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00153
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
APPLICATION TO ABANDON A WATER WELL
please print or type
PCHD PERMIT # -0�3
Well Location:
Street Address: TownNillage Tax Grid # N A
470 Cornwall Hill Road Patterson, NY
Map 3.20Block 2 Lot(s)102
Well Owner:
Name:
Address:
Town of Patterson
Patterson Town Half, 1142 RT. 311
PO Box 470 Patterson NY
Well Type:
x Drilled Driven Dug Gravel Other
Depth Data:
Well Depth 780 ft
Static Water Level 6' 1" ft
Date Measured 4-18 -o3
Use of Well:
1 Residential Public Supply Air /Cond/Heat Pump Abandoned
1- primary
Business Farm Test/Observation Other (specify)
2- secondary
Industrial Institutional Standby
Water Well
Name: Boyd Artesian Well Address: 1052 Rt. 52
Contractor:
Company Carmel, NY 10512
Reason For
ell initially drilled to provide water to Van Cleef Estates. However,
ue to its low yield, it was never used for production. A new sewage
Abandonment:
reatment plant is now planned to be built at the site.
Description of Work To Be Performed: The well will first be disinfected. It will then be
filled with
crushed stone gravel up to a depth of 200 ft. From 200 ft to ground level,
it will be filled
with cement through a pipe, and permanently capped. The abandonment
will proceed
according to the guidelines in "10 States.Standards" Recommended
Standards for
Water Works.
Date: April 18,
2003 Applicant Signature:
u
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.
4- W - 0 3
Date of Issue
White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WA -97
WE%"
Du rresne -Henry
April 18, 2003
Michael J. Budzinski, P.E.
Putnam County Department of Health
Division of Environmental Health Services
4 Geneva Road
Brewster, New York 10509
Re: 470 Cornwall Hill Road, Patterson, NY
Application to Abandon a Water Well
DH Project No.: 7600055.02
Dear Mike:
Creating Better Places To Live, Work And Play
Enclosed please find and Application to Abandon a Water Well located at 470 Cornwall Hill Road
in Patterson; NY. The well was originally one of three wells constructed to provide water to the Van
Cleef Estates subdivision. However, due to its low yield, it was never connected to the water supply
system. The well to be abandoned is located closest to the rear of the property, near a small stream.
With the construction of the new wastewater treatment plant planned for this site, we are seeking a
permit to abandon the well.
If you have any questions or comments, please call me in the Pawling office.
Sincerely,
DUFRESNE -HENRY ENGINEERS AND LANDSCAPE ARCHITECT, P.C.
John A. Kalin, P.E.
Project Engineer
JAK/mas
Enclosure
cc: Mike Griffin
Town Board
Rich Williams
\\Paserver\ General \7600055.02 \permitting\PCDOH Well Abandonment App Letter.doc
Engineers Planners Landscape Architects Environmental Scientists
145 Route 22, Suite 201 P. O. Box 417 Pawling, New York 12564
Voice: 845- 855 -1255 Fax: 845- 855 - 1780 E -mail: pawling @dufresne - henry.com
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