The URL can be used to link to this page

Home My WebLink About4047DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.66 -2 -17 BOX 31 . _ 1 , r i L 1. 1 04047 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health '� LURETI ~A 'Mfl"i1JINATYf; RFV; MSN'" Associate Commissioner of Health January 13, 2005 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT 1 110NDI County Executive Lilyan Geffner 137 -42 76`h Avenue Flushing, NY 11367 Re: Well Permit Application for Geffner Property — 47 Lake Drive (T) Putnam Valley Dear Ms. Geffner: This Department has approved the well permit for Well #W2 -05 at the above referenced site. 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 95 feet from on -site and/or adjacent subsurface sewage treatment system areas. 3. The well shall be installed with a minimum of 31 feet of casing. 4. 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. 5. All necessary Town permits for the installation of the well are required to be issued prior to well construction. Should you have any questions, please contact this office. Michael J. ] Director of MJB:cw Cc: C. Santos, (T) Putnam Valley 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 L AC, y 5.7 Y' l r PUTNAM COUNTY DEPARTMEAT OF HEALTH S ION DIE EIS V IRON ENTAIL HEALTH SERVICES IDD ® D APPLI CAT TAD C.ON - -W51l�L - - -L. .�.... -,a-. v . so-. •w a - ase t or hype Permit Well Location: Street Address: Town/Village Tax Grid -1 {.0 —A S� y-%+ 4 � E� (- WE' PEef<� k6W- Map Zs' Block Lots) CS S;t Well Owner: Name- �� FOE Address: L -7- S6 t�G ---SD, 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 _a, Est. of Daily Usage _gal. 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? ...................................... ............................... Yes No1v Name of subdivision No. _Lot Water Well Contractor: ��' ` 1A0 E u-- U i 1 ` ss: ORaR Is Public Water Supply available to site? .................................. ............................... Yel No p 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: Appljcant:.Signature:' -y-1j 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 represen ive shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the r0 remRts of the Putnam County Health Department. 3) Submit a Well Completion Report on a form c,Wided:iy the Putnam County Health Department. During all well drilling operations, the applicant and/or drillerr shall take appropriate action to assure that any and all water and waste products from such �t, rdrill ng operations be contained on this property and in such a manner as not to degrade or otherwise uxl entamin'Re surface or groundwater. COyD FOY� CO1�1ST)18UCT)tOI�: This approval expires two years from the date issued unless �ctien of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended 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 1 `—1 -5 0 6- Permi Date of Expiration Title: Permit is Non- Timnsferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 �Y 0 <..# q m yc/.sulu D, PUTNAM COUNTY DEPARTMENT OF HEALTH SION OF ENVIRONMENTAL HEALTH SERVICES D APPLICATION TO CONSTRUCT A WATER WELL -plea'se pmt o # ` h 3 Well Location: Street Address: Town/Village Tax Grid s�u`P s�3 Sr`F l--WE �)R Lwe Peef<! %6y, Map Zb' Bloci Lot(s) W Well Owner: Na �_i �N� Address: fA �� 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 _ Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason <-o q cd for Drilling Well Type Drilled Driven' Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ........... ............................... Yes NN Name of subdivision Lot No. Water Well Contractor: 5 S UU' E L-�-- J I) lid' ss: Is Public Water Supply available to site? .................................. ............................... Yek 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.:(( - Applicant Signature:c... ..... . l� _... — _ 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 represenWve shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the x 'irem�ts of the Putnam County Health Department. 3) Submit a Well Completion Report on a form 134 'ded*y the Putnam County Health Department. During all well drilling operations, the applicant and/or m drillet shall take appropriate action to assure that any and all water and waste products from such _. v l;drillmg operations be contained on this property and in such a manner as not to degrade or otherwise U, &hmir (Re surface or groundwater. QZOD FOR CONSTRUCTION: This approval expires two years from the date issued unless rructiari of the well has been completed and inspected by the PCHD and is revocable for cause or may be amewded 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 � ?J Perini Date of Expiration Title: Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 NY y 130/S39 PUTNAM COUNTY DEPARTMENT OF HEALTH SION OF ENVIRONMENTAL TAL HEALTH SERVICES tP'P&.BCA'Y' ^ r::;�i��Tsr�ari7C I , � ) please print or type T3, 66, -L�. ( Vl Permit # lA/,::2 — as Well Location: Street Address: Town/Village Tax Grid L- —1 S S ; WF_'�R LWE P4E�j�%6� Map Z� Bloci -Lot() W S Well Owner: Name* ) L, t11 FNE Address: I( � �L TWG q E _P, 7 Use off Well: Residential Public Supply Air /Cond/Heat Pump Irrigation I- primary Business Farm Test/Monitoring Other (specify) 2- secondzry Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served _&:— Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling- New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling V/ Well Type Drilled Driven' Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes NoK4 Name of subdivision Lot No. Water Well Contractor: AVbff;G N` Is Public Water Supply available to site? .................................. ............................... Ye& No p 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. l a`f ff ' ApplictltTt "SigiT tUTe: � :.,l- <� N PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 14 =of thee, Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code an4Trovided; that within thirty (3 0) days of the completion of water well construction, the applicant or their designated, represenAWve shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the'`' %qwreniRts of the Putnam County Health Department. 3) Submit a Well Completion Report on a form. ! 'ded*y the Putnam County Health Department. During all well drilling operations, the applicant and/or C3 drib shall take appropriate action to assure that any and all water and waste products from such >dril mg operations be contained on this property and in such a manner as not to degrade or otherwise i�in'Re surface or groundwater. O' D FOR CONSTRUCTION: This approval expires two years from the date issued unless ction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended IR 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. j Date of Issue _ % _'f J 0 S Permi Date of Expiration -01 Title: Permit is Non- Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller �Y A A A a A a A a a A a a A A a 2 A a I