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BOX 16
01797
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01797
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA.MOLINARI R1
Associate Commissioner of Health
ROBERT J. BONDI
County Executive
.:.::.:ROBERT MORRIS..PE . -
Director of Environmental Health
DEPARTMENT OF HEALTH
DRINKING AND RECREATIONAL WATER
Boyd Artesian Well Co., Inc.
c/o Henry Boyd
1054 Route 52
Carmel, NY 10512
Re: Proposed Well Dougherty
66 Old Road
(T) Patterson
October 30, 2008
Dear Mr. Boyd:
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.
cc: �fi-lE
Sincerely,
x�W- � , L
Mitchell D. Lee
Public Health Technician
110 OLD ROUTE 6, BUILDING 3 - CARMEL MY 10512
(845) 225 -5186 FAX (845) 225 -5418
A ,
PUTNAM COUNTY 1 DEPARTMENT OF HEALTH,
OF ENVIRONMENTAL HEALTH SERVICES
�r APPLICATION O iii '
please print or.tyDe. PI,PerlTllt_#
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Well Location:
Street Address: Town/Village Tax Grid #
Map �j.6 Block Lot(s)
Well Owner.
Name:
Address:
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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 gpm # People Served Est. of Daily Usage al.
Reason for
Replace Existing Supply Test/Observation Additional Supply
Drilling
New Supply (new dwelling) Deepen Existing Well
Detailed Reason
,t/ 6f- A&Z Z2
for Drilling
Well Type
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: Ad, Y�z� tj,t g2VZ- .Address:l, f�� ����
Is Public Water Supply available to site? .................................. ............................... Yes
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: /O 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. Any revision or alteration
of the approved plan requires a new permit. Well to be constructed by a ater well driller ertifed by Putnam
County. I A
Date of Issue _ —w—'92 Permit Issuin
Date of Expiration 0 �- f- . Title: _
Permit is Non - Transferrable -
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; QY`range copy - Well driller
9
Form WP -97
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