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Home My WebLink About1655DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34.13 -1 -75 BOX 15 I I i 1 11 1 L 01655 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Boyd Artesian Well Co., Inc. c/o Henry Boyd 1054 Route 52 Carmel, NY 10512 November 9, 2007 Dear Mr. Boyd: ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Proposed Well Carroll 52 Bullet Hole Rd (T) Patterson A field inspection was conducted on the above referenced lot by Mitchell Lee, Public Health Technician: The application to drill a new well is approved with the following stipulation: 1. 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. mi e, Sincerely, �w �,. . 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 111 tL�GrSt�� I B desian-Well-5; 1054 Rte. 52 Carmel, N.Y. 10512 (845) 225-3196 Fax (845) 225-8420 . ..... .... .. . o 4 4111 Yoe � �d I8 ( 0 PUTNAM COUNTY DEPARTMENT OF HEALTH ��Ti�N DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL "'+ la ^ please print or type PCFIPe�mit #� Well Location Street Address: Town/Village: Tax Map # 6/L M ap Block Lot(s) Well Owner: Name: Address: Ph? IM Use of Well: _ C 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 gpm # People Served Est. of Daily usage QzOp gal. Replace Existing Supply Test/Observation Additional Supply Reason for 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, 0_ Is well located in a realty subdivision? ........................................... ............................... Yes _ No ,a Name of subdivision Lot No. Water Well Contractor: y&A, 2, �1��h,�l,�f��D. /il/Lt. Address: Oar/ Is Public Water Supply available on site? ....................................... ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Date: / Q� 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 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 year /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 approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue ) l Permit IssVing Offici : , - Date of Expiration / Q Title: Permit is Non- Transferab e White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Rev. 3/06 DIWSRON 01F ENVIRONMENTAL HEALTH SERVICES APPUCATION TO ABANDON A WATER WELL please print or type PCHD PERMIT# A Lk)). q -10 1➢ Location: Street Address: TownNillage Tax Grid Block Lot(s) Mao zln- Name: Address: Well Owne Well Type: Drilled. Driven Dug Gravel Other De - pth Data: Well Depth ft Static Water Level ft �IDate Measured- Use of Well: ->4 Residential Public Supply _ Air/Con"eat Pump Abandoned I-primairy Business Farm Test/Observation Other (specify) 2-secondary Industrial Institutional Standby Water Well Name: Address: �%5 >� �` �j Contractor: AV-& 6-&L Reason For Abandonment: Description of Work To Be Performed: Date: Applicant Signature: r AkI �-D ca- 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 application for this permit has been completed. 11 Date of Issue '4-ppc- t Issuing Official Title White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA-97