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Home My WebLink About2778DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62. -1 -48 BOX 23 Is T . is .� r ' . is ir. or Pr 02778 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health �.; ...�..- 0 i - &T-TA:=- 'M- OLiNAFcr,:- .— RM,'I'dS N Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Norman Anderson, Inc. 152 Barger Street Putnam Valley, NY 10579. January 29, 2008 Dear Mr. Anderson: ROBERT J. BONDI County Executive Director of Environmental Health Re: Proposed Well Chapman 22 Skyhi Drive (T) Putnam Valley 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 stipulations: 1. The existing well must be completely disconnected from the house /drinking water systcr; b�pl^.ys, ��aly_sev�ru^ ?iz• c�nneptin line piRcs, or lumbin g >r _ g_ 3? _ g�_ - 2. 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: file: Sincerely, I L M> chell D. Lee Public Health Technician Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845)278 -6014 Fax(845)278 -6648 -o iI O C0 S PUT NAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL z ...,•. .._.,.. �._.,, � •, ... ,... •......p;::+ise N[iiiti'ill` ty'p�... ,... r •: tea_. _ . .� . , •.-- .�-- .:.*z ... _ i` l.:li cili 1'el Ili1l t}" .. V ✓ti J / � J.-a Well Location: Street Address: T ill'agye Tax Grid # _ q-g Rw V `le Map Blocky Lot(s) Well Owner: NQame Address: (� J Wi `, �j 9 i� R; d T d.i j l� / Use of Well: __1,JR6sidentia1 Public Supply Air /Cond/Heat Pump I gatio I- prAmary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought A_ gpm # People Served Est. of Daily Usage _gal. Reason ffor Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well IDetailed Treason j et Ch A— ffor IIDrMing 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 1 o. Water Well Contractor: ® cr�®w Address:' Gl/Y` Is Public Water Supply available to site? .................................. ............................... Ves No Name of Public Water Supply: TownNillage Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL - t 7 � -� This permit to construct one water well as set forth above, is granted under provisions of ArticloL D ofie! Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code a& 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 ater well driller c rtified by Putnam County. jJ Date of Issue Permit Issu* g Offi al: Date of Expiration Title: Permit is Non- TransfferrebRe White co y - HD file; Yellow copy - Building Inspector; Pink copy - Ownef;f Orange copy - Well tlriller �,d'gd'`� id � � �$, �lA4�� E �F0 � Form WP -97 �y �l ;9 i d �l '1 000i - V� L •ciii�:`�i3�F '�w«m +.ra_��d�.`:w. � �� '-a.. :.e� ..� n. ... /...� ,..^ _ _. - �.,.e:�. r ...-. .-.., r? .n r., ..... ...,.. \Y _ - ,. F_,L� o„ .. 1 i <r r ris 'f`- 7 AII�S7 �� 000i - V� L •ciii�:`�i3�F '�w«m +.ra_��d�.`:w. � �� '-a.. :.e� ..� n. ... /...� ,..^ _ _. - �.,.e:�. r ...-. .-.., r? .n r., ..... ...,.. \Y _ - ,. F_,L� o„ .. 1