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Home My WebLink About4604DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 85.07 -2 -18 BOX 35 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO C_ ONSTR/UCT A WATER WELL .. ti r wn r�+!..1 .-.yam••. .. t ! � -'fit- .. .... IqA� • K:' .i .•.Y' ., >a. r �- pleYV ase print or type Well Location: Street Address: Town/Village Tax Grid # 85.7 -2 -18 96 Wood Street Mahopac Map Block Lot(s) Well Owner: Name: Address: Katherine Heyd 96 Wood Street, Mahopac, NY 10541 Use of Well: x 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 5+ gpm # People Served Est. of Daily Usage gal. Reason for x Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason To replace hand dug well for Drilling Well Type x 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: P. F. Beal & Sons, Inc. Address: 4 Putnam Ay-e., Br, ffi . , NY 1050 Is Public Water Supply available to 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 pro > eet/plan. 4edpara. /111 Date :....601 : 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. 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 ller certified by Putnam County. Date of Issue Permit Issuing Offici : xal.-f Date of Expiration v Z Title: Permit is Non- Transfe able White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY HEALTH DEPARTMENT J DIVISION OF ENVIRONMENTAL HEALTH SERVICES John M. Simmons, M.D. Deputy Commissioner of Health - FIELD ACTIVITY REPORT - Sheet 0 of I NEE fl ��J� INSPECTION 1bN•7 TM No. MAILING ADDRESS O Box Post Office Zip Code DI -Nas • i •W •. « Name and Title Orig. Routine Orig. Complain Orig. Request Campliance Complaint Comp Final Group Illness Construction Reinspection Field, Sampling Only Field Conference DATE TYPE FACILITY IUD A§ Other TIME ARRIVED a yr TIME LEFT 10 Explain FINDINGS: PERSON IN CHARGE OR INTERVIEWED: I acknowledge this Field Activity Report. SIGNATURE: P.F. BEAL.& SONS, INC. 4 PUTNAM AVENUE ARTESIAN WELLS BREWSTER, NEW YORK 10509 WATER TANKS WATER SYSTEMS COMMERCIAL WATERS:YSTEMS AgT'? UN -S ACTuAm SUBMERSIBLE PUMPS TEL. 279-2460 - 2461 WATER CONDITIONING EQUIPMENT FAX 279-6613 COMPLETE INSTALLATION, REPLACEMENT AND REPAIR SERIVICE July 16, 2001 Putnam County Dept. of Health Attn: Robert Morris, P.E. 1 Geneva Road Brewster, New York 10509 Dear Mr. Morris: Enclosed please find the revised sketch for the proposed well location for Katherine Heyd, 96 Wood Street, Carmel, NY. Your prompt consideration of this permit application is greatly appreciated. PLB/mm enclosure Very truly yours, Inc. F.F. o EAL .& SONS9 INC. . 4 PUTNAM AVENUE ARTESIAN WELLS BREWSTER, NEW YORK 10509 WATER TANKS GOARClAL,WATER SYSTEMS. . 'JET�tl15iPS" - �...,.,:. _. zrr`aafi e�i /d91'-'Uuer /1;7GG7`lLel t�on� fed _ _ OFRACTUAING SUBMERSIBLE PUMPS TEL. 279-2460 - 2461 WATER CONDITIONING EQUIPMENT FAX 279 -6613 w 4v) 1 5. b COMPLETE INSTALLATION, REPLACEMENT AND REPAIR SERIVICE N A� 1Pciaa1 A(" SAS sef-h e 47,ay- gam. 611110 ! fhb o 1 Z, 15e-� P,4 P,4 0 m f o� RctJ o� I d�� • . U D 'f -17 Public Health Director a- ;<a;- .: -�.r rs��•..;ORETTA �=- MO�INAiZI''I'i:N:,. T�1'S:N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845)278-6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 June 18, 2001 P. F. Beal & Sons, Inc. 4 Putnam Avenue Brewster NY 10509 Re: Proposed Well: Heyd 96 Wood Street (T) Carmel, TM# 85.7 -2 -18 Dear Mr. Beal: Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: 1. Please find enclosed the current well application guidelines. Items 2 and 3 have not been completed. .... r -: _IJpoii�receipt::af a- submi'ssioli; revised to reflect. the - above'. c6mmerts;;.this alpplicatioli will,'•be K considered further. Very truly yours, Robert Morris, P.E. Senior Public Health Enaineer RM:tn enc. Katherine Heyd PUT NAM C®ITNT Y DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL plese.print.or.type ;. ? 4 �_..s .. PCHD =Perrinit, #_ A Location: Street Address: Town/Village Tax Grid # 85.7 -2 -18 96 Wood Street Mahopac Map Block Lot(s) Well Owner: Name: Iddress: Katherine Heyd 6 Wood Street, Mahopac, NY 10541 Use of Well: X 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 5+ gpm # People Served Est. of Daily Usage _gal. Reason for X Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason To replace hand dug well for Drilling Well 'Type X 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: P. F. Beal & Sons, Inc. Address: 4 Putnam Ave. , Br, wa , NY t o50 Is Public Water Supply available to site? ............ ................... ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to b7pro eepara ee t/plan. Date: 6/11/01 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. 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 Date of Expiration Permit is Non - Transferrable Permit Issuing Official: Title: White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 ' `ry, I' .. .. : k � ._ , ..'.t)�L: f... :. .... r .n- .:=C'. 'y't`. - �. .. . ;.:.. 1 ri'. e . r� �LJ" c. wqr .'2 =ia1r'q,. i,i`. Y �a. �•I APPENDIX E Date RE: Department of Health Review of Proposed Sewage Treatment System for Property Name: Address: 52a Wo. d s k . Town: T t -&i /. i os —�,, i Tax Map #: mss: 7__�_i19 Dear Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has been made to the Putnam County J),epartment..of Health. - AttacL-d.plGase fi! daa:�copy.of the la-test-- sits.`plar�. _._ :.._ . �� ...: , ...._.... If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call the Health Department at (914) 278 -6130. Received By: quy)ct, pat�ay_ Address: /C3 Tax Map #: • 1? ,2 �ZLD August, 1999 AppndxE Very truly yours, Title: It D APPENDIX E FQRVYAT CONSTRUCTION PERMIT NEIGHBOR NOTIFICATION LETTER Dear Date 6/11/01 RE: Department of Health Review of Proposed Sewage Treatment System for Property Name: Katherine Heyd Address: 96 Wood Street Town: Mahopac, NY 10541 Tax Map #.- 85.7 -2 -18 Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call the Health Department at (914) 278 -6130. Very truly yours, By: Katherine Heyd Title: Owner Received By: Address: Tax Map #: �" o'Z— �17 August, 1999 AppndxE APPENDIX E FORMAT CONSTRUCTION PERMIT NEIGHBOR NOTIFICATION LETTER Date 6/11/01 RE: Department of Health Review of Proposed Sewage Treatment System for Property Name: Katherine Heyd Address: 96 Wood Street Town: Mahopac, NY 10541 Tax Map #: 85.7 -2 -18 Dear Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has been made to the Putnam County Departmen ±_�f health, Attached_.please_find.axovy of the - latest -site pfan�- " - ' - .:, .• -' If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call the Health Department at (914) 278 -6130. Very truly yours, By: Katherine Heyd Title: Owner __ Received By: Address:'' N Tax Map #: 7, 7— 2 —. August, 1999 AppndxE APPENDIX E j I IQ, 11 011 1111 flora A 1 C We Date 6/11/01 RE: Department of Health Review of Proposed Sewage Treatment System for Property Name: Katherine Heyd Address: 96 Wood Street Town: Mahopac, NY 10541 Tax. Map #: 85.7-2-18 Dear Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has been made to the Putnam County. e Tledse: find '' o Denanm(�ntc;fHealth.',.,,kLtA�h'd. I a �c py of-the latest site plan. If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call the Health Department at (914) 278-6130. Very truly yours, By: Katherine Heyd Title: Owner Received Bye, Address: Tax Map #: Z—R August, 1999 AppndxE APPENDIX E Date 6/11/01 25 RE: Department of Health Review of Proposed Sewage Treatment System- for Property Name: Katherine Heyd Address: 96 Wood Street Town: Mahopac, NY 10541 Tax Map #: 85.7 -2 -18 Dear Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has been made to the Putnam County pepartment.ofiealth. Attached _please -find:a copy.ofahe latest site.plan. - - - -• - to If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call the Health Department at (914) 278 -6130. Very truly yours, By: Katherine Heyd Title: Owner Received By: Address: 9 Tax Map 9: e' '2 1— 1�— _ \1 August, 1999 AppndxE 1&_111j Date 6/11/01 25 RE: Department of Health Review of Proposed Sewage Treatment System- for Property Name: Katherine Heyd Address: 96 Wood Street Town: Mahopac, NY 10541 Tax Map #: 85.7 -2 -18 Dear Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has been made to the Putnam County pepartment.ofiealth. Attached _please -find:a copy.ofahe latest site.plan. - - - -• - to If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call the Health Department at (914) 278 -6130. Very truly yours, By: Katherine Heyd Title: Owner Received By: Address: 9 Tax Map 9: e' '2 1— 1�— _ \1 August, 1999 AppndxE BRUCE R. FOLEY Public Health Director L',ORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845)278-6130 Fax(845)278-7921 Nursing Services (845)278-6558 WIC (845)278-6678 Fax(845)278-6085 Early Intervention (845)278-6014 Preschool (845) 228 - 6108 Fax (845) 278 - 6648 June 18, 2001 P. F. Beal & Sons, Inc. 4 Putnam Avenue Brewster NY 10509 Re: I Proposed Well: Heyd 96 Wood Street (T) Carmel, TM# 85.7 -2 -18 Dear Mr. Beal: Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: 1. Please find enclosed the current well application guidelines. Items 2 and 3 have not been completed. Up'o'ri reeeipf of a subriiission, revised "to reflect the a ove comments, this application will W__ e considered further. Very truly yours, Robert Morris, P.E. Senior Public Health Engineer RM:tn enc. Public Health Director 41 MEMO ds Associate Public Health Director Director of Patient' Services DEPARTMENT OF HEALTH I Geneva, Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 E arly Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 To: All Well Drillers, •censed Engineers and Registered Architects From: . Bruce R. Foley Subject: Neighbor Notification Date: August 18, 1999 Please End attached this Department revised procedures relating, to Well Permit Applications. -S holuld you h ave �aq questions o n these Procedures, please contact this office.. Thank you, BRF:th t I I t. 1 BRUCE R FOLEY �wll:c Health Director 1. LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF BEEALTH . 1 Geneva Road Brewster, New York 10509 Eaviroament2i Flealth (914) 278 -6130 Fax (914) 278 -7921 Nursing Services (914) 278 - 6558 Fax (914) 278 -6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 NEIGHBOR NOTIFICATION A1PPLICATIONS FOR WELL PERMITS Applications to the Department of Health for Well Permits will not be reviewed until such time as the Director of Environmental Health Services of the Department of Health is provided with proof that notification of the application for construction was made to all property owners within 200 feet of the proposed well location. A location map (a tax map would suffice) with all properties shown within 200 feet of the proposed well location must also be provided to the Department. - An- example location map is attached. Notification shall mean receipt by each property owner of a copy of the .-.attached notification form along v,ith a copy of the latest site plan. - aFroof of recei0 ef notice by propeiiy owners tail inc luoe either of the following. 1. Copies of registered mail receipts. (Return receipts) 2. Copies of the notification form signed by the contiguous property owners. Failure to provide the Department with adequate documentation of the performance of the notice will result in our delaying, action on the application until proper notice is executed. _.. _ ._ -__ -_ :-._ Transmittal of this notification should be sent to the all property owners within 200 feet of the proposed well location, by the applicant or well driller. A format of this notification form is attached for your use. BRF&M/tn August, 1999 —e. w. ".,..e...,, ..u. .. .. .1v.'- ,.a.',vw� ..' lJ ". �l%... yyui.- ..Ae•:�%...:i....+.« ..e. a.. .� APPENUX E FORMAT CONSTRUCTION PERMIT NEIGHBOR NOTIFICATION LETTER Date RE: Department of Health Review of Proposed Sewage Treatment System for Property Frame: Address: Town: Tax Map # :... - -- — - - -- Dear Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has been .made to the Putnam County:. _ Departmeni afHealth. "AtLached`pleasc fin3 a copy ofthe'latest site pl "ari: If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call the Health Department at (914) 278 -6130. .Very truly yours, By: Title: Received By: Address: Tax Map #: August, 1999 AppndxE I _ k BRUCE, . - ;EOLEY Public Health Director - 10 =rA`4koiWriRl'RN., M.S.N. ' Associate Public Health Director Director of Patient Services 'DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) 278 - 6130 Fax (914) 278 - 1921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 . Fax (914) 278 - 6085 PROCEDURE FOR NEW "ELL PER -rIIT APPLICATIONS -1: Well permit application is to be submitted along with fee, $100.00 certified check or money order, for all permits other than redrills. Redrills require only permit applications. . 2. Locations of all sources of possible contamination within 200 feet of the proposed well location)are to be shown on a plan or tax map. 3. Neighbor notification is required for all property owners within 200 feet of the proposed well location.. 4. Feasibility of well location is to be confirmed by a representative of this Department. 5: If the proposed well is-within -152 feet of flie property`line the approved well location is to be staked by a Licensed Surveyor. If the proposed well location is within 100 feet of any source of contamination, the well location is to be staked by a Licensed Engineer, Registered Architect or Land Surveyor prior to drilling.. 6. As -built and well log to be submitted no later than 30 days after completion, by permittee. BRF/RNVtn August, 1999 pnwpa WELL PERMIT LOCATION MAP EXAMPLE SHOWING ALL SOURCES OF CONTAMNATION WITHIN 200 FEET OF PROPOSED WELL Copies of the tax map page for your property can be obtained at your Town Building Department and the Putnam County Dept. of Health • - 35 ss'd-s ocatioil S' \ 1.10 AC. •� ^� s name V. � "t5> •� ' � 1.47 F.S Cp o Hers n me $ / /tr. t x map ` m proposed we c _• -._ r o existing. we 1 -(if apps.' ole) r ", ti r J • 45 ° 1.20 l:C. o ' ssds to a n `� 1.00 AC. $ ss s oca io t! IV -it ers•.namLr NT S' d g •o =eca tax map d = owners• name :' 1 tax map .# ® ssds licat 1.00 AC. as -� ssds locat'on 51 43 1 2 r 1.30 AC. 1.00 AC. ' �� . . ` 3 rs /�^ �� %QA mss-• '.. 1 j bU b . U Vtl 114 J b ' I )'r,), a\, ., co.. Cti•, z .- ..r ••-Cc� L,. ... _- �.. ,. - � _ :Y.' .. z, ...r- � � _ :'.:.'� - +:; ;.,�, °.� •. -:.cc. - .'.•g,..u.:.' . .. .sx: .—;rA � , Gtk -.n •, :,;1 0 _..vim, cY—a ,_.... +�' i ' �`' �`� c ^�; ��1 r � .�N 9 x"/.9'93' ! •.. ? 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