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Home My WebLink About3091DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62.64 -1 -15 BOX 25 03091 !EI A tL... I � ELI �l N 03091 LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845)278-6130 Fax(845)279-7921 Nursing Services (845)278-6558 WIC (845)278-6678 Fax(845)278-6085 Early Interventlon/Preschool (945)278-6014 Fax(845)278-6648 Norman Anderson, Inc. 152 Barger Street Putnam Valley, NY 10579 September 1, 2004 Dear Mr. Anderson: ROBERT J. BONDI County Ewcutive Re: Proposed Well Campbell ..._. _.... _ .. kTY Ciui " = Valiey.�_ .', .. _.......... _. _.... 62.64 -1 -15 A field inspection was conducted on the above referenced lot by Brian Stevens, Public Health Technician. The application to replace the existing well is approved with the following stipulations: 1. The existing well is to be abandoned once the new well construction is complete. Please provide notice to this Department five days prior to abandoning the existing well so that this Department may witness it A Well Completion Report (WC -97) 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, Brian R. Stevens Public Health Technician cc: RM, file, Mr. Campbell _ _ .'�_'�` �' ._ _.. . _ ._ ti. _ -.---- �s�.:ay. _ `.._, ..� _- .....^�. +_pax -_._.. - ..a....w+.: o.. °. _�'^ =� ....- ..' ' _.'M._�..~eww...+a_+.e �.._ y _. _.. .' _ +�.:_�':.'.:•._.r`.r. PUTNAM COUNTY DEPARTMENT 01F HEALTH Rog DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # W % —W Well Location: Street Address: Town/Vill Id Ir79 Tax Grid # �� 3 5 MapC21 Block ! Lot(s) WeIR Owner: Warne: Address: Use of Well: Residditial Public Supply Air /Cond/Heat Pump _IrrigatiohJ I- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought __4:L gpm # People Served ----- --Est. of Daily Usage _dal. Reason foir Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detafled Reason for DriWmg 'V WeHI Type D ven` Gravel Other Is well site subject to flooding. ........................ ............................... Yes No _ e Is well located in a realty subdivision? ...................................... ............................... Yes No Name �:f subdivision °-. _.. _ _ Lct. No: Water Well Contractor: rs j�Vx r Address: 1 Is Public Water Supply available to site? ......................................................... ........ . Yes No;1� Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed we 1 location & sources of contamination to be provided on separate sheet/plan. Date: 3 Applicant Si �. 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. 6W revision or alteration of the approved plan requires a new permit. Well to be constructed by a water ell ller ce 'fied by Putnam County. �+ Date of Issue 11110i, Permit Date of Expiration Title: _ l'°elewit ns- Norm;-" - iahsfet -r -Vile - _ . - _ - _ White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO ABANDON A WATER WELL please print or type PCHD PERMIT # W33—o� • Well Location: Street Address: TownNil.,laagge L yT�x 11�9Lot S �+. Map Block (s) Well Owner: Name: Address. �• �- 3 . Well Type: Drilled Driven Dug Gravel Other Depth Data: Well Depth ft 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 Contractor: Name: Address: Q Reason For ._.. _ .. ._ . .. ..... . - .. _ . _- .... Abandonment: Description of Work To Be Performed: U'ov . j . � i 11R�t, -�t 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 .inf ation delineated on the application for this permit has been completed. 6 Mao White copy: HD file; Yellow copy -Building Inspector; Pink copy - Owner; Orange copy -Well driller Form WA -97 r d,r7e ... FDA i . . . . . . . . . . . IN VP 4, 4 4T P 2 Ile 0' -fir �.}�{s .- ! � � i i, "Y "� F • � ,E c. � ' t� Q�►' � � ' 1' , � iff 'O .!_ � �r�a �) 1 _ 1 1i � G j� • :.: • • • � /.r�`(�:L.' :�e.... 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SIGNATURE: 02/96 Title. Rev. C, �� C, a URIN Pl V iii G S 04 AUG 13 Pri 12: 59 Nee, VAAL, S,)Dtj,o- 0 PrLu CYD 0 e, VJ I shma v 41 14 0461094 I 40