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Home My WebLink About4305DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 84. -1 -10.2 BOX 33 din 0 1 1 gig . ;TI T L 1111 Mimi L 'j b ., 04305 SHERLITA AMLER, MD; MS, FAAP Commissioner of Health " "LORETTA M0LINAR1;1f1;N, M-9N -: 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 December. 13, 2006 Dear Mr. Anderson: ROBERT J. BONDI County Executive 'w`.ROBERT <MORRIS PE- Director of Environmental Health Re: Proposed Well Venezia 84.0 -1 -10.2 (T) Patterson 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: ''I'fie exi "sting well is to be abandoned once -the new weld ddinst ratticii -is complete. - 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, 6L': /Z. j�� 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 print or Woe CPC DPe mi # -- 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 app oved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam C unty. A ,A Date of Issue _ L Permit Iss 'ng Date of Expiration Title: Permit is Non -Tra sf ra le White copy - HD file; Yellow copy - Building Inspector; Pink copy - I� er; Orange copy - Well driller Form WP -97 Rev. 3/06 y :� Street Address: Town/Village: Tax Map # Well Location V A �s Map Block Lot(s) Well Owner: Nan: '/ �l Address: ��` p k lls Phone #: V h e�-L rya Va Ile 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 Yie!# 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 a,�2 +1.-116- f 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 Lot No. Water Well Contractor: v�, v a,K Address: Is Public Water Supply available on site? ....................................... ............................... Yes Novi Name of Public Water Supply: TownNillage to property from nearest water main: ,Distance Proposed well location & sources of contamination to be provided on separate sheet/plan. Date - _ ( -t 3� vb- i ..,�, A}iplidant Signature. itvt- 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 app oved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam C unty. A ,A Date of Issue _ L Permit Iss 'ng Date of Expiration Title: Permit is Non -Tra sf ra le White copy - HD file; Yellow copy - Building Inspector; Pink copy - I� er; Orange copy - Well driller Form WP -97 Rev. 3/06 y :� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH_ SERVICES ..r � ..t:.;�. :r.in Cf °n •mot "9e, .. .=. <a•'r. � a...�p�� .. ... • :�.{.. - -' .:,`.'� -ov. • _ _. .�.� ..., ... .: y:.'. .n t - .�. APPLICATION TO ABANDON A WATER WELL please print or type PCHD PERMIT # A,,03 +6(w Well Location: Street Address: Town/Village Tax Grid # 00 7-OIM4 03V /L► / &(Map . Block Lot s) Well Owner: Name-' Address: Well Type: Drilled Driven I Dug Gravel Other Depth Data: Well Depth ft Static Water Level ft Date Measured 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: Contractor: A Reason For Abandonment:�J 6 wJ Description of Work To Be Performed: LoA� V_ N NO 87 Date: 4:�26 Applicant Signature: 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. k�! Date o Issue White copy: HD file; Yellow copy - Building lnspector; Pink copy - Owner; Orange copy - Well driller Form WA -97 Nov 20 06 03:26p BILL VENEZIA 845 528 6963 p.1 �f 1 v J. 'J 1 J v i ,c `s 0 O, G cam! .1 t i g °Oz. /' if y 0 •� Y� 1- '�'�� BOO •,�U. '�. Jqj SHERLITA AMLER, MD, MS, FAAP Commissioner of Health j LORETTA MOLINARI, RN, MSN Associate Commissioner of Health ROBERT 9. BONDI County Executive ��f'QY'eH .._.Y w - 4:. _• r. .. I.'ei. � .r. .� J.. r ROBERT MORRIS, MORRIfS, 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 November 13, 2006 Re: Proposed Well: Venezia 84.0 -1 -10.1 84.0 -1 -10.2 84.0 -1 -10.3 (T) Putnam Valley Dear Mr. Anderson, I have received well permits application (WP -97), for the above referenced proposed wells. Comments are offered as follows: 1. A tax map must be submitted depicting the location(s) of the existing well(s) for ..these residences. 2. The plan submitted for 84.0 -1 -10.1 shows two well locations. Please note which well is being proposed. If there are any questions please contact me at (845) 225 -5186 ext. 2235. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. cc: file Very truly yours, 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 ----------------- P~ m ...... . . . . . . . . . . . . . . . . . . ............ ......... ................ .... ... ........ . ... 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