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HomeMy WebLinkAbout3514DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. vim.scanyourdocs.com 631- 589 -8100 74. -1 -5646 BOX 28 1 S6 013 v u 19, 17-2 If ■ 1 1. y }fI r 9L' 1 03514 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health L;pi2�TTA MOL IIYARI,' RN, M S N Associate Commissioner of Health ROBERT J. BONDI - ..� ;�ourrly F.�recutive° �• -.. , ROBERT MORRIS, PE Director of Environmental Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Norman Anderson, Inc. 152 Barger Street Putnam Valley, NY 10579 Re: Proposed Well Miller 91 Rochdale Road (T) Putnam Valley November 7, 2007 Dear Mr. Anderson: A field inspection was conducted on the above referenced lot by Brian Stevens and Mitchell Lee, Public Health Technicians. The application to drill a new well is approved with the following stipulation: 1. A Well Completion Report (WC -97) shall be submitted no later than 30 days after the well completion by the permittee. P1Ease' contact iri6 at (845) 225 -5186 ext.2233 if you have any questions. cc: file, Sin erely, 41 •� - L' Mitchell 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 " .1 .. ._. ...:r. . ,,i �.. �$X"C'^ •V.pV _ .. .. - -... ter.. JPutnam County Health Department Water Supply Section I Geneva Road Brew §ter, lY 10509 (845) 225 -5186 ext. 2233 fax: (845) 225 -5418 FAX COVER SHEET DATE: 11/8/2007 T®: Building Inspector, Town of ]Putnam Valley FAX NUMBER: (845) 526 -8806 ]FROM: Mitchell D. Lee SUBJECT: 91 Rochdale Road Water Well Application Approval PAGES: 5 (including cover) If you have any problems receiving this fax, please contact me at extension 2233. e I ' I -761 6 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES please print or type APPLiCA71Oklyd 6ON9ikt.1CT A .. . .- .,,... v..,i ; ;.• "•. , �,':v . WATER WELL Pdiff.iD 'er iit #� Asp Well Location Street Address: Town/Village: Tax Map # 3 �¢. vk/ r eoore /� / Q ' / qOC n �X a, r \� P, a n• V91 A& L Map Block Lot(s) Well Owner: Name: Address/: Phone #: Sall Mf idea 1 9/ aoC ko ,/I alp IQJ P.,ka4, ULI(e� Use of Well: esidential _Public Supply Air /cond /heat pump _Irrigation 1- Primary Business Farm Test/monitoring, _Other(specify) 2- Secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily usage gal. Replace Existing Supply Test/Observation Additional Supply Reason for Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason re,..f AX rt r4 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 —�' Q Lot No. Water Well Contractor: 46,fi, _ A, ct e_r y Address: / y a'' r-✓ �)� � �1� . Is Public Water Supply available on site? ....................................... ............................... Yes _ No ti Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on sepz rate sheet/plan. Date: l I ( U 7 Applicant SignatureAOAMI-14- M `• 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 Countv Health Department. 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 ey arifrom 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 Commissioner of Health. 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 I'. ( � ©� Permit Issuing Offici Date of Expiration Title: 5 'L a - .r Permit is Non-TransTerbbl& White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Rev. 3/06 DRVffSffO T OF ENVIRONMENTAL HEALTH SERVICES A}IDPLI<cCAUON TO ABANDON A WATER WELL please print or type /} w3 c) —O -7 PCHD PERMIT # WeH Locadon° e Street Address: TolwnNillage Tax Grid # al LJ e. ,jivxt � Ili V Map Block Lot(s) WellOwne>r: Name: ikr Address: -R .�A� Well Type: —7Dr?illed Driven Dug Gravel Other Depth I Data: Well Depth _ ft Static Water Level ft Date Measured Use of WeRh Residential Public Supply Air /Cond/Heat Pump' Abandoned I- pnAmal °y Business Farm Test/Observation. Other (specify) 2- secondairy Industrial Institutional Standby Water Well Name: Address: Reason Yo>r Abandonment: IlDesc>rap floon of Work To Be Performed: ramove� , kmoveX Date: Applicant Signature: PERMIT This permit, to abandon one water well as set forth above, is granted under provisions of Article 10 County Sanitary Code, Subpart 5 -2 of Part 5 of the New York State Sanitary Code and/or Part 75 and provided that: Within 30 days of the completion of the abandonment of the water well, the a the Putnam ITIM- L submit to the Department a certified statement that the information�Wineatyo on the applicatio for this permit has been completed. --I / / f /Z) Date o ssue White copy: HD file; Yellow copy - Building shall =AI A Pink copy - Owner; Orange copy - Well driller Form WA -97 s I s 6 r_�� y ae- JP ............. PI-Iq 4 i