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50.20 -1-41
BOX 21
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.-� ,- . <._.L'ORE`I"fA� " MOT ;IN.�TZTR.lef:",`�VT:S'N:.::° •"_ _ _.... - ....
Acting Public Health Director
Director of Patient Services
__� ,..�- ._.....,.:._....,,,.....:- ROBERT J. J. �BONDI
County Executive
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 .
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648
Norman Anderson Well Drilling, Inc.
152 Barger Street
Putnam Valley, NY 10579
Re: Proposed Well Seid
I I Far Reach Trail
(T) Putnam Valley
50.20 -14-1
May 20, 2003
Dear Mr. Anderson:
On May 20, 2003, a field inspection was conducted on the above referenced lot by Daniel
Hadden, Public Health Technician. The application to drill a new well is approved with
the:f llowin -sti i i -
- - o . - b P at ons: - - - -
1. A minimum of 42 feet of casing must be provided for well protection.
As -built plan, Well Completion Report (WC -97), Well abandonment, if applicable, and
water quality analysis shall be submitted no later than 30 days after the well completion
by the permittee.
Please contact the writer at (845)278 -6130 ext.2235 if you have any questions.
Sincerely, zwma 40641,
Daniel Hadden
Public Health.Technician
cc: RM, file
i
IPUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
APPLICATION TQ fCONST1I U.CT,A WATER WELL 2 /I
please print or type R - PCHD Permit # W3 -03
: 9 •n
Well Location:
Street -Address-
ToyolNillage Tax Grid # 5,0, tea •— I — V /
Map Block Lot(s)
Well Owner:
N �
A
Use of Well:
Residential
Public Supply Air /Cond/Heat Pump Irriga 'on
I- primal y
Business
Farm Test/Monitoring Other (specify)
2-secondary
Industrial
Institutional Standby
Amount of Use
Yield Sought _�5' gpm # People Served Est. of Daily Usage O6 gal.
Reason for
— Replace Existing Supply Test/Observation Additional Supply
Drilling
New Supply (new
dwelling) Deepen Existing Well
Detailed Reason
,rre_zeL�,
for Drilling
' k1,%
e o OAKS v
Well Type
Drilled
Driven avel Other
Is well site subject to flooding? ....... ................................ ............................... Yes No
Is well located in a realty subdivision? ......................................
............................... Yes No
Name of subdivision
No.
Water Well Contractor:
Address:>
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 provided on separate sheet/plan.
Date: _ 6.3 Applicant Signature::
� _.. _
CID
PERMIT TO CONSTRUCT A WATER WELL W
This permit to construct one water well as set forth above, is granted under provisions of Artic1iE10 e
Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code-&nd *d
thatwitl in thirty (30) days of the completion of water well construction, the applicant or theirztsi
representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordan6e
requirements of the Putnam County Health Department. 3) Submit a Well Completion Repoitn
provided by the Putnam County Health Department. During all well drilling operations, the zpli or
well driller shall take appropriate action to assure that any and all water and waste products
well drilling operations be contained on this property and in such a manner as not to degrad o se
contaminate surfa or ro dw ter. / 4 ,
iM`vl1V�l��t 2- Casl+��t$� b� P`��Ia� �,J�( ?V�c�`1.. .
APPIIB��YIEIID lF ®ll� C�1�1ST U TII ®N: This proval 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 wate 11 driller certified by Putnam
County.
Date of Issue T- 2(. 3 Permit Iss ' fficial: ltmo
Date of Expiration o Title:
Permit is Non- Trannsff >rz . e
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WP -97
o�
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
.s.r.urn.W .w..'w —•T +c .^.y�.tri C�.A Y-iT
APPLICATION TO ABANDON A WATER WELL
please print or type
PCHD PERMIT #
Well Location:
•
Street Addresskeac)� ownNillage Tax Grid #
_ �'
VatIN Z Block (
Cad' R�i 01 map Lot(s)
Well Owner:
Name:
56J
Add \j
it �✓'ai1
Well Type:
Drilled Driven Dug Gravel Other
Depth Data:
Well Depth ft J
Static Water Level ft
Date Measured
Use of Well:
Residential Public Supply Air /Cond/Heat Pump Abandoned
1- primary
Business Farm Test/Observation Other (specify)
2- secondary
Industrial Institutional Standby
Water Well
Name: Addre
ma.A �O✓1
�0%p tContractor:
V
Reason For
Abandonment:
y,t 1� 1A a. V ev W et l �0 a Ce I �y. 100)
Description of Work To Be Perfiormed
-:I
kewove- Jfc�vi'c'a 1 a via. Lt v l c�� 1D ,
Date: S /20 /03_ 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 inforg atiyn delineated on the application for this
permit has been completed.
4y /I-3 ' 41
Date of Issue Permit Issuing Official Title
White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WA -97
P
NAME• �✓
...r,,,
Street'.
Town =::
`State . ^ Zip
PERSON IN CHARGE
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