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Home My WebLink About4760DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 91.26 -1 -58 BOX 36 04760 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health � :�,� -.� �•I:��E'I'�':� M�2vINAdiI;- l�'�;t��l�Iti�:. � -.:x' w:.; :- -o..`: Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Norman Anderson, Inc. 152 Barger Street Putnam Valley, NY 10579 December 24, 2007 Dear Mr. Anderson: ROBERT I BONDI County Executive Director of Environmental Hea /th Re: Proposed Well Valladores 8 Melnick Place (T) Putnam Valley A field inspection was conducted on the above referenced lot by Mitchell Lee, Public Health Technician. The application to drill a new well is approved with the following stipulations: I. The proposed well is to be constructed with a minimum casing length of 89 feet. 2. A Well Completion Report (WC -97) shall be submitted no later than 30 days after _ the .well. completion by the pe.mittee. -�'_.. _ � .'.,;.:.;,;..� _o . � - ., _�,.. _, tea. • Please contact me at (845) 225 -5186 ext.2233 if you have any questions. 1S�incerely, n Mitchell D. Lee 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 please print or type PCI.,F= L+Tjj'Ifa ws M Well Location Street Address: Town/Village: Tax Map # a � / – / I // ., t:/�( 4 �(44 444 co-s, Lf_ Map Block Lot(s) Well Owner: Name: rrckrict V �64 J0r4s Address: / Phone #: �ee-AS�;� PUTNAM COUNTY DEPARTMENT OF HEALTH flh i`�% ze- /�� Use of Well: ___LeRe'sidential _Public Supply Air /cond /heat pump _Irrigation DIVISION OF ENVIRONMENTAL HEALTH SERVICES Business Farm Testimonitoring —Other(specify) 2- Secondary Industrial Institutional Standby Amount of Use Yield Sought -5 gpm # People Served Est. of Daily usage gal. Replace Existing Supply Test/Observation Additional Supply APPLICATION TO CONSTRUCT A WATER WELL please print or type PCI.,F= L+Tjj'Ifa ws M Well Location Street Address: Town/Village: Tax Map # a � / – / I // ., t:/�( 4 �(44 444 Lf_ Map Block Lot(s) Well Owner: Name: rrckrict V �64 J0r4s Address: / Phone #: �ee-AS�;� flh i`�% ze- /�� Use of Well: ___LeRe'sidential _Public Supply Air /cond /heat pump _Irrigation I - Primary Business Farm Testimonitoring —Other(specify) 2- Secondary Industrial Institutional Standby Amount of Use Yield Sought -5 gpm # 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 J uh for Drilling NNell T pe rilled Driven Gravel Other Is well site subject to flooding? ....................................................... ............................... Yes No Is well located in a realty subdivision? .. ......................................... ............................... Yes No _ n/ �i Name of subdivision Lot o. Water Well Contractor: � � u d e--•r s � Address: ^ �- 444C-4 � % k �a rat 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. tDate:. �.� I� `1 �_ _. Ap p licapt Sranature:'!. -= 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. take appropriate action to assure that any and all water and waste products from such well drilling operation- s 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 al ration of the app ed plan requires a new permit. Well to be constructed by a water well driller certified by Putnan Bounty.. Date of Issue 2— 4 Permit Date of Expiration — Title:_ Permit is Non -Tr nsferable White copy - HD file; Yellow copy - Building Inspector; Pink copy - 02'11 iS 0 ez �� s �G 2� vi : k� 0, Mt � iM Ar� o f 9 i 'Feet: �t,,—Orange copy -!Nell driller Form WP -97 Rev. 3/06 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ^ *' :k t.`... .\. .. - :6:11oa 2: ;ia, ':i�.a l: - .. ...'.\ ' :! ._. r...hr.. -. j" ... .. .. .r �+.o nY is:,'• -•� 'WI:Y&h& TO ABANDON A WATER WELL please print or type PCHD PERMIT # /An *��--D —] Well Location: Street Address: ownNillage Tax Grp %/ 6 — / , MCI Ae P4"041 1 hrc_fc e Map Block Lot(s) Well Owner: Name: M4 0 r ` ct h d 6 r es Address:) Q � h ,��-% I �tc L-e � ehS -�-6 I1 Well Type: t4nlled Driven Dug Gravel Other Depth Data: Well Depth ft Static Water Level ft 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 Contractor: Name• Address: 1 1 1 ��w 77t ' I r7 Y w� a-c d K .�„r o G!►� VN 1 Reason For Q i n/Aed'j 9a'i qj a x -K h/ '' 4/e4 k✓E�/ Abandonment: �� s rk ►� a'"-l`' aura Description of Work To Be " Tormed: c n e, fc t, Co tA 0n LA ''7 o a f•e,a�t �w.�i 0� Date: < < Applicant Signature i , 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. t A I Date of Issue Permit Issuing Off " �] White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -97 g'y Y s 1,W m h ®j o � o� ea ® ogs+vB ®rte . ®��p�g�eii s ® ®✓�/os r y �y�_q_.. � - -o-g- - _� __.._ �.8.... m °.� P°esa.v_t c� JunOx SUOTSS1LUO1+0 sloid2 :ej �® D 1 c. kaw 0 IF lk %i zo Qtr- P �O `° � • �� ., A ® moo-. 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