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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
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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
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L E G E N D
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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
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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
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