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Home My WebLink About4736DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 91.25-2-46 BOX 35 04736 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health February 3, 2.005 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Roy Ogden 1 Spruce Street Lake Peekskill, I Y 10537 Dear Mr. Ogden: ROBERT J. BONDI . County Exeeutive Re: Well Permit Application for Ogden Property — 1 Spruce Street (T) Putnam Valley This Department has approved the well permit'for Well #W4 -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 50 feet from on -site and/or adjacent subsurface sewage treatment system areas. -- 3: The well shal%be:insta'lled °with a-mirririruni'of $ -fec�w casing: _ ...... w - - 4. An ultra- violet light disinfection unit shall be installed on the incoming well line to the dwelling. 5. 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. 6. 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 WIG (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 ;r3,3 1 A PUTNAM COUNTY DEPARTMENT OF HEALTH ,�PI IC:,A.T.ION --TO -C,.O �S'TRU.,CT .A WA''.ER WE LL:; please print or type PCHD Permit # d� Weill Location: Street Address: Town/Village Tax Grid # . f 1- 4!Ife i° e% Map Block Lot(s) Well Owner: Name: Address: >� 7 Use of Well: Resi ential Public Supply Air /Cond/Heat Pump Irrigation I- primary Business Farm Test/Monitoring Other (specify) 2-secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served 3_ Est. of Daily Usage _gal. Reason for Replace Existing Supply Test/Observation Additional Supply IDrilIling t/ ew u 1 new dwelling) Deepen Existing Well Detailed Reason � d for IDAIRi>ing Well Type _j,/_ 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: f j/� �- �y p„ ,, Address: / —L 1 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 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. 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. I A Date of Issue z-- a) — D Sr Date of Expiration Z --:-S —6::7 Permit is No>n- Transferrable Perm Title: White copy - HD file; Yellow copy - Building Inspector; Form WP -97 e� Al IN -Z- 0 I-- a -4� �4 41 LJ _J - 1,0 k L E G E N D D No Fr. These sketches based Now Y.* State High Ratoltitlen Approx. Location Existing Well Q statewide 041tal Orthoknogery Program (2000 Plot –Presml) and digital to, - 1,0 L E G E N D No Fr. These sketches based Now Y.* State High Ratoltitlen Approx. Location Existing Well Q statewide 041tal Orthoknogery Program (2000 Plot –Presml) and digital to, mop Infixnnotion ftrn Putnam County. These sketches me Intended to Mow Subject Property Approx. Location Proposed Well A approximate property Ines, dwellings, and stptk systems tor use In assessing Po"Ablo well l000tAonf only These sketches We not intended lb�' my other, Approx. Location 99 Direction Of Ground Slope SLOPE purpose and am not intended to be scaled Prior to drilling my Proposed Existing SSTS Arrow Points Downhill wail, the appropriate surreys, designs, and permits must be obtained """"'LAKE PEEKSKILL FN7AftW Rr 10-11-04 N S / T E WATER SYSTEM SHUTDOWN SrAw I .-JO , WLI ENGINEERING, SURVEYING& mmzff w-' 041iU 100 If LWDSCAPEARCHITECTURE P.C. PLOT PLAN T" No 1 3 Garrett Place - C.rrnol, New York 10512 1 SPRUCE ST Phone (845) 225– 690 - Fax (845) 225-9777 91.25-2 w—'qInsite–ong.com