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04021
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DEPARTMENT OF HEAI;TH
Ar
Division of Environmental Health Services.
110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512; (914) 225 -0310
APPLICATION TO CONSTRUCT A WATER WELL
PCHD PERMST #
a FiELL LOCATION
Street Address Town Village Cit Tax Grid Number
114 Tanglewylde Rd, Lk Peekskill, NY 10537 86 -3 -15
V1ELL OWNER
Name
J & G Arnold
Mailing Address, hone 718 352 -0512 ,[Private
20 -31 169 St Whitestone NY 11357 '0 Public
%JSE OF WELL
1 - primary
2 - secondary
RESIDENTIAL
13 BUSINESS
O.INDUSTRIAL
O PUBLIC SUPPLY . O AIR /COND /HEAT PUMP O ABANDONED
O FARM O TEST /OBSERVATION O OTHER (specify
0 INSTITUTIONAL O STAND -BY Q
AMOUNT OF USE
YIELD SOUGHT 5 gpm /# PEOPLE SERVED 2 /EST. OF DAILY USAGE 300 gal
X1 REPLACE EXISTING SUPPLY* O TEST/ OBSERVATION Q ADDITIONAL SUPPLY
O NEW SUPPLY NEW DWELLING ® DEEPEN E ISTING WELL *supply now seasonal
HHo _
FZEASON FOR
DRILLING
DETAILED
REASON FOR
DRILLING
We are now ri-Stired
Inc.
aEd
plan some winter use. Non-seasonal water
supp y woula
be essen is .
Yes,
seasol, Apr.
WELL TYPE
NAME OF PUBLIC WATER SUPPLY: Lk �nPPkGki 11
PDRILLED
ni st- TOWN /VIL /CITY P. V. Put.
®DRIVEN
DDUG
(seasonal)
GRAVEL.
O'OTHER
SHEET
SU]3JE .CT, T;0 „FZ.00DIN(!,,?_ X ...NL.
_._ - _..._..._.._. .. ._ _.
_- Z F WELL IS LOCATED 'I NA REALTY SUBDIVISION,
NAME OF
SUBDIVISION:
Lot No.
WATER WELL CONTRACTOR: Name N. Anderson,
Inc.
Address:
Barger Road, PV
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE:
Yes,
seasol, Apr.
1, thru Nov. 15 '
NAME OF PUBLIC WATER SUPPLY: Lk �nPPkGki 11
ITrnyP
ni st- TOWN /VIL /CITY P. V. Put.
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: 33'
(seasonal)
LOCATION SKETCH SOURCES OF CONTAMINATI N PROVN�c��
ON SEPARATE
SHEET
Arnold
9/7/8'9
Joan Arnold George
(date) ,---
(signaturq)
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
thirt3�,(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
Department attached to this permit.
3. Submit a Well Completion Report on a form
requirements of the Putnam County Health
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 otherwise contaminate surface or groundwater.
'pate',oi....I��ti� =. - .��•;� ,2- ...:1:_���- :.- .. -....' , ,, ,. �r- �.:,�:•••- •�� .. .- - ... -
Date of Expiration 19 Permit Issuing Official
permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller
Jan. 29, 1990
Mr. William Hedges, Sr. Public Sanitarian,
Dept. of Health, Div. of Environmental Ieal:h Svs o ,
110 Old-Rt. 6 Ctr. , Carmel,,N. Yo 10512
Dear Sir: `Re: PROPOSED WELL, Arnold, 114'Tanglewylde,
L. Peekskill., Town of P. V.
Tax Map 86-3 -15
Thank you for allowing us to meet with you on the 23rd.
Pursuant to that meeting we, have cordoned -off our septic system to
make it more visible. The perimeter is marked with green hemp. We
have verified that the distance from our proposed well site is in
excess of 100 feet.
Also pursuant to our meeting, we have established the exact
1
location- of the , E -vans - septic ..system. .r *_ i s-= _jii§t. ? r:_. front . -_,f:_ -,the
Evans House, (be' ieath '"the' pati�oy.' We have measured a distance of
185 feet to our proposed site. We are prepared to adjust the location
of our proposed well still further, but it is our hope that you will
find we are in substantial compliance with the'requirements for the
issuance of a permit.
We feel we can be of assistance at the time you inspect and,
if you will inform us of your schedule, we will arrange to be present.
Again, thank you for your consideration of this matter.
Very truly yours,
J. and G. Arnold
Joan Arnold George Arnold
20 -31 169 St.$ Whitestone, N. Yo, 11357 -4111
Tel. 718 352 -0512 (Please feel free to call collect.)
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
John M. Simmons, M.D.
Deputy Commissioner of Health - FIELD ACTIVITY REPORT - Sheet of
,Io a 9
Aft M017
MAILING ADDRESS
P.O. Box Post Office Zip Code
TELEPHONE % ./J -gel
INSPECTION
Orig, Routine
Orig. Camplain
Orig. Request
Campliance
Camplaint Canp
_ Final
_ Group Illness
Construction
Reinspection
PERSON IN CHARGE Field, Sampling Only
OR INTERVIEWED Field Conference
Name and Title
P _ Other
DATE %� TYPE FACILITY
TIME ARRIVED TIME LEFT %..��t / �~ lain
FINDINGS:
i.
PERSON IN CHARGE OR INTERVIEWED:
I acknowledge this Field Activity Report, SIGNATURE:
6/86 TITLE:
i
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
John M. Simmons, M.D.
Deputy Camnissioner of Health - FIELD ACTIVITY REPORT - Sheet of
TNSPFY" PTnM
O A
ADDRESS
No. Street Town TM No.
MAILING ADDRESS "";:7
P.O. Box Post Office.. Zip Code
PERSON IN CHARGE
OR INTERVIEWED
Name and Title
Orig. Routine
Orig. Canplain
Orig. Request
Canpliance
Canplaint Camp
Final
_ Group Illness
Construction
Reinspection
Field, Sampling Only
Field Conference
Other
- ATE _ '•. .�,•.. , : TYPE. -FACI-LITY
TIME ARRIVED ' / TIME LEFT / < <-/ s Explain
FINDINGS: - _/ �/ ,/. ., 4, L49 0 4e e.
INSPECTOR:
PERSON IN CHARGE OR INTERVIEWED:
I acknowledge this Field Activity. Report. SIGNATURE:
6/86 TITLE:
TELEPHONE: l
PETER C. ALEXANDERSON
County Executive
JOHN KARELL Jr., P.E.
Director
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(914) 225-0310
J & G Arnold
20 -31 169 Street
s, NY 11357
4-41 JAe S /L 7 Lo
December 13, 1989
Re: Proposed well
Arnold, 114 Box 422, Lake Peekskill, NY
Tanglewydle Road - TM #86 -3 -15 Lot #145/147
(T) Putnam Valley
- r....,..._.... ..... _ ...;near J, & °G
I have received and reviewed the plans to construct an individual water supply on
the above mentioned parcel.
Based on this review and a field inspection of the proposed site, the application
to construct a individual water supply is denied for the following reasons.
1. The sewage disposal system northwest of the proposed site (Evans 86 -3 -5) is
considered in direct line of the proposed well site and therefore a minimum
separation distance of 200 feet is required. Approximately 120 feet is
provided.
2. The sewage disposal system for your residence (Arnold 86 -3 -15) appears to be
less than 100 feet from the proposed well site. 100 feet minimum is
required.
If you have any questions please contact me at your convenience.
Very truly yours,
William Hedges
Sr. Public Sanitarian
_j
Jan. 189 1990.
Mr. William Hedges., Sr. Public Sanitarian.,
Dept. of Healthp Div. of Environmental Health Svs.2
110 Old Rt. Six Ctr., Carmel, N. Y. 10512.
Dear Sir..-,, Re.* PROPOSED WELL$ Arnold, 114 Tanglewylde,
L. Peekskillq Town of P. V.
Tax Map 86-3-15
Thank you for your letter of Dec. 139 1989 which rejects our
application. We do have questions., (as your letter suggests)., and we
would be very grateful if we might discuss them in your office. May
we ask for a bit of your time at your convenience?
Ttiky:.you SS-
Jo and G. rnold
• Joan Arnold George Arnold
9
20-31 169 St.., ) This is our correct address. Your letter
Whitestoneg N. Y. 11357-4111) of Dec. 13$ was improperly addressed and
delayed.
'Phone
718 352-0512 Please feel free to call.collect.
i
MARVIN O'DELL
Inspector
TOWN OF PUTNAM VALLEY
BUILDING, ZONING, AND SANITARY DEPARTMENT
Date: November 10, 1989
Pu na mm County Dept. of Health.
116 Old Route Six Center
Carmel, N.Y. 10512
Att: Bill Hedges, Health Sanitarian
TOWN HALL
PUTNAM VALLEY, N.Y.
(914) 626 2377
e
�._�...,__..._...d.._�..,._. _ _.:._: _.: _ ._...'.. ,..... Re: `PT ropose u Well -15 & Arn ld� T # 8 6 3 _j:...
Dear Mr. Hedges:
An inspection of the above noted site reveals the
proposal to construct a water well is not in
compliance with required distance separation from
adjacent sewage disposal system.
It is, therefore, recommended further review be given
this _proposal.
Thank you.
Very truly yours,
MARVIN 0 LL
Building & Zoning Inspector
MO'D:es
enc.
PUTNAM COUNTY
DEPARTMENT OF HEALTH
MEMORANDUM
W
Date: OCT P.•' 1989,
To:
Subject:
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