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HomeMy WebLinkAbout2509DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 51.14 -1 -28 BOX 22 I,y7. . - .' 1 } - , 6 '1 - �I '� i '6' T a I ` F '. F 1 1. 1 .. a r a1 I I� IN 02509 0 0 MUCE R FOLE Y' Public Health Director LORETTA M0LINARI -RX, ' M.SA. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 pi �r Nursing services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 t August 14, 2001 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Norman Anderson 152 Barger Street Putnam Valley, New York 10579 Re: Matthews, 1 Oakdale Road (T) Putnam Valley, TM# 51.14 -1 -28 Dear Mr. Anderson: This office has received an application to deepen an existing well on the above referenced lot. The reason for drilling stated no water. We have also received an application to abandon a water well. Please clarify. It is the understanding by receipt of the above stated that the "existing well" is to be deepened, not abandoned. - T- 1?- lsoffi- e- will•contim.le its - re:tiewup0ncons er-ation•ofthe- abovementicscl d wmments: Please feel free to contact me at ext. 2157 if any questions arise. Very truly yours, Adam B... Stiebeling Assistant Public Health Engineer ABS:cj cc: Albert Matthews PUTNAM COUNTY (DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL f ' please print or type PCHD Permit # Well Location: Street Address: Town/Village Tax Grid # �.�Q �r Map-r/-/'/Block Lot(s) Well Owner: Name: Address: �p Use of Well: Residential Public Supply Air /Cond/Heat Pump I igat' n 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought 5— gpm # People Served Est. of Daily Usage o gal. Reason for Replace Existing Supply Test/Observation Additional Supply 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 Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision Lot No. Water Well Contractor-2Ldj Address: Is Public Water Supply available to 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: d / - A licant Signature.:- ___ ., .._ Pp 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 water well driller certified by Putnam County. Date of Issue Date of Expiration Permit is Non - Transferrable Permit Issuing Official: Title: White copy - HD file; Yellow copy Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 yl1 ' PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO ABANDON A WATER WELL please print or type PCHD PERMIT # Well Location: Street Address: TownN�illage Tax Grid # �7 / MapS/,Pplock 1 Lot(s) Well Owner: Name: Address: / 7� 1 /c- AL� �° �/ IV V,, e .- ,4 Well Type: Drilled Driven Dug Gravel Other Depth Data: Well Depth ft Static Water Level O ft Date Measured Use of Well: r/ 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: Contractor: Reason For Abandonment: Description of Work To Be Performed: , —o/ �r c(C e Date: G Applicant Signature: C.-�j WIRUVITI 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. 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