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51.14 -1 -28
BOX 22
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02509
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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,,
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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