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Home My WebLink About4819DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 91.34 -1 -9 BOX 36 1 %96 �Ll J�l �` Er Qom` PUTNAM COUNTY DEPARTMENT OF HEALTH -7 t O'Dl DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL t ase print or type` -a,. PCHD ple Permit Well Location: Street Address: Town/V'llage Tax Grid # 3 � �. Map Block C Lot(s) Well Owner: Name: � A Address: k Ora) pu,,� Vq oc� L Q /46,91,v 4� Use of Well: esidential Public Supply Air /Cond/Heat Pump ' Irrigation 1- primary Business Farm Test/Monitoring Other (speci ) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily Usage _gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Y' Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision Lot No. A Water Well Contractor: Address: Is Public Water Supply available to site? .................................. ............................... I Yes i No y 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. dDate: 7 '7 Applicant Signature:_ o t -_ -� '- 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 c rtf ed by Putnam County. Date of Issue 't � Permit Iss ' Offic' : Date of Expiration – �0 Title: Permit is Non -Trans errable White copy - HD file; Yellow copy - Building Inspector; Pink copy - er; Orange copy - Well driller i Form WP -97 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health.. . LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Norman Anderson, Inc. 152 Barger Street Putnam Valley, NY 10579 July 18, 2007 Dear Mr. Anderson: ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Proposed Well Eagens 63 Hollow Brook Road (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: 1. The well is to be constructed with a minimum casing length of 44 feet. . - A 'del trarletio;� repo (`r� C =97) shall -be subrriitted r�o later thai3 3U days after the well completion by the permittee. Please contact me at (845) 225 -5186 ext.2233 if you have any questions. cc: dle Sincerely, 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 �.7.�.Cx - vey�wA "•fir �. ... +3� .. -i . v- t .. .��• s a. .,f.. -?�. ,�.;t -. .. ^01:...P O(.A�.. '��. ` � ` .. 'I'. .. .a: — • 1vj ,, �J �3 I:.. �?. fill I • I ` , I rYoad D. ,Q � . , •. o " ✓� /fit y�li�t *,pit Af ins � _ . -. • • _ -�; -, ea 67" V ; , � .�- a _ z -. lVYS T�.x ZA.A19 AIS r ;'c`�FL- ''4/•'<S tsr�" �`�.� 3�'.�..sa JE��i.�'' y�° L'�!�'L•il/17�5 d.� !v�%G`'1'Tr�E,f °:'E,�' I�• Yj /'i' ✓°KI S'i /'�.'.' it Li .F.� ./ i/ �/•I••.� I4l I E��SE1) 104a"^,q 1976 .9EE 11471,'