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Home My WebLink About3350DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73.05 -2 -53 BOX 27 03350 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION T�CONSTRUCT A WATER WELL .. try. � ... .. _.:._._ - - -• -- � .. , -� � -• - -iiea ep?inib�ry ee JA_ Well Location: nee) Addre e /+r,/ . Tax Grid # tV�I Map -7 ,$ Block Lot(s) Well Owner: Addres Use of Well: R6sidenUl Public Supply Air /Con eat Pum rigition 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 ° cb gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling —,NeAv Supply (new dwelling) Deepen Existing Well Detailed Reason C't�� — U-nz 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 X Name of subdivision Lot Water Well Contractor: `Zu.t,� Address: 1,f- - 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.. 7�' /' _' . n 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. y revision or alteration of the approved plan requires a new permit. Well to be constructed by a water el driller certified by Putnam County. Date of Issue Permit g Offici Date of Expiration v Title: . Permit is Non- Transfe abl White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 1. - -1- k a tl, tl Ft I S/ N _., ENVIRONMENTAL f; L 3 H SERVICES i. s'"' APPLICATION TO ABANDON A WATER WELL please print or type PCHD PERMIT # WO —Q Well Locatio>m• Street dress:: 1];p /- GI - TownNillage �lj"" �, Tax Grid # �o , MaP73.5'Block Z Lot(s) 5 Well Owner: Na Address: i � 7 Well Type: Drilled Driven Dug Gravel Other Depth Data: Well Depth ft Static Water Level ft TDate Measured Use of Well: Residential Public Supply Air /Cond/Heat Pump Abandoned I- primary Business Farm Test/Observation Other (specify) 2- secondary Industrial Institutional Standby Water Well Name: Address: �-- % Reason For Abandonment: Description of Work To Be Performed: 6 Date: / Applicant Signature ° <��C. 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 t to ormati�deh eated on the application for this permit has been completed. /// 17 :--�/ �q 6� 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 _ . - f`A 4;1, �v:.ci..'., _. ....._......- _. ..... ..�. . . .. � • - -..... • — tS — •- -.' -.n. .f.... .... -n .r ve< a -r r r. M... vas e- tT...- Wv -.v. -. r< .y •. .�.-. •...� .... p _ . - .r< • .•. c- ..ter a .. .-. n..•'6'.... w�. - ...,.. -.. - .. `� -�„ T\ AS \ � O \ \ \ \ Ir PIZ � 9 is L i s I--- , L�� C� P \ 66 \ !� Ivn J g eel �Y IATW gel csc "gr "Lf'gy ` / `86 / �£ 10 0 t3'a.�� b+v� i 98 i / e; / d9 � egg _ to ; � , 99 Sep Lf i i I �; OE/ `g� 6Z / L9� 89 i LZ� 0 o9t6, °�� 9Z i�L; , l O�eft 8! � _ ® ® �! 94 ®� fto / 19 BPdp! I--- , L�� C� P \ 66 \ !� Ivn J g eel �Y IATW gel csc Page 1 of I TI I IIEW -7rne@nce -P-R1NT0UT,T1TL-E.--Z:,--..,. F-1 Town Lines Ej Parcels - - -�-_ �' r %`� _ - -- �_ �' +� , Old Parcel Lines ,A/ Streams T Lakes and Ponds Wetlands 4 R Carmel Road Names Kent Road Names Patterson Road Names Philipstown Road Names Putnam Valley Road -j Names Southeast Road Names LN 7 Disclaimer: http://imsserver.puttlamcountyny.conilFreeancelClientILandRecordslprintFrame.htrnl 7/21/2004 LORETTA MOLINARI Public Health Director DEPARTNiENT OF HEAD 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, Inc. 152 Barger Street Putnam Malley, NY 10579 July 29, 2004 Dear Mr. Anderson: ROBERT J. BONDI County Executive Re: Proposed Well beating 18 Cedar Drive (T) Putnam Valley 73.5 -2 -53 A field inspection was conducted on the above referenced lot by Brian Stevens, Public ...Eealt .Texhmc ,n :The- l:ca 9 e ce fir exist j �,a �ra�n �► . v�r, e � � ...... ..� _....� t la _ _ w:. _ .ct -Y %bowing 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 Stevens Public ealth Technician cc: RM, file 01/28/2004 11:15 (EATING INS 4 2793578 NO. 934 DO1 ... v' isv^• e. w.. GO. �e; r�'',.'.,. aiy. �o;.'% 9-:. �.: ��+: �?',::`:+: r� ::vv'�_h+.�W�a..9F�✓P�e.e.'.Ci :'�1W'R1V P. �R- �'Th:A�t.y�Tl-.rII.V...Y. Wia 4Xo' w'. �rtlia .R:-F�R��_.�M�t.-naYN'...� "�^o �:.si'3�:.::.•:�«:+'n ous r i II � Iri oilrti I e-v 1 -C% i PUT C UNITY DEPARTMENT OF HEALTH DIVISI RONMENTAL HEALTH SERVICES E COMPLETION MPLETION REPORT P p �YlMap T Block Lot(s) Well Owner: Nam Address: (J 4e- Use of Well: 1- primary 2-secondary Residential Public Supply Wcond/heat Omp Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary — Cable percussion _ Compressed air percussion Other (specify) Well Type Screened Open end casing ?< Open hole in bedrock Other Casing Details Total length eft. ft. Length below grade T— Diameter t in. Weight per foot A lb/ft. Materials: Steel Plastic Other Joints: Welded _2!!C- Threaded Other Seal: � Cement grout Bentonite Other Drive shoe: ":< Yes No ILiner: '� Yes /;,<No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First — Yes No Hours Second Well Yield Test Bailed Pumped X/_ Compressed Air Hours Id Yield / 0 gpm Depth Data Measure from land surface-static (specify ft) During yield test(ft) Depth.,6f completed well in feet Well Log If more detailed information descriptions or. sieve analyses are avai aDie, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump/Storage Tank Information Pump Type)& � Capacity Depth -sd6g*7 Model Voltage HP Tank Type Volume Date ompleted 7/0,f Putnam County Certification No. Date of Report I lWell Dr re) D 1171E: Pact location of well with distances to at least two permane lartilmarks to . be provided on a separate sheet/plan. a L Well Driller's Name CGi%o�- Address: L Signature: Date: White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC-97 xl