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Home My WebLink About3053DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 62.25-1-27 BOX 25 ME mg IN JAI.NN � , , NN -�;.- NN IN L 03053 �� rya. Dais a' rAW. nJUU •- /'+3 :�r�•t3�W'••�L ^u1�1r.LV �asa+ic.� �•- _._._�.. al�s's.i+riSll�.�[�Y+Gti:htr... '-i3Jb'a+^rm.4.vu Lati•• •.....+�::.: 1d5. YUi� '- �:}•�d��e:y� "rLtK+�r.'..IN DEPARTMENT OF HEALTH Division Of Environmental Hh Services • �'� TWO COUNTY CENTER — CARMEL, N.Y. • 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL .iIS WELL SITE SUBJECT TO FLOODING? YES 24 NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: n LOT NO -: WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES x NO 17 NAME OF PUBLIC•WATER SUPPLY: TOWN /V /C -DISTANCE -TO PROPERTY FROM - NEAREST WATER-.MAIN - LOCATION SKETCH & SOURCES OF CONTAMINATION. � �.._ _� (date) + (signature) _ PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of 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 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 attached to this. permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department... Date of Issue: J l 39 t �� y _T Permit Issuing Official Permit : is Non- Transf errable '`:, A00HESS. OWN /VILLAGE1C - AiU u. WELL LOCATION 2' _fT1.4f. J WELL OWNER NAME. • )KRESI NTIAL AOORESS: l ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP AO6 ❑ P$IVATC ❑ PUBLIC ❑ ABANDON 'D USE OF WELL 1 - primary ❑BUSINESS ❑ _FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) 2 - secondary ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF-USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED 13 /EST. OF DAILY USAGE • �� gal. REASON FOR NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑TEST /OBSERVATION DRILLING. IIEPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL WELL TYPE.. DRILLED F-1 DRIVEN DUG GRAVEL OTHER .iIS WELL SITE SUBJECT TO FLOODING? YES 24 NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: n LOT NO -: WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES x NO 17 NAME OF PUBLIC•WATER SUPPLY: TOWN /V /C -DISTANCE -TO PROPERTY FROM - NEAREST WATER-.MAIN - LOCATION SKETCH & SOURCES OF CONTAMINATION. � �.._ _� (date) + (signature) _ PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of 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 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 attached to this. permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department... Date of Issue: J l 39 t �� y _T Permit Issuing Official Permit : is Non- Transf errable '`:, 6A Hillside Terrace White Plains, NY 10601 September 19, 1986 Department of Health Division of Environmental Health Services Two County Center Carmel, New York 10512 Attention: John Kavell, Jr., P.E. Director Environmental Health Services PROPOSED WELL CONSTRUCTION APPLICATION W -18 -86 LAKEFRONT, LAKE OSCAWANA PV TM 34D Dear Sir: In your letter to me dated August 27, 1986, you requested additional information or clarification concerning the above application. The following information or claiific"ation- follows the numbered items in your letter: 1. The main reason for drilling the well is to provide our house for summer service with water for drinking, cooking and sanitary purposes. The water from the well will not be used for lawn watering. At some point we intend to winterize the house, at which time, year -round water service will be a necessity. 2. At present, the Hiawatha Improvement Company supplies water from approximately mid -April until early November. Hiawatha does not provide water during the winter. In addition, the cost of Hiawatha water has been steadily increasing over the years as more and more people either have wells or take water from Lake Oscawana. ''�1. -; -:.. �,-�--D:epartment o-f Health ` - '2 "` "Sep'tember '19, 1986 3. The site is presently served by a sewage disposal system. 4. The present structure is not expected to be reconstructed or expanded. 5. There are no existing wells on adjacent parcels within 200 feet of the proposed well. There is, however, an existing sewage system on Lot 9 within 200 feet of the proposed well. This sewage system adjoins my Lot 8. This existing sewage system is approximately north of the fence between Lots 8 and 9 and approximately directly north of my sewage system. 6. The attached sketch, revised 9/15/85, shows the sewage system on Lot 9. I, therefore, request that further consideration be given to my application. Very truly yours, Allan Weitzen fer AW. -rs- Attachments: Application W -18 -86 Sketch, Revised 9/15/86 �Y 1--7 t C".j i BY DATE NEW YORK SHEET OF DE PT. CHKO. BY DATE OFS NO. "'LIENT- PROJECT I/ . .. ...... .......... ... SUBJECT 1--7 t C".j i FORM 581 REV 7-71 CJ w . .. ...... .......... ... y. -- - ------- kill k4- FORM 581 REV 7-71 CJ w kill FORM 581 REV 7-71 CJ r k:. •. DAVID D. BRUEN County Executive Mr. Weitzenhoffer 6 A Hillside Terrace White Plains, NY 10601 Dear Sir: r _. •- -• • - ' "" —'« _ "'` +�� JOHN• SIMMONS, M.D. ^ ^ 1 • Deputy Commissioner DEPARTMENT OF _HEALTH Division Of Environmental Health Services August 27, 1986 RE: Proposed Well Construction Application # W 18 -86 Lakefront, Lake 0scawana PV IiK34D Review of the above captioned application has been completed. Additional information or clarification is required as checked below: Al. A detailed reason for drilling the well is required. A short narrative is required. For what purpose will the well'be used, i.e., drinking, lawn watering, etc. V2. Is the'site presently served by a wellor,other source of water supply? Explain. 3. Is the site.presently served by a sewage disposal-system ?::-Explain. _.. ✓4. -Is .• the,.present `_structure to. be reconstructed ? - Expanded Hoyt? VS. A sketch showing the location of: - the. proposed well - the existing sewage system on this parcel - the existing house on this parcel 7 existing sewage systems and wells on adjacent parcels within 200 feet of the proposed well. - all of the above is not provided. 6. The sketch provided is not sufficiently detailed. See #5 above. Upon receipt of the.above information this application will be considered further. JK:mk cc: M. O'Dell, BI PV vices F/h /jk 3 ..-TWO. COUNTY CENTER,- CARMEL N.Y. 10512 (914).,..225-3641 DAVID D. BRUEN^ County Executive Mr. Weitzenhoffer 6 A Hillside Terrace White Plains, NY 10601 Dear Sire DEPARTMENT OF ..HEALTH Division Of Environmental Health Services August 27,1986 RE: Proposed Well.Construction Application # W 18 -86 Lakefront, Lake 0scawana PV TH 34 D Review of the above captioned application has been ccMpletede Additional information or clarification is required as checked below: JOHN SIMMONS, M.D. Deputy Commissioner Al. A detailed reason for drilling the well is required. A short narrative is required. For what purpose will the well be used, i.e., drinking, lawn watering, etc. V,2. Is the,'site presently served by a wellor other source of water supply? Explain, 3a .Is:.th7e site presently served by a sewage disposal system? Explain. r the rpresent �-structure - to -be- reeonstxucted?-::. Expanded ?: Harw? - VS. A sketch showing the location of: - the.proposed well - the existing sewage system on this parcel the existing house on this parcel 7 existing sewage systems and wells on adjacent parcels within 200 feet of the proposed well. -.all of the above is not provided. 6. The sketch provided is not sufficiently detailed. See #5 above. Upon receipt of the above information this application will be considered further. your , o Kar 1, Jr., P.E. JK:mk irector Environmental Health Services cc: M. 0 °Dell, BI PV .:`;-TWO F/L /jk -3 COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 w A By NEW YORK PATE SHEET OF DATE ' DE PT..:,-, -OFS'NO.' NO. �CLIENT WEI (ZEU�Wf6(� L PROJECT SUBJECT f 7 77 7! 7'—T C —_ _a • 1 _� I r r .� i- s. !17 4- T.— 7 7-7-: 7 -7 0 ol t J, I p is MI 1q: q; L4 T q .I -F � j � e;-.� � � ��rl i _ � i - .r'° �.ac"+> >I iri r• t{ ,.:. �j 44 L L -L r .-7 f �7- 7 T ...... Lj . .. ... or. FORM 551 REV 7-71