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631- 589 -8100
84. -1 -10.3
BOX 33
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SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINAUI;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
December 13, 2006
Dear Mr. Anderson:
ROBERT I BONDI
County Executive
• ROBERT MORRIS; PE
Director of Environmental Health
Re: Proposed Well Venezia
84.0 -1 -10.3
(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. The existing well is to be abandoned once the new we ll'corisfructiori-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,
s;4;, /Z. 5''�
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
r
please print or type
..:. ,:.
Well Location
Street Address:
Town/Villagle:/ Tax Map #
i Au «S
J /
� PtA,-k �ap�
rd r�l
u V`L f Block Lot(s)
Well Owner:
Na e' CA �
A ress: 19, Phone #:
TDB I( to S (��
lit1 �L J
Use of Well:
"�esidential
_Public Supply Air /condlheat pump _Irrigation
1- Primary
Business
Farm Test/monitoring —Other(specify)
2- Secondary
Industrial
Institutional Standby
Amount of Use
Yield Sought S
gpm # People Served Est. of Daily usage gal.
.✓ Replace Existing Supply Test/Observation Additional Supply
Reason for Drilling
New Supply (new
dwelling) Deepen Existing Well
Detailed Reason
S
for Drilling
Well T e
l/Drilled
Driven Gravel Other
Is well site subject to flooding? ....................................................... ............................... Yes _ No
Is well located in a realty subdivision? ...........................................
............................... Yes No
Name of subdivision
Water Well Contractor:
Lot No.
Address: /S-�- &2:21,- Cl mot, 441, 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.
A cant atu d _
ppli Sign :re
,Date:,. _
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 Couh.
In
Date of Issue Permit I
Date of Expiration O Title:_
Permit is Non -Trans era le
White copy - HD file; Yellow copy - Building Inspector; Pink copy -
copy –Well driller
Form WP -97
Rev. 3/06
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENV_ IRONMJ ENTAL HEALTH SERVICES y +/
..r .T ..\ rC. cC•'� •. An` a v.. e. .. .� _ .~M. —•.[ s ... .— [ ...r � _ :.q . � �a .�"a'I i". i. . ( t. � .y. . \... r�4'a�•t.l
APPLICATION TO ABANDON A WATER WELL
please print or type
PCHD PERMIT # A IN S � ' 0 6
Well Loc ation:
treet Address:
Town/Village T G4da#
ap Block
TN
)'
Well Owner:
e*� <S
Address:
Well Type:
Drilled, Driven Dug Gravel Other
Depth Data:
P
Well De th . ft
p
Static Water Level ft
r
Date Measured
Use of Well:.
esidential
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:
Reason For
Abandonment:
Glj
c 0 CIL
Description of Work. To Be Performed:'
a4l,
jtj"",
01� �
12!111
� _
NO
Date: �-� -� 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.
2 �
Date o Issue
White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WA -97
Nov 20 06 03:32p BILL VENEZIA
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POR77ON OF LOT "
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PHIL SCALE
100 200
IN FEET
nch = 50 ft.
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Revised August 16, 2005 to show
bearings and distances
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TN
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Norman Anderson Inc.
152 Barger Street
Putnam Valley, NY 10579
November 13, 2006
Dear Mr. Anderson,
ROBERT J. BONDI
County Executive
ROBERT MORRIS, PE
Director of Environmental Health
Re: Proposed Well: Venezia
84.0 -1 -10.1
84.0 -1 -10.2
84.04-10.3
(T) Putnam Valley
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