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HomeMy WebLinkAbout4740DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 91.26 -1 -3 BOX 36 &III r 56 Lr n` ' ,';i II �6 04740 05/08/2014 09:02 8452258420 BOYDARTESIANWELLC PAGE 05/06 Town/Village: �/ Tax Map #�1�� Map Block Lots Materials: V. Steel Plastic Other Well Owner: Name: Address: Drive shoe: _)6: Yes No I�fNA�M_COVNTX ISEP 4RTMEN 1' C?F HEALTH _Residential Public Supply DIVISION OF ENVIRONMEN50WALYH SER'1/1�Go-S 4S WELL COMPLETION REPORT well Location Street Address: Town/Village: �/ Tax Map #�1�� Map Block Lots Materials: V. Steel Plastic Other Well Owner: Name: Address: Drive shoe: _)6: Yes No of Well: _Residential Public Supply it condlheat pump _Irri tlon 1Use I- Primary Business Farm Test /monitoring — Other(specify), 2-Shc6ndary Industrial institutional Stan Drilling Equipment ,.,.,_Rota Cable percusslon Com pressed air Eercusslon Other(specif WN Willi Type Screened O en end casing 0 en hole in bedrock Other Casing Details Total Length a ,ft. Length below grade62ft• Diameter 1-6 in. W61aht Per foot Albift Materials: V. Steel Plastic Other Joints: Welded . Threaded Other Seal: Cement grout Bentonite Other Drive shoe: _)6: Yes No Liner: —Yqt Screen Datails First Second. Well Yield Test Ballad Depth Date ON—.. from Information Land 5urfaea descriptions or sieve analyses are 6618ble, please attach, If yield was tested at different depths during drilling list: From Surface . 7`73F,7_77- _.a ,.....i.T,.. _ __ ..-.- I- _--- -, Compressed Air I Hours _6— Yield veil ulameter Gallons Per Minute Pumpls / Rump Type It Depth Voltage Tank TVPe _Yes —No � Hours ZZ+° pth of completed well I t. tion -i eser! : tion- . nk Information Capacity Model _ HP Volume _ N TE: E x ocation of w011 with distances to at least two permanent landmarks to be provided on a separate sheet/plan, Whltit copy: HO File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy • W-6II driller Form WC-97 Rev. 3106 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES :�•+4;: :>..•:j,c.:.... ,7 v <"r• 11: Z`'., - . �vz.^� -�. - ..� :ice 9; =,r+..:a �•. ::.�'.�� -�� _ .a'...�.. � ...f•:'•; _ '.d'r;:•:. _ . , .�: =.;a,; APPLICATION TO ABANDON A WATER WELL please print or type PCHD PERMIT #� ` �• Well Location: Street Address: TownNillage Tax Grid # Map Block Lot(s) Well Owner: Nam : Address: 10653;7 Well Type: Drilled Driven Dug Gravel Other Depth Data: Well Depth _0& ft Static Water Level ft T 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: /,2Jy� Address: / Contractor: )0//`Y/V-7 Reason For Abandonment: Description of Work To Be Performed: -rJ �.... c•... .. r i- a -- .p... -�. ,,.y.}..,,....,,�,..._.._ _A -,- ¢ ,. .•.. •...r•-> �..•S . w ..y, .i,r.+.w..�n�•.... 'o._p'pr . Date: Applicant Signature: Ailll /0/1 0, 1 t el F 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. a Date k Issue White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -97 REBECCA WITTENBERG, RN, BSN Public Health Director ROBERT MORRIS, PE Director of Environmental Health Boyd Artesian Well Co., Inc. c/o Henry Boyd 1054 Route 52 Carmel, NY 10512 Subject: Proposed Well Knapp 30 Pecoho Rd. (T) Kent July 24, 2012 Dear Mr. Boyd: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 845= 808 -1390 MARYE]LLEN ODEILL County �' "Executive.... A field inspection was conducted on the above referenced lot by Vincent Perrin, Public Health Technician. The application to drill a new well is approved with the following stipulations: - - Tile fell l;tzm and- arr electrical components are to be removedfrurn de existing.weli'-durirlg abandonment. 2. The well is to be constructed with a minimum of 50 feet of casing. 3. A Well Completion Report (WC -97) shall be submitted no later than 30 days after the well completion by the permittee. Please contact me at (845) 808 -1390 ext.43131 if you have any questions. Sincere , �f Vincent Perrin Public Health Technician cc: VP, file ' V Q PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ea ;�r'fi. � ,,tie .4. -J... -�.. .-.. -. ex . .-.pe: Yr'C`.' � ai:'V_-.a ":rm ._. .. •u .. «�'r.- �`+:'^�c�'CT. "<".G..�.i `..v .: ..«.:��'•o. APPLICATION TO CONSTRUCT A WATER WELL please Print or type �`�+ 'W w '; Well Location Street Address: Town/Village: Tax Map # 2 a Bloch Lot(s) Well Owner: Name: Address: /o,! � �1 E)5 Use of Well: Residential _Pu lic Supply Air /co d /heat pump _Irrigation I - Primary Business Farm Test/monitoring —Other(specify) . 2-Secondary Industrial Institutional Standby Amount of Use Yield Sought____1.P7gpm # 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 for Drilling Well T e Drilled Driven Gravel Other Is well site subject to flooding? ...................................................... ............................... Yes _ No Is well located in a realty subdivision? ........................................... ............................... Yes _ NO-,V- Name of subdivision Lot No. Water Well Contractor: Address :� ©�l� Yes._ No Is Public Water Supply available on site? ....................................... ............................... Blame of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provid d on separate et/plan. L 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 C nty. Date of Issue lcZ,q °� Permit Issuing Offici Date -of Expiration Title: S, Permit is Non- Transf cable White copy - HD file; 'Yellow'copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 fnJ1 /7°U^ Rev. 3/0.6 7 1054 Me. 5 Carmel, N.Y. 10512 (845) 225-3196 Fax (845) 225-8420 Sheaf .f t'tr .7 Poec i e7 Dw /Ay 1�14 h Vo jj�s r V" qo' to Ld kj Grl Pf ml 4� 0 Buy-,O-Artwes- an-WeA.-Co! 1054 Rte. 52 Carmel, N.Y. 10512 (845) 225-3196 Fax (845) 225-8420 -Inc. --------- - --- xk