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Home My WebLink About1868DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36. -3 -4 BOX 17 I,y'V 1 •' �� T 26 J. I' ,. � L 1..; d ,ji .. .. , Q:.:� ALLEN BEALS, M.D., Commissioner of Health �� - .;ROBEItT,�MORRIS��P Director of Environmental Health Boyd Artesian Well Co., Inc. c/o Henry Boyd 1054 Route 52 Carmel, NY 10512 Subject: April 23, 2014 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 Proposed Well MacRae 495 East Branch Rd (T) Patterson Dear Mr. Boyd: YELLEN ODELL County Executive A field inspection was conducted on the above referenced lot by Vincent Perrin, Public Health Technician. The application to drill a new well is approved with the following stipulations: _..__ __ :.. L- ._The:finisla dwell is_to.:have its ,casing.ext,.end.to.aLleastJ:g inched_above.. grade - _._ -:. 2. Well Completion Report (WC -97) shall be submitted no later than 30 days after the well completion by the permittee 3. The current well must be properly disconnected from the domestic water supply. An application to abandon this well is to be filed when appropriate 4. Well is to be completed in accordance with all local regulations. Please contact me at (845) 808 -1390 ext.43131 if you have any questions. Sincerel , Vincent Perrin Public Health Technician cc: VP, file 13 N_GWA CERTIFIED Boyd Artesian Well Co., Inc.,_ 1054 Rte. 52 Carmel, N.Y. 1051 (845) 225- -3'196 Fax (845)x`225-8420 L P�IAI.V AA,&,- QAX I _lit __g4g Ph ;(4"' 'v w w// Z' / I '? ... . ............ Pull VA "',P 'RIO /,*)d I I A� r. look r� ti lite. ea Ste tt ey =�z Al, � Yv^ ��a•.t, .�3f•'ri��F�,�.2? i'z" skt 3'rj'.�. �fiF =ktli a`Wf � Y k�AV 6a�s_� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES � D CONSTRUCT- A•WATER- WEEL�za;. °T please print or type'yH�QPI'�i�l Well Location Street Address: Town/Village: Tax M�appj# A�&/A�Map "` Block Lot(s) ire Well Owner: Name: on r Use of Well: Residential _Public Supply Air/ and eat 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 = gal. _>�_Replace Existing Supply Test/Observation Additional Supply Reason for Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason 77 77_ for Drilling . Well T e Drilled Driven Gravel Other Is well site subject to flooding? ....................................................... ............................... Yes _ No Is well located in a realty subdivision? ........................................... ............................... Yes _ No Name of subdivision Lot No. Water Well Contractor Address- Is Public Water Supply a ailable on site? ....................................... ..............................: Yes _ o Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separat sheet/plan. Date: / 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 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 approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue /"� 3 !Y Date -of Expiration -2 /fo Permit is Non -Trans rable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -9? � Rev. 3/06 FFFF-F-`- ., • • /spy; C° ••, h o AQ I` � N IV . � 99 .22 N � J m r 0 0 A551�