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631- 589 -8100
83.58 -1 -6
BOX 31
03967
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03967
OWNER'S NAME T G
SITE LOCATION
MAILING ADDRESS 17(
PUTNAM COUNTY HEALTH DEPAR'IlMENT
DIVISION OF ENVIROIWAL HEALTH SERVICES y
PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR L.7
�-----"
tx s4 � ✓. Al V i a �1 _
PERSON INTERVIEWED PCHD Cag3laint #
Name & Relationship (i.e, owner,tenant;' etc.)
DATE L % TYPE FACILITY
PROPOSED INSTALLER _ PHONE
REGISTRATION #
Proposal (include sketch locating all adjacent wells):
NOTE: Repair must be in same location and of same type as original sewage disposal system.
Different location may require submittal of proposal fran licensed professional engineer or
reg i tered architect.
.� n . J A A111- c; .fir X1(•2i
,-4.:W",- ,
V-1
JJU
Proposal ed Proposal Disapproved
Inspector's Signature & Title tate
Proposal approved with the following conditions:
1. Procurement of any Town permit, if applicable.
2. Submission of as built repair sketch in duplicate showing:
a. Owner's name.
b. Site Street Name, Town and Tax Map number.
c. Location of installed canponents tied to two fixed points (e.g.,house corners).
d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diem. x 6' deep
drywalls surrounded by one foot + gravel).
e. Installer's name and number.
3. System repair to be performed in accordance with the above proposal and oonditions.
I, as owner, or reported agent of owner agree to the above conditions.
SIGNATURE v TITLE �� %�/ � DATE
'v
CP1 �'N : Waite (RED): YeUc w (2trAn HI); Pink (,Applimat.)
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NOW
Dr. Robert 0. Nelson
Jacqueline Nelson
1706 Molmingview Drive" '
Yorktown Heights, New York 10598
(914) 962 -4241
May 8, 1995
Putnam County Board of Health.
Robert Morris, P. E. Public Health Engineer
Putnam County Department of Health
4 Genera Road
Brewster, New York 10509
RE: t,,Tell installation
159 Tanglewy1de Road
Lake Peekskill, New York
Tat Map # 83.58 -1 -6
Dear Mr Morris,
Enclosed please find a copy of the well log, as supplied by
P. F. Beal and Sons, also a copy of the laboratory report
f ind-i.n.g-_. hp_ well too Vie, of ;s . ;t.isfact.ol. y s riitai ;y.. ;cJtt ;fit i ty.
I have installed a seven gallon per m.i.ncite ultra violet light
system with a seven gallon per minute floii rest.rictor.
I believe this completes my responsibility with the Putnam
county Health department relating to this well in.sta_Ilati.on.
If you need anything else from relating to this, of course
all you need do is contact me.
Thank you again for your assistance
Sincerely,
Ro e.rt and Jacqueline Nelson
1706 Morn.i.ngview Drive
Yorktown Heights, Nesi York 10598
914 - 962 -4241
Enclosure. .
YM| FNVIRONMENTAL SERVICF�
321 Kear Street
Yorktown Heights, N.Y. 10598
(914) 245_2800
Albert H. Padovanir Direytor
NELSON, ROBERT DATE/TIME TAKEN: 05/02/95 13:30
1706 MORNINGV7EW DR DATE/T7ME REC'll: 05/02/95 14:30
YORKTOWN HOTS!, NY 10598 REPORT DATE: 05/05/95
PHONF: 1914)-962-4241 �
SAMPLING SITE: 159 TANG EWY-DE RD KITCHFN TAP SAMPLE TYPE..: POTABLE
: LAKE PEEKSKILL, NY ` PRESERVATIVES: NONE
COL'D BY: ROBERT NELSON TEMPFRATURE..: { 4C
NOTES... : COLIFORM METH: MF
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
DATE FLAO PROCEDURE RE&ULT NORMAL - RANGE '
05/03/95 MF T. CO IFORM ABSENT /100 MI.. ABSFNT
COMMENTS:
BACT THESE RESU|'TS INDICATE THAT THF WATE NOT) OF A
SATISFACTORY SANITARY QUALITY ACCOROI HE NEW YORK STATE
AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS
TESTED, AT THE TIME 0F COLLECTION. �
SUBMITTEI}BY:'_ n I ------------------------
Albert H. Pado«ani, M.T.(ASCp)
Director
FLAP# 1002:3
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
APPLICATION TO CONSTRUCT A WATER WELL
PCHD PERMIT #
WELL LOCATION
Street Ad ress
/3'9 T a o-w
Town/Village/City Tax Grid Number
Ir LA IV' P�KS iGt 3. v
WELL OWNER
p Name Mail Address ,, rr PIPrivate
1�0 1M2� LS
/��vA✓ (7�- arcn.iw ilCw�z ar�C° � LV InMOPublic
USE OF WELL
primary
2- secondary
RESIDENTIAL
O BUSINESS
0 INDUS RIAL
O PUBLIC SUP AY Q AIR /COND /HEAT P O ABANDONED
O FARM O TEST /OBSERVATION O OTHER (specify,
U INSTITUTIONAL O STAND -BY O
AMOUNT OF USE
YIELD SOUGHT
gpm /# PEOPLE SERVED IdX3 /EST. OF DAILY USAGE��ga�
REASON FOR
DRILLING
jKREPLACE EXISTING SUPPLY O TEST /OBSERVATION M ADDITIONAL SUPPLY
O NEW SUPPLY NEW DWELLING Ll DEEPEN EXISTING WELL
DETAILED
REASON FOR
DRILLING
/-/0- L'
!C -1' 11tZ L4XA �.✓,
Ato ( , l v �t a
WELL TYPE
®DRILLED
DRIVEN EIDUG
OGRAVEL
0 OTHER
IS WELL SITE SUBJECT TO FLOODING? YES __p!�`NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No.
WATER WELL CONTRACTOR: Name
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO
NAME OF PUBLIC WATER SUPPLY: L414- d'z�f %<f�/ TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM'-NEAREST WATER••MAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
ON SEPARATE SHEET
(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.
During all well drilling operations, the applicant shall take appropriate action to assure that
any and all water or waste products from such well drilling operations be contained on this
property and in such a manner as not to degrade or otherw' contaminate- surface or groundwater.
Date of Issue: '� l f 19_
Date of Expiration 19�� Permit Issuing Official
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. I s Orange copy: W 11 Driller
fail Y A�.A o �,if� 11 ��j
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
March 1, 1995
Robert and Jacqueline Nelson
1706 Morningview Drive
Yorktown Heights, NY 10598
-' '-6RUCE-- F? FOLEY, R.S.
Acting Public Health Director
Re: Variance Request
Nelson, 159 Tanglewylde Road
(T) Putnam Valley,
TM# 83.58 -1 -6
Dear Mr. & Mrs. Nelson:
You are hereby advised that your request for a variance from the provisions of
Article III of the Putnam County Sanitary Code and''the standards of the Putnam
County Health Department relative to the design of a well to serve the above
captioned property has been considered by the Putnam County Board of Health on
February 27, 1995 and has been approved with the following terms and conditions:
o...Wel1 to be double cased
2. Ultra Violet disinfection to be installed.
Be advised, as built approval is required before the well is to be put on line.
Please contact the Putnam County Health Department for further information.
Very truly yours,
Dr. Michael Schoolman
President, Board of Health
MS /BF /jp
cc: BI (T) Putnam Valley
Pf1.OJECT I.D. yUMBEri 61721 SEAR
Appondil C .
State. Environmental Quality Review
- _ SHORT: -EN�IIRbUMIENTAL. ASS9SSMENT FORM -_
For UNUSTED ACTIONS Only
PART I-- PROJECT INFORMATION (To -be cornoleted by Apolicant of P�clec: s=ersor)
1. AP?4CAW VC14SCR y. PAOJEET NAME. }
Robert. rlei ;on, Well Vitriance Reailpst I
Muniaoallty l.,Lk � . Peekskill Counry Putnam. 1
A. PRECISE LocAncy Street actress and road intersections.;rcmment :anamarKs. 4tc_. :r :raKt! Ma01 I
l j4 rj';r1 (e�`•,ylcli Roe d
e k.r "ir,?: 1i :', New York. 10537 :
5• IS PROPOSED ACTION:
Naw Ex 7in�IOn MOfJlfiGittOn /alteration ;
8. OESCA18a PROJECT 3R(EFLY:. r q
r i .''ox one fumil,y, one bedroom House
7. AMOUR' IF LAND ;F=:-`:-E0: n a
a; Ci size I
o c inte Of l�' d'
Initially acres Ultimately aces
8. WILL PROPOSED AC7;CN COMPLY WITH EXISTING ZONING OR OTHER EXISTING :ANC
Yes I_ 'No It No, describe briefly
d ic_t,- rnce sepration of septic
and well limited.
9.. WHAT IS PRESEN' LAND USE IN VICINITY OF PROJECT?
4•: r
Regjuential '� Ind El ustrial Commerpal C Agriculture _ PsrkF=W C.en 3CaC8 Omer
DeSt:ribe: '
t,a1.ix'< :. not change
10. OOES'ACTION IRVCLVE A PE;3M1T aPPROVAL 68 OUROING, NOW OR ULTIMAT`_Y F=Cv ASY' OTHER d6%i&NMcNTAL AGENCi (FEdErA L _
STATE OR LOCAW?
Yes U_ vo It yes. list agency(s) and perrniUaoprovats
i.riStullation permit.
11. GOES ANY ASPECT OF THE ACT. :►I HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? -
❑ Yes ON- If .'yes. !lit acency namij and permitlapprovd
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION?
O Yes .i.d.No
1 CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO ThE NEST OF MY KNOWLEDGE
Appllcanuspcnscr name: _Robert Nelson' oaty:
t .
SI.gnatu :o:
if the, action is in the Coastal'Area, and you are a state agency, complete the
Coastal Assessment Form before proceeding with this assessment
PART 111 - ENVIRONMENTAL ASSESSMENT (To be completed by Agency)
A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.127 If yes, coordinate the foinoxr process and use the FULL EAF.
Y4s ' No
,'a. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR. PART 617.67 if No, a negative aeciaration
may be superseded by another involved agency.
Yes -- �io
C. CDtTC1C a("iZ°fdRESUL'T.`N "dNY DV&SE EFFECTS ASSOC:ATED WITH -TAE FOLLOWING. :An*s*drs'map:oa.nanaantten•
C:. Existing air quality. surface or groundwater aumity, or, quantity. noise teveis. existing traffic - atterns. saiia baste ;roauctton or disposal.
Polemist for erosion. drainage or !Iooding prootems? Explain briefly:
C2 Aesthetic. agricultural. arc:iaeotogical. historic, or other natural or cultural resources: or community or neignbomcca wiaractet? Explain onsfiy;
N�
C3. Vegetation or fauna. `isn. snellfisen'or wildlife species, significant habitats, or threatened oc endangered species? Explain briefly:
Cs. A community's existing :tans or goals as officially adopted. or a change in use or intensity of use cf !and or other natural resources? Explain briefly
'V 0
C5. Grown. subsequent :eveiaoment, or related activities likely to be induced by the proposed acticn? Exciain oriefly.
1tl
C6. L:ng term, snort term. ::;mutative, or other effects not identified in CS-05? Explain bnefly.
N
C7. Cther impacts (Inducing : ^anges in use of either quantity or type of energy)? Explain oriefly.
D. IS THERE. OR ISrTTHHERE LIKELY TO BE CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS?
[Yes LUNG If Yes, explain briefly
PART III — DETERMINATION OF SIGNIFICANCE (To be completed by Agency)
INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant.
Each effect should be assessed in connection with its (a) setting (I.e. urban or rural); (b) probability of occurring; (c) duration; (d)
Irreversibility. (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that
explanations contain sufficient detail to show that all relevant adverse Impacts have been Identified and adequately addressed.
❑ Check this box if you have identified one or more potentially large or significant adverse Impacts which MAY
occur, Then proceed directly to the FULL EAF and/or prepare a positive declaration.
'Check this box If you have determined, based on the Information and analysis above and any supporting
documentation, that the proposed action WILL NOT result in any significant adverse environmental Imps is
AND provide on Xtachments as necesIM, the reasons supporting 4his determination:
S -Na;;--
ame o ea Agency
C d� + �rfitN f
Znt or r /aff'eResponse i in LVU Agency Title or Responsible Officer
ignatu ead Agent Sirawre *I Prepaw tif different frorn resporutble o icer)
r' •!`49'0.J!••Wjt e�.. i ^• y. ..• -.a:% _�. ..Pate� "�. �. _ :7 a a �' r •� :� :.'• i...•�
• �'S S:' �`'. �" 1` �ti•. � :�.' ,.. � - .,: .�.'` „• � ♦ ; .. -. � a, ��;', � � '• �± sus � :,y� ,....
. ,_ ... .. ...?. .��.` '�- `rte- ^x�.•s'�'` :-L. a��. _. _,_... .
`b
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i
December 12% t"
.y I
Putnam''-Gounty Board of llealth
Yresiden.t of:Boar..d,.`Dr Michael'Schoolman
P riam Cotrnty Department':o.f Health,
4`6 e A
`Road
;13rewst er; N16 York '1.0509
Vari�ance' for well int lat�, o M
RE •
159 . Tarigl ewyl:deR�$,Fs� \��
, ,:,;�
t
Lake T.
Tax
Z a clap .# 83 '5 8 ti
^
: a
Dear••, Dr, "Schoolm ,rr,
s ls..a f�.tma'l `req�.test for a variance for-.an instal!l:ation,,
of 'a well for dornesti.c water -at the above c:apt honed. cation. !
We' are requesting approval of the installation' ",of a' well on
t}.re.. Drily' l.o.c'at lor►, that is. possible to .reach with the
r >c7u.iprneirt necessary to drill the well. The ..9rad:e make.s.. an .
irllrnedlate ,.sharp rise that is much to steep for equipment to
1 itth..
The - well. Will be located in chose proximity ag' ahe
welly - that, is serving the house directly in. fron;t of•?ours
Ir 'wall,, be about 50 feet from the well _that. sex'ves 'they house
just 'north. of o.ur property. Both of t'he existing weals Have
beeri• .tested and prove to have no problem with contamination
i)ii our properly is a lovely orle bedroom house .that has. been
G011113, le renovated and upd4ted. It is however 'o ly supplied .
iqi th" water Trpm the Lake Peekskill Water' District for,,'s en'
i�iotlt- is ,6f t -he yea r.-., The d:istr..i..c.t. water, is rusty, d.,rty .,and
r: e`tl:1 y 'not, :'.good water. The balance oT the year:, f ve`;inoriths,
tiYe\, ha" e. ab:solUtely no water .source. Without vour,:approval of '
1 i °,is request the house is worthless. We might as well: c.l:ose
i.t, lock -the cjoors, arid let it rof..
I. ha.ve. enclosed .l4 co1Aes of the following:
1', 'T hi' s..1 ettE:r.
2,..Co.,py' o-f .reject.ion of well permit.
'+ 3, •Dra:w,ing 'of the location of the proposed well.. arrd'':th.e
sur1roundi.ng structures and septic systems. „
' 4, Drawing' of the location showing the grades. The - drawing..
Shows ,that the only system above . the well location: is ;90 feet
away, `only 10 feet under the desired distance.
5, A copy .of a. sut'vey to show the sha} ?e of the property..
6, A r�ecert t ce r t i f ica to of' occuparicy. issued by the ; To.wn of
Putnam Valley on June 23, 1994, to document the property
j is a.legal towelling.
7, al copy of ttre laboratory repot ~ts on -tile we11s -.o.n the
..O'Brian acid Bianco property which are the same distance from
A' t:
the exs.tzng ssos as, the proposed well would be, 'f�,hy '
labor ato;ry reports show' that the wells are OK . y
8, A. letter from Mr "Bianco', signed at mss request, stating he
has .rro ab0ee ion.:to :the.' .variance be grant ed.
Pleaee mote that ;the Prop;osed._well is '90 feet fom,ne ssosi S
thai > zs above the well and that .the other wells'` °t��tLsam'e
F T } � � �
area ax'e riot .effe:cted in ":a 'ne:gativ.e .w'ay The ath
'h
oGate 11tUC ower on:.gr
h l:ade . than ,the propo
are Sl d
C Y •ti f - 4 F 5 :Y3ji . p Sf PJ,J 4 j 4 7 "��
forix'R1h t :Frea Qn should not be a problem for
MAN
°I. understand that it `is the _concern o;f. this bgar r,� "gct:
'the :;hea'lth of the`res.iderits of this dwelling Wes; are`iailling
to do t.h6 'things ,necessary to attain that goal We ;are'
wrll'ih g -to .doub]e. case the. 'well even .to extra depth to
P'r.ot.ect. the `welI.. We are . will in
g' . to perform annual ;water
L st's.,t;o• assure the safety of the water.. Sho.u'1d it be,
ne,cessar . we c: =il_t install are ultra violet treatment, dev' ise� to
Purify .:t }ie Ovate "r... 'We are. certainly open to further :{
sugg.estons..:from '.the -bo a
Ybur: favorable decision 'regarding this variance request' ;is
v:er.y 4..r.gent'. This.. riroperty i.s. worthless without. this well.
'�-1 r s: Nelson and I would . be most pleased to attend the me.eti n'g
regard ing this" variance in order to answer any- questlo,ns -t'he
board. might: have. concerning material with which" we,would be.:
Sti1CICIE?.L \'
�:.:,
{2ut,E:r t. acid Jacdue.lire ivc.lson
17 06 Morningv:i ew Dr:i ve
`o: - kto,wn Heights, New York 10598
911•= 962, - 43241.5
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New York 10509''
(9141..273 =6130 - -
APPLICATION TO CONSTRUCT A WATER
&'iC4 :R�1TT' #
ILL E.00ATION
Street :Ad teas
If 9
Town Vill ge Citgr arc c ;,beat -
t-A ��
_
e�
-777
we i�aili q, Addr��s
.
WELL OWNER
di7o
� ��I9'�IAL PUBLIC SUP LY
® AIR /C 1O��
USE OF WELL
primary. • .
$ ®FARM
® TEST/ B5
a - �ecosadasq
`�[ !r AL INSTITUTIONAL
® STAND�B
t ...
AMOUNT ,VS�
, QW PEOPLE
SERVE D
(
F
: �»` �". � �- � STING SUPPLY �° Q�..ItST /0$SERV�,�
REASON �y �p
dVCe6'�SON �OdM,�U.e r '`
DRILLING."-,
SUPPLY NEW
DWELLING), 13 DEEPEN
�.2
E r L
j .
! DRILLING
1
...
j WELL TYPE
DRILLED
®DRIVEN
®DUG GRAVEL ..
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES _FAO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
WATER WELL CONTRACTOR: .Nameg"j AddFe:.
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES y,
NAME OF PUBLIC WATER SUPPLY: 1- AI�0- &- vie -114! TOWN /VTR./ IT9(. I �a-
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
®ON SEPARATE SHEET
(date) (Sig
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
thirt -% (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 Departmen
During all well drilling operations, the applicant shall take appropriate action to assure that
any and all water or 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
Date of Issue: 19
Date of Expiration
Permit is Non - Transferrable
V89
19 Permit Issuing Official
White copy: HD File, k.ik.:co;py: Owner
Yellow copy: Bldg.'Iiisp. Orange copy: Well Drille
h
r•
i ' • it r., - :r yi � Idrl4h 7('t2 k5�5 `l1 d 5 1�. 5 ,� try. i t� �
CBl1ZTIFiCATB OF r.000UPANCY Intxgn
n
Certificate of Occupancy No 94 100•.., Application No. 93 592 `
t.ocation .of Premises Tanlewylde Road - 'TM #83 58 -1 6
Robert Nelsen of 159.'Tanglewylde Rd. Lake Peeksklll,NYg
a.. ....
heretofore filed an appplication for a building permit pursuant to the Zo Ordinance, sanitary'
Code and the Laws in effect in the Town of Putnam Valley, • Putnam • Co, New 'York • having;
paid the 'required fee therefor and the `undersigned having by personal ; tion :ascertained that
inspec
the ap licant :has au, uentl roceeded with she erection or. . im rovemel7t oi;''the ro struc-
r '�... pp, Y p P P. Cdr'; .
cure • -in, com' Hance with : the . requirements'' ot':the ` laws as. aforementioned; and" Abat the said : work,,
and mate `met"?every requirement. of. the. laws as aforemegtioned,.and that'the premises' have
now been fully com leted,.•and, are ready,, for occupancy, pursuant to 1 the provisions .of Lw, ,Now,
therefore, this cate of occupancy isi hereby. issued under the seal , of 1bw Putnam,'
the
„ Valley ..this 2 3.. day of .. Ju ne . ,19..9 4
i Not :valid, unless, maned in ink -by a duly authorized agent TOWN OF .VAJJ SY,
1 £; of and under,,, the seal of , the Town of Putnam Valley.
I r
1414-4 =71—Text 12 _ t
Pf10JECT I.D. NUMBER 61721 SEOR
Appendix C .
'State Environmental Quality Review •: :,
SHORT ENVIR&NMENfiaLA SESSI�f�T °t�t�R�IR- -•
Y 7,
For UNL;STED ACTIONS Only
PART 1— PROJECT INFORMATION ITo :be comoleted by Apolicant or F•Dlec, s =crsorl
I. APPLICANT SFCNSCrrl 2. PgO.lECT VANE
Robert Nelson Well Variance�
3. PROJECT L OCATICN: '
Munimoauty Lake Peekskill county Putnam I
♦. PRECISE LOCATION Street address and road intersee:wns. arcminent fanomancs. etc_ __r :rcy+ee maao
159 Tanglewylde Road
Lake Peekskill, New York• 10537
5. IS PROPOSE) ACTION: I
c-f r I
New _ Esaansion '' � Modificationlalteration
6. DESCRIBE PROJECT BRIEFLY:
Drill well for one family, one bedroom Douse
7. AMOUNT OF LAND AFFECTED: no change of land size
Initially acres Ul'mately aces
8. WILL PROPOSED AC ,CN COMPLY WITH EXISTING ZONING OR OTHER EXISTING :ANC '_S_ =_. FZICT:CNS?
CJ Yes ! No If No. describe briefly
However distance sepration of septic and well limited.
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
Residential ` Industrial D Commercial C Agriculture _ ?3.•+cFrest.'C:en scace Omer
Describe:
Total area is residential, will not change
10. DOES ACTION INVOLVE A PERMIT APPROVAL OR FUNDING, NOW OR ULTIMA7ELY F =CW A.%rY OTHER GOVERNMENTAL AGENCY (FEDERAL
STATE OR LOCAU?
❑ Yes IX No If yes. list agencytsl and penniUatiprovals
Only a well installation permit.
11. DOES ANY ASPECT OF THE ACT, :PI HAVE A CURRENTLY VALID PERMIT OR APPP.CVAL7
0Yes OW: If yes. Rit acency name and permit/approval
r
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION?
Yes Aallo
CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicantlsponsoe name: Robert Nelson /11 22.149
Signature: 7\).A
If the action is in the -Coastal Area, and, you are a state agency, complete the
Coastal Assessment Form before proceeding with this assessment
_ ._.... OVER
� •i,. � ...� :r ter. i•E ..'i + .„i -�Z .�'..'��.'�• 't'•�,• •�.:�•t�a•���.. �.
�PAR'T 11iENVIRONPOENTAL. ASSESSMENT (To be completeq oy.Agvrityl .
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A POr•E1S ACTION EXCEED ANY TYPE I THRESHOLD. IN 4,NYCRA. PART. 617.12? It yeu ccaro)nate tho rc;mw procaw and use f)tc9 FULL EAF.
C.: yes ONO.
.
e. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN a NYCAR. PART 817.81 " If No: a nogative declaration
may be superseded by anolnerinvolved agIency.
(' Ye. r-- Nd
C. in 1414. . '!Cj1.fiFeJL': rk ANY. ADVERSE EF. ECTS ASSOC:ATED WITH THE FOLLOWING. :Answers flay bo nandwritten. -f ;ogibiat
usurrg air Zualily..suria . or grounavrater ausnty N. "Cu , Ilty noise lovols. Oxisong trbific - alterr%L sdilri .`mtsa :o';„udut :!art ;or :aa;COgat�
:otenpa, for erosion. irainage or 1000ing proWenls? Explain briefly:
CZ Aestnet,c. agncutturai. wt.naeoiogical. nisionc, of other natural or cultural resources: or community or neignbomcdo;Aamctef? Extilatri brtetly:
C3. v.t ,gallon or fauna..lisn. anetilisn or wildlife species. significant hapitats. or threatened or enoange(ec- sakids? Exptatn.bn@Hy:_
C•s. A cwntnunityls @xisting,:ians or go3sy,as otf c;aily A000teq. Ora Change in use or intensity of use cf !an6 ;Of other,riatural resources? Explain briefly
•
C5. Grc"Kin, subskuent :e�eiaUittent. ar reiated activities likeiy lobe induced oy the proposed ae:ien? Exciutn prlolty . 1
Co. L: n; :arm, snon te:m.: :anuiative• :;r otner eifec:s not identified in C:-05? Explain Briefly:
C7. Ct: et :mcac :s ttnciucir•g :ranges in-use of either quantity or type or energy)? Explain cnofly.
I
D. IS THERiE. OR IS THERE UKE: Y TO BE. CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? '
i!Yes' [1 No it Yes, explain briefly
k PART Al- DETERMINATION OF SIGNIFICANCE (To be completed by Agency)
k, INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important .or•othefwise,significs nt.
Each effect should be assessed in connection with Its (a) setting (I.e. urban or rural); (b) probability of. occurring; (c) duration; (d)
Irreversibility:. (e):geographic scope; and (0 magnitude. It necessary, add attachments or reference supporting materials. Ensure tfiat '
explanations contain sufficient detail to show that all relevant adverse Impacts have been Identified'and adequately addressed."
❑ Check this box if you have identified one or more potentially, large or significant adverse Impacts➢ which MAY
occur, Then, proceed directly to the FULL EAF and/or prepare a positive declaration.
❑ Check this box it you have determined, based on the Information and analysis above and any supporting
cu
domentation, that the proposed action WILL NOT result in any significant adverse environmental imps is
AND provide .on attachments as necessary, the reasons supporting 4hls determinatiow. .
Name of Lead Agency
i
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Prmt or tvyi: Name of Response le O tier in lead Agency lide of. Itesponsibb Officer.
aixr�arure o Ri�esp+ns,- 5�7iicev`ui tead'Agrncy SiM wry W Prepater (it diffm-nt fr9m fripmillwa Officer)
.t T���Ji -TOOT •h ` .-. '.. . S. at2- `�. - � ✓ a a. •y � .Z i r�— 1. ;��_7.
} • -� 1 ~ • : I ' _ -: � -rte •• � ' '::; �, 3 ; 4.. � •s•l•� � �. a/'f;�
YM1. ENVIRONMENTAL SERVICES
321..Kear Street
t Yorktown Heights, N.Y. 10598
k (914) 245 -2500
Albert H._Padovani, Director
.O'ri :l.• -. a •L'- .. i_ • ,. -F 4'w -\ Y :N_i "1 !'ro•. s -. /f}!!f' f nip• .`AA r.'R'YL1•n .. . •. '. rn, K.
LAB #:: 32.'404231. CLIENT # :. 1917 NON STAT''.PRC1C -PAGE.. '
ld- -- IJ —II—--------- — ------- -IJ—II -------------------
b NNNNNNNIJ,N NlJ1NN NNNNN
NELSON., ROBERT., DATE /TIME •TAKENa;, 12/23/' 4'
1706 , MORN INGVIEW' DR DATE /TIME REC'i7.: .12/28%94 iF.: 3
YORkTOWN.-HGTfi, , NY , 10. 98. REPORT DATEa ^ 12f30Y9q '
•
. PHONE;: (9 ]; 4) .91x2 -4241.
�AMPL LNU `�.I TE' 155 . TANCLEWYLDE :RD KITCHEN TAP SAMPLE' TYPE POTABLE
�,. _A
„I Al E' PEEkSI ILL, =NY "ESE AT I VES • ' K NE
�`��L �� . E+Y RO�+EFt.7 NELSON'. TEMPERATURE..::,
NOTES., • r, ° t t.
FF4C
JNI ! N/ !/ NN NNlJlJ JIJ JlJNN NN NlJNNNNNlI JlJNNNNNIJ IJ IJlJlI NIJ IJ NlJYJNNN NNIf/��G�I�IFORMMMET
t
GATE FLAG PROCEDURE; RE$,ULT -F7A(.
.•' . .. • -,..E - - :nk c'�i[ x 4 1 v it , l t ,
lip i (
12/ X0/.94+ : MF T, COL I FORM ABSENT.
/ 100 •ML ,1f } t ABCENT
COMMENTS
BACT THESE . RESUL'TS 1 I IUD I CATE., THAT THE WATER ( WAS ( WAS NOT) &,-.A'
`3ATI'S FACTORY SANITARY QUALITY - ACC,OR I : THE ..NEW Yl'1Rk: �'TATE
AND . EPA. 'FLDFRAL DRINKING WATER .STANDARDS,, FOR . THE , PARAMETER$
TESTED . AT , .THE TIME . CiF COLLECTION..
SURM I TTED BY • ---- __ - --- -------------------
-Albert` H..'' Padovani, M.T.: (ASC.P)
Di:recr
,t,r.: + EI_AP# 10323.
YML ENVIRONMENTAL. SERVICES
321 Kear Street
Yorktown Heights, N. Y° 10598.
(9 14) 245-2800
Albert H °'Padovani., Director
arc •- . . . p.: • : n.i • r 9 F v _ r. - Yl, "•... F.. ... •�•IM.l C. 1wl a'1 t:
LAB #: 32. 404232 CL- ENT � s 19.17 Nt�.1N BTAT . t�ROC PAGE
_+�• /rN /rN r /r /r N/r IJ/ /J fJNN N/J /JNNN NN NNIJN/J /I /JNNN /J /J /JIJ /J IJN NN /r /r /JNIJ IJNNN NNN N /IN /INN /J IIN /JN /JNNNNN/
;
` GATE. /T %�ETA_ 12/28/ 4:`'.
NELSON,.. ROBERT
h.. 1706 MORNINOVLEW DR DATE/ TIME REG:'Da::12 /28/9.4:1U
?, YC►RK.TtIWN `HGTS._, '.NY 1.0 l3 RFPOR' DATES 2/ 0%•94
I,.
t; PHONES (,914) 962=4241
' SAMPLING ITEo 157 TANGLEWYLGE RD KITCHEN TAP SAMPLE TYPE ° °.,s POTABLE
LAKE PEEKSK ILl_,:.NY ,. � P E RiJ,�IT <I VESs: '. NOPIE
COL ' [i BY: ROBERT NELSON TEMPERATURE ° C 4C:
NOTES. ° ° ° GLQI, %FO►RM METH4 MF
NN JN YN ♦N' , N NNN / NNN
NN N r INNIVNN ..,{
. ` N N rpN�ITk }MFINKy/414NH1• (VNN NN NMN N
DATE FL Aim PROCEDURE / RESULT, Rt�NGIF r
54,r �L M.c•nty\ xl �.4 ` {: t 51'
1.2 /;30/94 MF T ° 1_ OL t FORM . ABS ENT - / 100 . P9L Y RBA ENT
4, {
COMMENTS'
BAGT THESE RESULTS. INDICATE. THAT THE WA T
ER
( A
S N T
).OF.A
SATISFACTORY .SANITARY QUALITY ACCORDING "HE
•
NEW;.YORK,'-ST
ATE
'r AND EPA FEDFRAL :DRINKING . WATER STANDARDS,' FOR THIS PARAMETERS
TESTED i , AT THE `T I ME. OF C OLLEC:T I ON.
fix, •
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December,; 19;94 "
Putr am, County Board of Health. -
r.esi.dent` of,,Board, Dr Micheal .Schoolman
Nutnam, C.6unty Department of - Health
4 ,Genera -Road,`�
l;rw41tei , }New York 10509
h y F + • -:�t '',ytish} �,, y'�" Jx �f fiF > N;�i� a a . t•
y� � - l' - � n �- �kfsiL AT�� 1. •i''St�,. tit.M, ; >y! � i /l' , - ,l^ 5
F," Rt✓: Variance .for
159. TangIewylde
.Lake Peekskill
Tax Map # 83, 58 -1t 6
Owner: Jacqueline and Rp;be>rt "Nelson
ljlvrr own t�coperty adjoining the .above captioned .property.
i lWe utidiL� r•--; t.,and that Jacqueline arid. Robert Nelson, are .'• :
rlo.q Uesti.r,5 a variance from the Board of Health of .Put nam'
Courity, in order to install a well on their property to.-
:;u w'.at_or to their house.
{,`Wc ua,�i� r::t.�xnd that .t.he well will, be' located, on': the most
i:.,;terly por•c.iori of .their pruper•t.y. This loca;t. or!'' s• at. the
Of Ahe itairs arid is., appmacha.bae by ,equ'x` t n.o' ded--
-iT i 1. t. t.•i� ! -well .
tithe. !,o objection to the board granting a `►�►t',3$nGe or
tiF.: arlsLi<,,l.1.4tt.iu of t,e w ll.
-i
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).l.p;r,[ t,lrt;
Atldress
db
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t vWr1,at.dlN ;
�uk;ulitted 'to tt-�e board by:
JtecctuelirIe <tiid Robert Nelson.
1106 Morningvie.w Drive.
`� c,rkt:uwn lice i i, AS , New Vork 10598
;i14- 962--1 'Al
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'.OFFICE ON AIAY ed, 124`9 ASV,4P1V-91d5�
70ISEXqER W17R. A 6-S FT. W IDE ACCESS
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subsequent Bank. Title Co. or Owners
BROUGHT TO.DATE.... KE�VIN
ATS W_.
map and copies thereof only if said map or
JOHN SALVATORE ROMEO.
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4
I NORTARIDGE ROAP "it
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by the New York State Association of Pro-
FILED IV.4P AM 1,65,F NOT FOUVD, 711,C
ZoF7_-R,WIA14T10N OF Tye L,W,65:
`q,5EI) e
-7-V M0410106,V7.4rIOAl AND
6 0;r1?;CR. 4rcle 70 THE L4cle
OF ORIGIM141 ?-f0,VV1W--N7Wr101V1*
0.,- 61P TO / ^r - /,V 4 NORTHERLY OA? ,50ulsmeRly
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CERTIFIED TO:_
IM
SURVEYED . Certifications hereon are valid for Bank, SURVEY OF PROPERTY I
Title Co. & Owners for this transaction
.
BROUdkT Id 6A*'••.'• _ only ce'rifi-t;—, a,. to FOR
subsequent Bank. Title Co. or Owners
BROUGHT TO.DATE.... KE�VIN
All certifications hereon are valid for this
LEVEWCH
map and copies thereof only if said map or
JOHN SALVATORE ROMEO.
. copies bear the impressed seal of the zur• SIT PATE INJHE
Go-Wimg Enizinter & iAnd SuTtACYPT whose signature appears hereon,
TOWN OF, PUTNAM VALLEY
I NORTARIDGE ROAP "it
hereby Certified that this survey was POTNAM: COUNTY
P EJE.KSKILL. N..Y... w
prepared in accordance ;th the existing
Code of Practice for LandStirveys adopted -."NEW YORK"
by the New York State Association of Pro-
P. E. & L. S. NYS LIC. NO 027"6 fesoistnal Landlurveyom" SCALE.- I eo,
(rxS,9tPT W�64CRZ, kvTep�
ENCRJACHMZNT5.88LOW.'QItA0K SURVIIEVED AS M POSS6811111014
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DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
March 1, 1995
Robert and Jacqueline Nelson
1706 Morningview Drive
Yorktown Heights, NY 10598
BRUCE R. FOLEY,• R.S.'
Acting Public Health Director
Re: Variance Request
Nelson, 159 Tanglewylde Road
(T) Putnam Valley
TM# 83.58 -1 -6
Dear Mr. & Mrs. Nelson:
You are hereby advised that your request for a variance from the provisions of
Article III of the Putnam County Sanitary Code and the standards of the Putnam
County Health Department relative to the design of a well to serve the above
captioned property has been considered by the Putnam County Board of Health on
February 27, 1995 and has been approved with the following terms and conditions:
1. •'4611 -to- be double -cased
2. Ultra Violet disinfection to be installed. «~
Be advised, as built approval is required before the well is to be put on line.
Please contact the Putnam County Health Department for further information.
Very truly yours,
DWMichael Sc ool
President, Board of Health
MS /BF /Jp
cc: BI (T) Putnam Valley
February 20, 1995
Putt -a.m Count <' Boa:rd of 11e cal th
Actin,_:? Public Health. Director, Mr Bruce Foley
Putnam County Department of Health.
4 Geneva Road
Brewster, New 'Co r I.- 10509
RE: Variance for well installation
159 Tandlewylde Road
Lake Peekskill, New York
Tax Map 4 83.58 -1 -6
Dear Mr Bruce Foley,
Enclosed please find six mail receipts. Five of the receipts
are correct. One proved to be in error.
I mailed out the meeting notices and received a call from Mrs
I:igon advising me of the error, in that she was not one of my
neighbors. I checked and found the correct address and sent
the additional notice in a timely manor.
The proper Na.rne and address was; Gertrude, Robert, and John.
Russo, % Erwin_A. Fehsinger, 3007 50th Street, Woodside, New
York 1.1377.
I have enclosed a.copy of the .map showing the address
correction.
I believe this completes my preparation for the meeting of
February 27. 1.995. which is scheduled for 7:30 PM. I look
forward to seeing you and the board at that time.
Thank you.
S.ince.rely,
Y bert and Jacqueline Nelson
1706.Morningview Drive
Yorktown Heights, New York 10598
914-962-4241
Y
I stILL HAND DELIVER HYSELF
SUB-MIT .TO THE "SPECIFIED ,DEPART` M FOR .Im.- _
SIGNATURE - r --
APPLICATION FOR PUBLIC ACCESS TO RECORDS
TO: RECORDS ACCESS OFFICER DATE:,
Name of Agency
Address
JOSEPH L. PELOSO, JR., PUBLIC
INFOR'iATION OFFICER
I HEREBY APPLY TO INSPECT THE FOLLOWING REC08D:
nature Mare
Ire I-f
Represencing _
,%ailing Address
FOR ACE.YCY USE ONLY
APPROVED
DENIED
Record of which this agency is Legal Custodian cannot be found.
•' Record is not maintained by this Agency
Signature Title Date
r
NOTICE: YOU HAVE A RIGHT TO APPEAL. A DENIAL OF THIS APPLICATION TO THE PUTNM
COUNTY EXECUTIVE.
Name Business Address
i.'HO MUST FULLY EV --LAIN HIS REASONS FOR SUCH DENIAL. IN WRITING SEVEN DAYS OF RECEIPT
OF AN APPEAL.
I HEREBY APPEAL:
i
q„ Cap
t
PUTNA 1 COUNTY DEPARTMENT OF HEALTH
Date December 15. 1994
TO: Robert & Jacqueline Nelson
1706 �lorningview Drive
FROM: Bruce R. Foley, R. S.
Acting I-ubilc ea
For your information xxxx
For signature _
For your files
Referred for handling
Attached as requested
Returned as requested
Please see me _
Read and return
COMMENTS: _
Enclosed please find Procedure for
Variance Request as requested.
DEPARTMENT, OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
Robert & Jacqueline Nelson
1706 Morningview Drive
Yorktown Heights, NY 10598
Dear Mr. & Mrs. Nelson:
UT
"r:BitUt E "'R: POLEY,
Acting Public Health Director
January 31, 1995
Re: Variance Request
Notice of Meeting
Name: Nelson
Street: 159 T ?iglewylde Road
Town: Putnam Valley
Tax Map: #83.58 -1 -6
Please be advised that the !utter of your request for a variance from certain
provisions of the Putnam County Sanitary Code has been placed on the agenda for
the next meeting of the Board of Health to be held on February 27, 1995 at
7:30 P. M. in our Health Department Conference Room, 4 Geneva Road, Brewster, New
York. You or your representative must attend the meeting to present your case.
Bd- &dvised, attached "Neighbor Notification requests must be satisfied.
Ver t ly yours,
Bruce R. Foley R. S.
Acting Public Health Director
For the Board of Health
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November 1, 1994
Department of Health
Division of Environmental Health-Services
4 Geneva Road
Brewster, New York 10509
RE: Construction of water well
159 Tanglewylde Road
Lake Peekskill, NY
Tax Grid# 83.58 -1 -6
Dear Sir or Madame,
Enclosed please find an application for a water well for an
existing dwelling. This dwelling has no permanent water
supply. Summer water is supplied by the town. This leaves the
house without water for a five month period.
I understand that the regulations require one hundred feet
separation.between the well and surrounding septic systems. I
have complied with that requirement by proposing the
installation of one hundred feet of steel casing to protect
the well and not only fulfill, but - exceed the one hundred
feet separation requirement.
The separation will be partly horizontal and partly vertical,
and in excess of the one hundred feet requirement.
I have not contracted with Mr Beal, I.did however enter his
_.. name on..the application because I intend to have him do the
installation when the'permif is issued.
If there are questions, or if additional information or
requirements are needed, please advise. You my reach me at
914- 962 -4241.
Your cooperation and assistance is greatly appreciated.
Sincerely,
C Vw
Robert 0. Nelson
1706 Morningview Drive
Yorktown Heights, New York 10598
PETER C. ALEXANDERSON
County Executive
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(914) 225 -0310
December 13, 1989
Fir. Kevin Leverich
Tanglevyle Road
Lake Peekskill, New York 10537
Re: Proposed dell site Lot 250
Block 55 of Flap 185F
TM #81 -1 -19 (T) PV
JOHN KARELL Jr., P.E.
Director
Dear Mr. Leverich:
I have received and reviewed the application to construct an individual water
supply on the above mentioned parcel. Based on this review and a field
inspection of the site, the application is denied for the following reasons.
1. The proposed water supply is 75'feet from the sewage disposal system on this
parcel. A minimum separation distance of 100 feet is required.
If you have any questions please contact me at your convenience.
Very truly yours,
William Hedges
Sr. Public Sanitarian
WH /Jp
1
•o
`i. S. ROMEO, PE. LS
JOHN.. S. R0.7 -F Q:
CONSULTING ENGINEERS do LAND SURVEYORS
1 NORTHRIDGE ROAD
PEEKSKILL, NEW YORK 10588
914757 -1056
April 14, 1982
Mr.'Kevin Leverich
Tanglewyle Road
Lake Peekskill, N.Y. 10537
Res Proposed well installation on
property known as lot 250 (Port)
Block 55 of Map 185F
(Lake Peekskill - Section G)
Dear Mr. Leverich:
I have reviewed the proposed well installation for the above
property. I believe that a well can be installed as shown'onthe
accompanying sketch, that should function satisfactorily and safely.
The properties west of the proposed well installation are over
200 feet from the proposed well. The only SSDS to be concerned with is you]
own system. That is located on the southeasterly side of the house
at"a much lower elevation than the proposed well installation.' The
proposed well will -be a minimum of 75 feet from your own septic
system. Properties on either side do not have any septics in
this area that would be of concern with the well installation.
The provisions of the Town of Putnam Valley Ordinance dated
May 17, 1978 must befully complied with: i.e.... Well to be double
cased with cement grout between casings; laboratory testing to be
_ made "to. = insure _ -notable, water; casings to:be -a minimum of 10 feet
intp bedrock.
If for some unforseen reason,.the bacteria count becomes -
excessive, then additional measures will have to be employed, such
as the installation of a chlorinator and /or a filtration system.
Very truly yours,.
8John S. Romeo
P.E. & L.S.
JSRs dlx
ccs Mr. Marvin Odell, Building Inspector
with accompanying sketch
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A - ORT /ON OF LOT Z$O'BLOC& $5 AS JrA �
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PEEA4S,r /LL SECT /ON'G SA /D MAP S�PKE Y' PpLE� A N �I �� �EN�E i
F /LEO iN THE PUTNAM COUAITd'CLER,r3
OFF /CE ON MAY 28 /9P9 /QSMARN$/BSF c " k y �NAI, p/OR _
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TOGETHER`' iV /TH %A jj S FT. W /OE ACCESS V1 ` s ' y l0 (u
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THE ORIGINAL. /' /.O.LGsYENiS 'CALVE ^- ' "FOLt 5' \ " wal!`, nu z4 ' t y
F /LED MAP N —a 185,ocr /, T'FOUNO, -THE o'•:- " " -` t ��? m
- JETERM /Nr4T/ON OF THE L /NES'�SHOWiV HEREOV.
BASED' ON MONUMErVTAT /ON ,A.VD MAPS r
B Y OTHER $LJRf�EYORS ''OUE T,O 7fK LACK y , 2 ,
OF ORIGINAL MONUMENTAT/ON;'O /FFEREUCL°S"f R1 "D io x y j
OF UP TO / FT. /V A NORTHERLY Or4,SOUJh4'RLY 3 �a u 0
D /RECT /ON MAY Be- EiVi^IXJNTERED .8ETX/'EEN
OTHER ; SURVEYO4S r
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CERTIFIED TO:
.k TANS ,
Certifications hereon are valid for Bank, t
SURVEYED: MACH 6 /982.: Title Co. b Owners for this transaction.'
SURVEY OF PROPERTY
only. CertiFicatiuro ere not fiansferebie io FOR
BROUGHT :Td DATE_ - y' - r,•
subsequent Bank, Title Co, or Owners.,,
KEVIN
BROUGHT TO DATE.+Akt,t<'
mlep and copies sthereof only if said d mephor , • LEVER (C H
JOHN SALVATORE ROMEO_ ','.map
copies bear the impressed seal of the sur. SITUATE IN -THE 4'
(;on.xnhing Engineer & Land Su+i:eyot ` "= �Jeyor whose signature appears hereon.
TOWN OF PUTNAM VALLEY
1 NORTH RIDGE' ROAD' 'Hi;'hereby certified that this survey was PUTNAM COUNTY,
PE KSKILL. N Y prepared in accordance wifh the existing j
/
/`_. �.�i .. ti�e'+�•o - Code of Practice for Lend Surveys adopted -
NEW YORK
Bydha New York State Association of.Pro -. z,.-:
'
P. E. Bt L S NYS LIG. NO OII a
�u •.
rveyon SCALE: 1 '' ZO'
'rF X -i 7r .IEXGR P.r' WNGRC NOTGD• t _
•' hNCRGACHMENTS BELOW 'GRA06 IRANriNO�•
�{ y / ry SURVEYED A8 IN 'Pf789E8910N
r
.. i � i. •:, q' .e,`�;r'e,,,'��- .�T..: Cd:�. �'�s s iv�aii q, '�L' f +.
John M. Simmons, M.D.
PUTNAM COUNTY HEALTH DEPARTNENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
Deputy Cammissioner of Health - FIELD ACTIVITY REPORT Sheet of
INSPECTION
NAME /�Q (/ i .� i / .�v �` 6• _ Orig. Routine
) _ Orig. Complain
ADDRESS �/ h y % vr/�� !✓ �O` _ Orig. Request
No. Street Town TM No. - Canpliance
Complaint Camp
MAILING ADDRESS _ _ Final
P.O. Box Post Office, Zip Code _ Group Illness
TELEPHONE ;.
1 P // rte" , ' _ Construction
PERSON IN CHARGE
OR INTERVIEWED
Name and Title
DATE Z TYPE FACILITY
TIME ARRIVED fin TIME LEFT
Reinspection
Field, Sampling Only
Field Conference
Other
FINDINGS:
/ /'AF J J � � /'fit'% / ✓G''S S'� 4 ��r/ f i� C i . ��
Explain
INSPECTOR:
PERSON IN CHARGE OR INTERVIEWED:
I acknowledge this Field Activity Report. SIGNATURE:
6/86 TITLE:
TELEPHONE:
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
"'AfPI;YCATTON . TO 'CO9§TRUtT -A.. ATEk `WELL
PCHD PERMIT #%ls -s6�'
WELL LOCATION
Stree�ddress. . To Villa e City Tax
Fw . a f
Grid Number
-01-
WELL OWNER
iling d�d� ress Private
C ��,� rr L /Uy0 Public
E OF WELL
primary
2 - secondary
RESIDENTIAL OPUBLIC SUPPLY QAIR /COND /HEAT PUMP
0 BUSINESS O FARM 0 TEST /OBSERVATION
0 INDUSTRIAL C]INSTITUTIONAL 0 STAND -BY
"'EWANDONED
0 OTHER (specify
AMOUNT OF USE
YIELD SOUGHT_ gpm /# PEOPLE SERVED 57EST. OF DAILY USAGE al
REASON FOR
DRILLING
EJNEW SUPPLY 0 PROVIDE ADDITIONAL SUPPLY
AREPLACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL
0 TEST /OBSERVATION
DETAILED
REASON FOR
DRILLING
Y -P
et 2 Of
WELL TYPE
,*LLED
®DRIVEN
ODUG OGRAVEL
O OTHER
IS WELL..SITE „'.SUBJECT TO FLOODING? YES „ NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No. Z3"O
WATER WELL CONTRACTOR: Name�///p,Pjyj/a� Address:,( 0f&,!!,�'_ST/?lT.�/1J1 !/LY.
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES __X_NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
DISTANCE `TO PROPERTY "FROM NEAREST`W'ATER
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
[]ON �����
ON REAR OF THIS APPLICATION PARATZ
SHEFX
( ate) (signature)
PERMIT
TO CONSTRUCT A WATER WELL
This permit to.construct one water well as s.et 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:
19
Date of Expiration: 19
Permit is Non - Transferrable
2/87
Permit Issuing fficia
White copy:
Yellow copy:
Pink Copy:
Orange copy:
H. D. File
Building Inspector
Owner
Well Driller
PETER C. ALEXANDERSON
County Executive
April 22, 1988
' %- . ::: 'ENID .L'.'..CARRUTH, M.P.H..,
. ,.. �.. ,. .. .,. y,'. -, 'c .
I Pu�tilic Health Director
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(914) 225 -0310
Mr. Kevin Leverich
Tanglewylde Road
Putnam Valley, New York 10579.
RE: Leverich
Tanglewylde Road
Lake Peekskill
TM 81 -1 -14
Dear Mr. Leverich:
Review of an application to construct a well for potable
water supply purposes to serve the above- captioned property
has been completed.
Such review indicates as follows:
JOHN SIMMONS, M.D.
Deputy Commissioner
JOHN KARELL Jr., P.E.
Director
1. The lot is presently supplied by the Lake Peekskill Water
Works with summer water.
2. The proposed well on your lot s located approximately' 5 -
feet from the existing sewage disposal system on your
lot.
Recognizing the above, your application for a permit to
construct a well on this property is hereby denied.
If you have any questions, feel free to contact me at Ext.
304.
I ohn y rul yours
Karell, Jr., .E.
Director,
Environmental Health Services
JK:pt
cc:JK
File
o �
v
PETER C. ALEXANDERSON
County Executive
April 22, 1988
: ENID C:: CA.RRUT.K. Md::_H:._ . •..:.
Public..,Health.. Director
JOHN SIMMONS, 'M:D:
Deputy Commissioner
JOHN KARELL Jr., P.E.
DEPARTMENT OF HEALTH Director
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(914) 225 -0310
Mr. Kevin Leverich
Tanglewylde Road
Putnam Valley, New York 10579
RE: Leverich
Tanglewylde Road
Lake Peekskill
TM 81 -1 -14
Dear Mr, Leverich:
Review of an application to construct a well for potable
water supply purposes to serve the above - captioned property
has been completed.
Such review indicates as follows:
le The lot is presently supplied by the Lake Peekskill Water
Works with summer water.
The proposed well'on yourrlot is located approximately 75
feet from.the existing sewage disposal system on your
lot.
Recognizing the above, your application for a permit to
construct a well on this property is hereby denied.
If you have any questions, feel free to contact me at Ext.
304.
V ry rul yours
ohn Kare
Director,
Environmental Health Services
JKapt
cc:JK
File
e
Inspector
TOWN HALL
,..:.;;.:o- ::::�.,.. ,,... ... ,. - :PUTNAM=`VALLEY, .N.,�,.• .,, :..
(914) 526 2377
TOWN OF PUTNAM VALLEY
BUILDING, ZONING, AND SANITARY DEPARTMENT
April 18, 1988
Putnam. County Dept. of Health
Two County Center
Carmel, N.Y., 10512
Att: William Hedges Re: Kevin Leverich
Tanglewylde Rd. - TM #81 -1 -14
Dear Bill: Proposed Water Well
A review of the attached site plan by John S. Romeo
showing proposed well location on portion of Lot #250
in Lake Peekskill, the following was observed:
1. House presently limited for summer use only (seasonal
water).
2. Gaining access to well site with drilling rig not shown.
3. Adequacy of existing SSDS not shown (rock outcropings
.exist)..
4. Existing SSDS system approximately fifty(50') feet
from neighbor to .southeast at a, higher elevation.
• -5: 'Pro posed- well" does- not' meet " requr`ed" separation` from`"'
existing SSDS, seventy -five (751) feet shown.
6. Area for repair or expansion of existing Septic System
appears not to !exist.
9�
AIR
Yours truly,
r
MARVIN 0 DE L
Building Inspector
MO'D:es
cc: James Gordon, County Legislator