The URL can be used to link to this page

Home My WebLink About3572DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 74.06 -1 -8 BOX 28 03572 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLIN.ARI* RN, MSN :...:. Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Anderson Well Drilling Inc. c/o Norman Anderson 152 Barger Street Putnam Valley, NY 10579 January 30, 2007 Dear Mr. Anderson: ROBERT J. BONDI County Executive ROBERT MORRIS, PE.; Director of Environmental Health Re: Proposed Well Pulick 74 -6 -18 (T) Putnam Valley 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 stipulation: 1. A minimum casing depth of 60 feet is required. _ Z .The_ex?stiv_g w_0l is to�be b�ndob.od.orce.the :'hemp .well construction is-.wmlileto.. - Please provide notice to this Department two days prior to abandoning the existing well so that this Department may witness it. A well abandonment report form (WAR -97) is included for your use, and must be submitted within thirty days of the abandonment of the old well. 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) 225 -5186 ext.2235 if you have any questions. cc: file(2) Sincerely, % ,..n, sue, Brian R. Stevens 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 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please arint or tvae )'PCIH e�t)llt��+��'�� l�^ Well Location Street Address: Town/Village: Tax Map # r7 dA� Al u X% V Map% Block �Lot(s) Well Owner: Name: Address: Phone #: e1A r B cnt 5-9, v S� uk t4 4M Use of Well: Residential _Public Supply Air /cond /heat pump Irrigation I - 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 Drillin New Supply (new dwelling) Deepen Existing Well Detailed Reason u X v etc/ -e rQ ', k fe WII - 6 C, a 4 / for Drilling Well Type rilled 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: h a Address: /,S a (3nn a r G e✓ Sfi a Is Public Water Supply available on site? ....................................... ............. ................... Yes No L/ Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be pr vided on separate sheet/plan. Date: /. t� L '7 Applicant Signatar2: - 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 Departmei 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 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 C nty. Date of Issue ^ 01 Permit IssuinA Official: \ Date of Expiration % —Ci Title: Permit is Non White copy - HD file; Yellow, copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Rev. 3/06 cX.a �.j kf.-b� � 60 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO ABANDON A WATER WELL please print or type PCHD PERMIT # A vt% 1-0-7 Well Location: Street Address: TownNillage Tax Grid # 4 a, r y, Ad va I Map ✓ j Block Lot(s) Well Owner: Name: 1)� Address: " fj� 4 f � a Well Type: Drilled Driven Dug Gravel Other Depth Data: Well Depth ft Static Water Level ft Date Measured I 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 Name: Address: IS 4.14wd Contractor: %�1�' yt � d L) 18 .. Reason For 1 4 Of de u� �� GJait � 4 Abandonment: ��l4j Description of Work To Be Performed: i Y� . . . . ....... Date: le'll v Applicant Signature>� //W 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 information delineated on the application for this permit has been completed. I — 23 Date of Issue White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -97 Location of Premises TM# ~l z, - - f�' S v .ND ;d,. v j having heretofore fifed a renewal application for Special- �crmit Ilse pursuant to tic Conversion Ordinance, of Putnam Valley, New York, and havit g paid the rep: d re fe;e, in the: sum. of Zola cam' it appearing from the said applicution'that.the proposed improvement is intended to and will compiyywit =Uh,,- requirements of the.law as a,`.ormentioiied, a CONVERSION PERMIT is hereby granted this day NOTE: This permit is due for renewal onJ!� v TOWN OF PU FPRAM VALLEY JUN 21 2004 ..............e��w� Mpg✓ n?� off E � W = \ v 3 OO ' a 3492 N 2 I T u�•o moo- ��\ 3 �a�ft Q Gg.• fan ,� ' \\ ' 3447ke c I i 79 G-1 -b 50RVEYED NOVEMBER W,,, )%'3 GERrIFIEU To:- T-ip-sr RDERAL 5AVIVCgS i i A9D LOAPI A5SOc- j 5ECUQITY TITLE 4 GUAQAWY,' Cq. i SURVEY OF PROPERTY FOR THOMAS M " ROCNE T - l SITUATE IN HE i JOHN SALVATORE ROMEO TOWN Of PU NAM VALLCY E L CONSULTING ENGINEER & LAND SURVEYOR I NORTHRIDGE: ROAD - PUTNAM COUNTY Ij PEEKSKILL N.Y ,[ NEW YORK SCALE 3O PE. & LS NYS NO 27846X--X I' I