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HomeMy WebLinkAbout4046DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.66 -2 -16 BOX 31 71- ' % :J: � I ` T40 r ti ii L J L � y� 1� 1�. SHERLITA AMLER, MD, MS, FAAP Commissioner of Health Associate Commissioner of Health May 9, 2005 Marilyn Lubin 7402 Bay Parkway #C3 Brooklyn, NY 11204 Dear Ms. Lubin: ROBERT J. BONDI County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New .York 10509 Re: Well Permit Application for Lubin Property 49 Lake Drive (T) Putnam Valley This Department. has .approved the well permit for Well #W27 -05 at the above referenced site. Please be advised that if site conditions and/or site plans change and/or are revised, thereby compromising the approved separation distances, siting approval of the well must be re- approved by this Department. This letter shall serve as record of approval and by initiating construction of the well covered by this approval of plans, the applicant accepts and agrees to abide by and conform to the following: 1. The well location shall be survey located and staked prior to drilling. 2. The proposed well is approved 90 feet from on -site and/or adjacent subsurface - sewage treatment system areas.: . 3. The well shall be installed with a minimum of 44 feet of casing. 4. A water sample shall be collected and analyzed for coliform bacteria after the well is drilled. The sample result is to be submitted to this Department along with the well completion report within 30 days of completion of the water well. 5. All necessary Town permits for the installation of the well are required to be issued prior to well construction. Should you have any questions, please contact this office. Respectfully; Michael J. u ins i, PE Director o Engineering MJB:cw Cc: C. Santos, (T) Putnam Valley Insite Engineering Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 PUTNAM COUNTY DEPARTMENT OF HEALTH Y 3, � 6 � � l � ® SION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL_ ' - --. _ �. -:::, ..- : ,a. - �'�e�e prrnY��.yN�e•: -. ...�.. ., . - .. 't�'n11�PeI4tY1�# `�o� %- ��. ,. Well Location: Street Address: Town/Village Tax Grid # Q L+K - ? P 34LBlock a Lot(s) Well Owner: Name: Address: c Z V-o 0- / PryU 63, &A'livd A) N_uV Use of Well: / Resi ential Public Supply Air /Cond/Heat Pump Irrigation I- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served _,V _ Est. of Daily JUsage gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reasons S 0 FF . for Drilling Well Type L/15rilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No .L,— Name of subdivision Lot No. Water Well Contractor: Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: orn -e - Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Dal: o� Applicant..Signature:_ - ...:. -2 ffi ( "nSC"1 PERMIT TO CONSTRUCT A WATER WELL '�o :: This permit to construct `one water well as set forth above, is granted under provisions of Article I O*f the-5 Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and' ovicd' that within thirty (30) days of the completion of water well construction, the applicant or their designated representative 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. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and 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. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless , construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. /. _ - h Date of Issue — _<:� Date of Expiration 59 --0 Permit is Non - Transferrable Permi Title: White copy - HD file; Yellow copy - Building Inspector; _ Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH F4E�rAPPLICATION SION OF ENVIRONMENTAL HEALTH SERVICES TO CONSTRUCT A WATER WELL lei Vit #' �e��::�5 ._.:.:..... .•- Well Location: Street Address: TownNillage Tax Grid # Lam- Q L1'i� b4fitp 33tolock a Lot(s) % (p Well Owner: Name: Address: X63 L 7yo-q-& Aid �(W l N y 1. Use of Well: Resi ential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby ._ Amount of Use Yield Sought gpm # People Served _ Est. of Daily Usage _gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason AIQ w 61, L— C k_5 L• v L S L, , F for Drilling S,&, 21' OFF. Well Type ,i/Srilled Driven Gravel Other Is well site subject to flooding? ................................................. ........................:...... Yes No L_ Is well located in a realty subdivision? ...................................... ............................... Yes No ei Name of subdivision Lot No. Water Well Contractor: 2!!r-- Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: 1 0--Vn 'e- Town/Village Distance to property from nearest water main: ►�., m Proposed well location & sources of contamination to be provided on separate- sheet/plan. c Dat o? 020© Applicant Signature: rt PERMIT TO CONSTRUCT A WATER WELL, This permit to construct one water well as set forth above, is granted under provisions of Article 104f the= Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and' ooviad • that within thirty (30) days of the completion of water well construction, the applicant or their designated representative 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. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and 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. APPROVED.FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. 1. -A ' Date of Issue T - " Permit Date of Expiration --0 Title: _ Permit is Non - Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owller; Orange copy - Well driller Form WP -97 f. A „k f s t , f f �a*” �4011 J �Xit +'+1PSA.f'�i''d•/ Mntk F` '}YT"i •. al ' c s i1X f A�$ �?ti t at rtw x Rey fat 's .t f f,. �, �r � ti ✓c"�.snay'q�,� � �,r's.*���'"�rm� ass f4 h" r�, s x k s i d 'V May 2, 2005 Marilyn Lubin 7402 Bay Parkway #C3 Brooklyn, NY 11204 Mr. Michael Budzinski, Director of Engineering Putnam County Dept.jof Health, Water Supply Dept. 1 Geneva Road Brewster, NY 10509 Re: T.M.# 83.66 -2 -16 -Well Application Dear Mr. Budzinski, ,.4 I received a letter from Supervisor Carmelo Santos advising me that a variance has been granted for a well from the Putnam County Board of Health on 1/20/05. Enclosed you will find my well permit application for 49 Lake Drive E., Lake Peekskill, NY. I have also enclosed a certified check in the amount of $150.00. If any further information is required please do not hesitate to contact me at the above address. Thanking you in advance for your assistance in this matter.' Encs. Sincerely, Ja .tO r1 IN. A i5l' 01. 'J': V , ! A• Those sketches are based an Now York State High Resolution LEGEND 0 Approx. Location Existing Well NSfatE*w;de Digital Orthaknagety, Program (2000 Not —Present) and digital tax --P Wbrnn-tiOn from Putnam �nl)' Them sketches are Intended to show Subject Property Approx Location Proposed Well A approminnote property lines, 'dwafting,% and septi: syclerms for use in assessing possible well locations only. These sketches are not intended for any other Approx. Location Direction Of Ground Slope SLOPE purpose and am not intended to be sealed, Prior to &Hl;ng any proposed Existing SS7S E�g SL Arrow Points Downhill well,. the appropriate surveys, designs, and permits must be obtained PROAC1.1 MPAND Or. DAM 10-11-04 L A KE PEEKSKIL L INS/ TE- $CALL' 1.30' WATER SYSTEM SHUTDOWN ENGINEERING, SURVEYING & L4AIDSCAPEARCHITECTURE, P C -a: 04183.100 mneee PLOT PLAN 3 Garrett Place • Carmel. Now York 10512 ra 0 49 LAKE DR. Phone (845) 225-9690 • Far (845) 225-9717 83.66-2-16