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Home My WebLink About4033DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.66 -1 -1 BOX 31 04033 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Jeanette Mason 350 West 55th St. New York, NY 10019 Dear Ms. Mason: ROBERT J. BONDI County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 February 11, 2005 Re: Well Permit Application for Mason Property — 319 Lake Dr. (T) Putnam Valley This Department has approved the well permit for Well #W53 -04 for the above referenced project. Please be advised that if site conditions and/or site plans change and/or are revised, thereby compromising the approved separation distances, siting approval of the well must be re- approved by this Department. This letter shall serve as record of approval and by initiating construction of the well covered by this approval of plans, the applicant accepts and agrees to abide by and conform to the following: 1. The well location shall be survey located and staked prior to drilling. 2. The proposed well is approved 45 feet from on -site and/or adjacent subsurface sewage treatment system areas. sha ll ve isiailed witrs a.;linimur;, cf. 89 fee tof casing. 4. An ultra- violet light disinfection unit shall be installed on the incoming well line 10 the ' ' dwelling. 5. A water sample shall be collected and analyzed for coliform bacteria after the well is drilled. The sample result is to be submitted to this Department along with the well completion report within 30 days of completion of the water well. 6. All necessary Town permits for the installation of the well are required to be issued prior well construction. Should you have any questions, please contact this office. Respectfully. JU Michael J. Director or MJB/ky cc: C. Santos, (T) Putnam Valley Boyd Artesian Well Insite Engineering 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 0 PUg'NAM COUNTY DEPARTMENT OF HEALTH o r1 - -DIVISION OF ENVIRONMENTAL HEALTH SERVICES .i` 7 . ApPLICA7[ ION T_O rO1o1�71'RgJCT-- A- -16'AT9,R -Y�T1 please print or type PCHD Permit # ii/—,5 3 " Dy Well Location: Street A ess: Town/V'llage Tax Grid # Map Block i Lot(s) I Well Owner: Name: Address: d Aso S'S �' ; , a ylv-k Oy loo/ Use of Well: Residential 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 s Est. of Daily Usagel al. Reason for Replace Existing Supply Test/Observation Additional Supply fllr ftg New Supply (new dwelling) Deepen Existing Well Detailed Reason for.Drffimg Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... es No Name of subdivision /�, �p� �/ Lot No. Water Well Contractor: Address: —�, / / Is Public Water Supply avai able to site? AfL- ISA 44.. No A/ Name of Public Water Supply: & *f4 h/ Town/Village Distance to property from nearest water main: j �� f 4A 1 ,�/VAI�� Proposed well location & sources of contamination to be'provided on separate a t/plan. Fatty: - -Applicant RigAatwe ]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. 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 '?--11-057 Permit Is uing Official: Date of Expiration 2-11 __0 Title: Permit is Pion- Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH o r1 — DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A. WATER. WELL q,- - please print VV or type _ . 4. _. _.... P(;HD Permit # 7 ._•o; • - Well Location: Street A ess: TownlV'llage Tax Grid # -J� �y Map Block Lot(s) I Well Owner: Name: Address: nl Use of Well: Residential 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 S Est. of Daily Usages al. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? .... .......... .................................................................. Yes No Is well located in a realty subdivision? ...................................... ............................... es No Name of subdivision Jn�- Lot No. Water Well Contractor: Address: / . / / oo-4W 94 �0 61t Is Public Water Supply available' vai able to site? lf�..JV A.dN , No V Name of Public Water Supply: {9pAK `I/ Town/Village Distance to property from nearest water main: A4i %f &5 ,¢�! i� ,o�y Proposed well location & sources of contamination to be provided on separate shedt/plan. ,:Date: / 4I?plicant S`gnatu_re:_ .. .. 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. 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. ► 12 Date of Issue •?--1f _0 5- Permit Date of Expiration 2 1 —01 Title: _ Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner/ Orange copy - Well driller Form WP -97 u 2 I`iO6'6086": -.-iO Fi u 2 I`iO6'6086": -.-iO S Ll- a y v\,8 ek ESQUIRE ATTORNEY FOR 7777-777, BLOCK ....................... LOT ..: ............... . TITLE No. --t,A-407... SECTION ................. SH r--'C- T ...... ....... .. . . _: )?oy A-\ ' c SURVEY OF l,Q—V.5 \C)A-) \ S , AS SHOWN ON a 1K9- sy% 0 SITUATED IN !FILED IN THE COUNTY CLERK'S- MAP NO.Vb.s1w 2gtRV TEE aZ&SLS� \V:'F- 77TTI&I IN ACCORDANCE OVITH MINIMUM STANDARDS FOR TITLE SURVEYS OF e-INEW• YORK S E LAND TJTLE 4SSOCIATION- N.Y.C. LIC#36181 "All 'certifications hereon are valid RD G. M.IHALC.ZO LIC. LAND SURVEYOR for the map and copies thereof only I�SHIR,I; EW.. YQN-KERS.-.N.-Y---,----- 2 ................ if said map or copies bear the im 4_BERKSHIRq qR. Y0-NKEfZS, N.Y.S. ... ........ . ....................................... pressed seal of the surveyor whose ................................................ ........................................ signature appears hereon." � tu j ,0 0 1 Ile. � We s-v