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Home My WebLink About4021DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.65 -2 -5 BOX 31 !- ` . �r r I -L ti- %�,:4. -� �1 �, i 04021 K AM 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: -46? e-- 711W,17 L) 9 S15 -7 - 8 HOAA� UP A16. 3 216 - 71 WX 03-5T 7/8" Sri oT i ,-'&T5 917le7 0 .1 4 k)ezz. , "-fac"&r 1VC, 7AA,6-:1 / 73, 41Y 4r A'lt/ -/7 7f Fig-3-7 2 0 0 '4' S 7Ct.