The URL can be used to link to this page

Home My WebLink About2410DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 50. -1 -5 BOX 21 �. %16 :. 1 r�� I r t 4u7l fl.. 02410 Ll . ILL'i r 02410 i I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION 'OF ENVIRONMENTAL HEALTH SERVICES r. APPLICATION TO ABANDON A WATER WELL please print or type PCHD PERMIT # 4w) 1 —Q Well Location: Street Address: TownNillage Tax Grid # MaVLP Block / Lot(s) Well Owner: Name: Address: Well Type: _ Drilled Driven Dug Gravel Other Depth Data: Well;Depth ft Static Water Level ft Tate Measured Use of Well: ;XeI Residential Public Supply Air /Cond/Heat Pump Abandoned 1- primary Business Farm Test/Observation Other (specify) 2- secondary 'Industrial Institutional Standby Water Well Name: Address: U4?y� Contractor: Reason For Abandonment: t✓ �' 442-11 Description of Work To Be Performed: 1611 Date Applicant Signature: 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: 0716t Date A Issue 7ermit Issuing Official Title White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -97 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINAl L R -N; MSN; . Associate Commissioner of Health ROBERT J. BONDI County Executive ROBERT MORRIS. YE 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 Heitmann & Heitmann 375 Dennytown Rd (T) Putnam Valley August 8, 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: Sincerely, Mitchell D. Lee Public Health Technician 110 OLD ROUTE 6, BUILDING 3 - CARMEL MY 10512 (845) 225 -5186 FAX (845) 225 -5418 please print or Woe I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO 'CONSTRUCT A WATER`WELL PCHD re m iti,y Well Location Street Address: ': ' Town/Village: Tax Map # �Q Block Lot(s) ap Well Owner: Name: Address: ,asya Phone #: - 6W�t' or Use of Well:. _12esidential _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 gal. 'Replace Existing Supply Test/Observation Additional Supply Reason for Drilling New Supply (new dwelling) Deepen Existing Well, Detailed Reason 6. for Drilling. Well Type Drilled Driven Gravel Other Is well site subject to' flooding ? ....................................................... ..I............................. Yes No' C _ Is well located in a realty subdivision? ........................................... ............................... Yes No Ne Name of subdivision Lot No. Water Well Contractor: Address: Is Public Water Supply available.on site? Name ;of Public Water Supply � �: 'S � i Tow�nNillage 4' � ? ` ' r• n s ) Distance.ao'property.fron nearest water.,main. ` Proposed well location & sources of contamination to be provided on separate sheet/plan. Date:: Applicant Signature: 0;019a 01, A OW PERMIT TU GUN51 RUG I A WA I EK 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:' 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 ground eater::,,. APPROVED FOR CONSTRUCTION: This approval expires q�earsromthe date issued unless constructiq pf 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 CAunty. 1 Date -of Issue 7 O`2� Permit Iss ing Offi "al: Date of Expiration Ve7 lo5 ! Title: JI&5 � C.. Permit is Non- TransfbraBle White copy - HD file; Yellow copy Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Rev. 3/06 .ter I1 (`3#1 N®iM �j4f — /I a J%k 1l OJVI is M Mai s