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HomeMy WebLinkAbout4032DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.65 -2 -38 BOX 31 04032 *'•tea ,�.M �� •:i>.J1 ••a v..r. •� . 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 Henry Wong 127 Brewster Road Scarsdale, New York 10583 Dear Mr. Wong: September 14, 1988 M0,111 ENID L CARRUTH, M.P.H,� 1. Public Health Director JOHN SIMMONS, M.D. Deputy Commissioner JOHN KARELL Jr., P.E. Director Re: Proposed Well Construction - Wong 158 Lake Drive West (T) Putnam Valley TM #89 -2 -7 Review of an application to construct a well for potable water supply purposes to serve the above property has been completed. Review indicates as follows: 1. 2. [<111! The lot is presently supplied by the Lake Peekskill Water Works with summer water. The lot area is approximately 10,000 square feet or 2/10 acre. Any proposed well location would be less than 100 feet away from the disposal system on your lot. Recognizing the above and that a minimum restrictive distance of 100 feet is required between a sewage disposal system and a well, your application for a permit to construct a well on this property is hereby DENIED. Very truly yours, Lawrence C. Werper Assistant Public Health Engineer LCW /jz cc: Putnam Valley, BI DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNT CENTER - CARMEL; N.Y. 10512 (914) 225-3641 APPLICATION TO CONSTRUCT A WATER WELL VVV«<+++ - �a WELL LOCATION Street Address Town/Village/City Tax 158 d&W MNr'Lr, & rupom VALLEY�= Grid Num .WELL OWNER Name Mailing Address HFEWY W®W_-�, 127 oo vvojrze, RD . GCAR5>-0ALrr, NY erPrivate 0 Public USE OF WELL 1 - primary 2 - secondary eRESIDENTIAL O BUSINESS O INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION O INSTITUTIONAL O STAND -BY O ABANDONED 0 OTHER (specify AMOUNT OF USE YIELD SOUGHT gpm / # PEOPLE SERVED /EST. OF DAILY USAGE gal REASON FOR DRILLING 05EW SUPPLY O PROVIDE ADDITIONAL SUPPLY UREPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL O TEST /OBSERVATION DETAILED REASON FOR DRILLING f 'ICU V-0 AT 90 Ik'9710 D WELL TYPE DRILLED DRIVEN ®DUG O GRAVEL O OTHER IS WELL SITE SUBJECT TO FLOODING? YES V NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME.OF SUBDIVISION: a Lot No. I-UTT%MM VA WATER WELL CONTRACTOR: NameWAMAt! A(4 k�0rJ f(VG Address: RC 3 &,406ee% ,pT $f -ZAA- IS PUBLIC WATER SUPPLY AVAILABLE TO SITE YES NO NAME OF PUBLIC WATER SUPPLY: W< (7CW W( i9PRcfiy i7j!K TOWN /VIL /CITY W ;K DISTANCE TO" PROPERTY. FROM NEAREST WATER 'MAIN: d - LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ( O ON REAR OF THIS APPLICATION O ON S_ E SHEET V := (d te) (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: 19 Date of Expiration: 19 Permit Issuing Official Permit is Non - Transferrable White copy: H. D. File Yellow copy: Building Inspector 2/87 Pink Copy: Owner Orange copy: Well Driller Ax. 4 t 70 -4CA:`� 4r d � � Yom• � �� .32 30.00 73B �{ IN ell ' I �d