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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
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