HomeMy WebLinkAbout4127DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
83.74 -1 -7
BOX 32
J
E,
r .
04127
ALLEN BEALS, M.D., J.D.
Commissioner of Health
.:: .kG- BE+ -fib=, M RRIS; !i:E: ; ... :.........
Director of Environmental Health
Boyd Artesian Well Co., Inc.
c/o Henry Boyd
1054 Route 52
Carmel, NY 10512
MARYELLEN ODELL
County Executive
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Phone # (845) 808 -1390
Fax # (845) 278 -7921
Subject: Proposed Well Denehy
21 Point Drive South
(T) Kent
October 24, 2013
Dear Mr. Boyd:
A field inspection was conducted on the above referenced lot by Vincent Perrin, Public Health Technician. The
application to drill a new well is approved with the following stipulations:
1. A Well Completion Report (WC -97) shall be submitted no later than 30 days after the well completion
by the permittee.
2. Well must be constructed with at least 100 feet of casing 18 inches of which must be above ground.
3. An NSF approved ultra- violet disinfection system must be installed prior to use.
Please contact me at (845) 808 -1390 ext.43131 if you have any questions.
Sin rely,
Vincent Perrin
Public Health Technician
cc: VP, file
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
APPLICATION-TO CONSTRUCT A- WATER WEI! - _
please print or type $113 erri<i....
_�.
Well Location
Street Address: Town/Village: Tax Map
ap Stock Lot(s)
Well Owner:
Name:
Add ss:
� e�
Use of Well:
_7V esidential Public Supply Air /c nd /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 Drillin
New Supply (new dwelling) Deepen Existing Well
Detailed Reason
for Drilling
Well T pe
Drilled Driven Gravel Other
Is well site subject to flooding? ....................................................... ............................... Yes Nox,—
Is well located in a realty subdivision? ........................................... ............................... Yes _ No_X_
Name of subdivision Lot No.
Water Well Contractor: Address;//1�AnGJ,i2, 6d��y
Is Public Water Supply available on 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: Applicant Signature:
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.
4) The well driller shall abide byall conditronsof the permit 5) During altwell drrllmgoperatrons the well driller shall gd
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 County.
Date of Issue a 3 ! Permit Issuing Official• P,re
Date -of Expiration ,2 Title: S 2
Permit is Non - Transferable
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Wel( MvS; bp F&Y.,ofied L, ,)-k ct r t-o Sim a-F Cari Np Form WP -97
Rev 3/06
11 4-N v jf Nisle -►- .� ?f rf+ �oN y�rS rh u h:�`c� i 5 N S Prod /'L..1 cr fSa t� �• k
G rhjt }YJ>h,hm
08/05/2013 06:11 8452258420
V9
—F/f -O^W h4l,-eT 017 3&//?
0 ,
�4 I�
#,oVea PVAf A.FrooP f- A
BOYDARTESIANWELLC PAGE 01/01
Zv
37
`4-44