26 Well Owner: Name: Address: Jahn Klett 1630 Fair Street - Camel, NY 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 Amount of Use Yield Sought 5 gpm # People Served Est. of Daily Usage gal. Reason for _y Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason Low yielding well 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 No X Name of subdivision Lot No. Water Well Contractor: Mill Dri 11 i no Inc. Address: - 75 A itnam Ave jire� rstpx� b jt Is Public Water Supply available to site? .................................. ............................... Yes No X Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination ovid ed on separate sheet/plan. Xbe Date:. 517,/f)7 Applicant Signarire:. 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. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. J A Date of Issue ' -7-16? Permi Date of Expiratio - Title: Permit is Non-Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Rob Mill 75 Putnam Ave. Brewster, NY 10509 July 16, 2007 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 Klett 630 Fair Street (T) Carmel 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. 2. A Well Completion Report (WC -97) shall 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: Aj e Sincerely, Awl b- 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 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 I d PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: 630 Fair Street TownNilla e: g Cannel Tax Ma # p 372400 Map 33 Block 2 Lot(s) 26 'GP ,xnR 41 °27'35N 073038t58W Well Owner: Name: Address: John Klett 630 Fair Strut - Cannel, NY 10512 Use of Well: 1- Primary XX 2- Secondary X Residential _Public Supply Air cond /heat pump _Irrigation Business Farm Test/monitoring —Other(specify) Industrial Institutional Standby Drilling Equipment Rotary _Cable percussion X Compressed air percussion _Other(specify) Well Type Screened _Open end casing X Open hole in bedrock _Other Casing Details Total Length 61 ft. Length below grade _qft. Diameter 6 in. Weight per foot 17 lb/ft Materials: X Steel Plastic Other Joints: Welded Threaded Other Seal: Cement grout X Bentonite Other Drive shoe: X Yes _ No Liner: _Yes X No Screen Details Diameter in Slot Size Length (ft) De t to Screen ft Develo ped? First I I _Yes _No Hours Second I I Well Yield Test _Bailed _Pumped X Compressed Air Hours 6 Yield 60 gpm Depth Date Measure from land surface - static spec ) 30 During yield test (ft) 180 Depth of complet;d well in ft. 325 Well Log If more detailed information - descriptions or 1 sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter in Formation Description ft. ft. Land surface in 6 qand. loan 10 15 15 24 -3 v 24 46 Y sandy soil 46 50 boulder 50 90 wmiw 90 325 gneiw If yield was tested at different depths during drilling list: Feet Gallons Per Minute Pump /Storage Tank Information 325 60 Pump Type ersible Capacity 11 Depth 180 Model X3GS1 12 Voltage 230 HP -_ Tank Type diram Volume 62 Date W611 Completed r 7/2/0 Well Driller PC`Certificate # :023 -07 NY State # 10071 : _Date ofReport Well Driller Name S� Address pp�' tee, ill (stgnatur) h r n Mil 7 Dn7l�i>g, . Inc x 75, RiitnamAve Brewster%" NY._10509..r Pump Installer Name 8� Address `> z P mpkl t ller (signature) .. t ! :: a'f T 4 sRYt:: i '' • �'. 5 ;:: 4 Hid ,;., , M33a..�'?.'r" 0 T)rll7 ing r a E r x x S^* ,.�, i "S.Y` �P 3' �iqy [x+' Y. 'i`" ,• Inc 75 Putna6 Ave` ,;�Brewstex NY 10509 �� �� _{{ ,. NIPS lnL uki .4'F.'...:ut�... NOTE: Exact Location of well with distance,1to �t lepst two permanent landmarks to be provided Tn a separate sheet/plan. UU �1 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3/06 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL A BAN R�. D ®NIVIEN'Y' P�IZ'I`. ,- Y.�.:- _. >i♦ WELL ABANDONMENT CERTIFICATION 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 # AW11 -07 to ab don said water well. 8/1/07 Date: Signature: Print Name: Robert M. Mill Jr. 75 Putnam Avenue Address: Brewster, NY 10509 krd Form WAR -97 11D Well Abandonment Permit # AW11 -67 please print or type Well Igcation {.;�� :; t: Street Address: TownNillage Tax Grid # 372400 s 630 Fair Street Carnal Mapes Block 2 Lot 26 rLa3* 'y: t . Vell Name: Address: a� John Klett 630 Fair Street - Carmel, NY �ejl'ry k - S { X. Drilled Driven . Dug Gravel Other } Depth of Nell 4� �;' Well Depth 30 ft Static Water Level 0 ft Date Measured 7/27/07 r i'. : Beason for No water - no yield Abandonment Description :of Filled concrete from bottom to top of well. Com leted Work = WELL ABANDONMENT CERTIFICATION 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 # AW11 -07 to ab don said water well. 8/1/07 Date: Signature: Print Name: Robert M. Mill Jr. 75 Putnam Avenue Address: Brewster, NY 10509 krd Form WAR -97 O (/ Page 1 of 1 Environmental Services, fec. 41 tCenosla Avenue . "j " 15r 'TER 5a -W-AKO AIR ANALYSIS a "IZisr�tiuiy. Carpi#�t, istli ;38&7E}-i ^TCE�3pik7 la ti3� 8 =22a� ._. _ _ -. Mill Drilling Co Mailing Information: Collector's Information: JIMS ID: 059326 Name: Mill Drilling Co Name: .Russ Mill Address: 75 Putnam Avenue Address of site: Klett 630 Fair Street City: Brewster City: Carmel State: NY Zip: 10509 State: NY Zip: Phone: (845) 279 -5041 Fax: (845) 279 -5075 Phone: Sample's Information: Site: Top of Well Date Collected: 7/30/2007 Date Received: 7/30/2007 Preservative: HNO' Time Collected: 3:30:00 PM Time Received: 4:15:00 PM Temperature: <4 Lab No.: J0708117 Matrix: Water Date Analyzed Test Name 07/31/07 Manganese 07/31/07 Sodium 07/30/07 pH 07/30/07 Color 07/30/07 Turbidity 07/30/07 Hardness 07/30/07 Odor 07/31/07 Iron 07/30/07 Chloride 07/30/07 Nitrate <0.05 .ppm.- - - Nitrite 07/30/07 Sulfate 07/30/07 Chlorine Free Residual 07/30/07 E. Coli 07/30/07 Total Coliform Result MCL <0.05 ppm 0.3 ppm 20.7 ppm N/A 6.8 S. U. 6.5 -8.5 S.0 ND 15 Units 1.3 ntu 5 ntu 176 mg /L N/A ND N/A 0.07 ppm 0.3 ppm 26.8 ppm 250 ppm 0.46 ppm 10 ppm <0.05 .ppm.- - s ,...}.pp — 35.7 ppm 250 ppm <0.1 mg /L N/A Absent Absent ** *Present Absent Comments: ** *ABOVE ACTION LEVEL At the time of the analysis the sample was Unacceptable for Total Coliform At the time of the analysis the sample was Acceptable for E. Coli Method SM 3111 B SM 3111 B SM 4500 H B SMWW 2120 B SMWW 2130 B SMWW 2340 C SMWW 2340 C SMWW 3111 B SMWW 4110 B SMWW 4110 B SMWW 4110 E -- - - —_ SMWW 4110 B SMWW 4500CIG SMWW 9223 B SMWW 9223 B CFU = Coliform Forming Units MCL = Maximum Contaminant Level mg/L = milligrams per Liter N/A = Not Applicable ND = None Detected ntu = Nephelopmetric Turbidity Unit ppm = parts per million S.U. = Standard Unit Units = Units Signature: �a4e - Reviewed By: ,�� .iaa'� Michael Lapman Sharon Houlahan, Director President State #: PH -0218 ELAP M 11715 io :b Rd CC NNECTICUT, N6w YORK AND N&LAC CEATIF120 Tall Free Bee- 097r-1 Corporate Fax 203- 79B -24ce 1 lab Fsx 203- 988 -2107 1 www.jnmsenrrironmental.com O "I' £k Page 1 of 1 41 KGnosi Averusa Ep ritonmeniall�ertr ivai drre . .._._ - _ - WATEU, 'So1e'AN6AMa ACYSIa & Danbu1°y.Odrin9ittzttKiF3.91D'I Tel3ph r1s- s -22as' Mill Drilling Co Mailing Information: Collector's Information: JMS ID: 059530 Name: Mill Drilling Co Name: Robbie Mill Address: 75 Putnam Avenue Address of site: Klett 630 Fair Street City: Brewster City: Carmel State: NY Zip: 10509 State: NY Zip: Phone: (845) 279 -5041 Fax: (845) 279 -5075 Phone: Sample's Information: Site: Pump Discharge Date Collected: 8/3/2007 Date Received: 8/3/2007 Preservative: N/A Time Collected: 9:00:00 AM Time Received: 12:15:00 PM Temperature: <4 Lab No.: J0708316 Matrix: Water Date Analyzed Test Name Result MCL Method 08/03/07 Chlorine Free Residual <0.1 mg /L N/A SMWW 4500CIG 08/03/07 4:00 PM E. Coli Absent Absent SMWW 9223 B 08/03/07 4:00 PM Total Coliform Absent Absent SMWW 9223 B Comments: At the time of the analysis the sample was Acceptable for Total Coliform At the time of the analysis the sample was Acceptable for E. Coli CFU = Coliform Forming Units MCL = Maximum Contaminant Level mg/L = milligrams per Liter N/A = Not Applicable Signature:! Michael Lapman Reviewed By: k"1 Sharon Houlahan, Director President State #: PH -0218 ELAP #: 11715 0 did' CONN'.CITICU'r, NGW MRG AND NEL.A« 06RTIr1CO 888 -UAYt6 Tall Free -50971 1 ,Corpera.te Fax203- 798 -24ae I I.ab Fax 203-798 -2107 I w%V%v.jmsenvir©nmental.ccm