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Home My WebLink About4049DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.66 -2 -25 BOX 31 -mill r ' �I � ■� 1 `l■ is J ` f� . q +� T 116 l 16 ■ r1 {1�� r I ti I ` t ��' I' rr ' r r SHERLITA AMLER, MD, MS, FAAP Commissioner of Health i _ LOR ETTA; MO,LINARI;.R *d, MSN._ 4ssociate Commissioner of Health July 14, 2005 ROBERT J. BONDI County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 George Rubistello 20 William Street Lake Peekskill, New York 10537 Dear Mr. Rubistello: Re: Well Permit Application for Rubistello Property, 20 William St. Town of Putnam Valley This Department has approved the well permit for Well # W -45 -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 76 feet from on -site and/or adjacent subsurface sewage treatment system areas. 3. The well shall be installed with a minimum of 65 feet of casing. -- - -4:- - -A- wvater- sample - shall. be -collected -wid 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 concerning this matter, please feel free to contact this office. MJB:cj Respectfully, Michael J. Bui Director of En ii Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Environmental Health (845) 278 -6130 Fax (845) 278 -1921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845f 278 -6648 L O T MD 00'00 °f 100.73' FLAG zo-a O O ws� I otp. V� -rte 4. till t LA 1 :_s�S PUTNAM.COUNTY DEPARTMENT OF HEALTH IVISION OF ENVIRONMENTAL HEALTH SERVICES ® APPLICATION TO CONSTRUCT A WATER WELL -PCHD Permit # -l; G�: r Well Location: Street Ad ess: To ilia e - Tax Grid # g 3, (, -a — A 51 a o cu 1 5 iA �if Map Block Lot(s) Well Owner: ame:� �t/�ls} -e� � o AO e`llra�v► Use of Well: esidential Public Supply Air /Cond/Heat Pump Irrigatio lVrimary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served a Est. of Daily Usage_gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling __V/ New Supply (new Owe i Deepen Existing Well Detailed Reason eason -.1- S U for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No Name of subdivision Lot No. Water Well Contractor: fiJam fJAr1&9501V Address: / S &rq eg 51' ✓ v Is Public Water Supply available to site? ..................:............ ..............................L Yes No / Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contaminatio to be pro i d on separate shee Ian. Date: (0 6 5 Applicant Signature: C PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and 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 or their desig�ted representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance wi3 theme, requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on aormc provided by the Putnam County Health Department. During all well drilling operations, the applica`At anvv! �,o well driller shall take appropriate action to assure that any and all water and waste products from soh well drilling operations be contained on this property and in such a manner as not to degrade or otherwisg;;� "... contaminate surface or groundwater. Q c° APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued Q ess Cl) construction of the well has been completed and inspected by the PCHD and is revocable for cau8�or n4&vy 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. I Date of Issue os Permi Date of Expiration L 111401 Title: Permit is Non -Trans errable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 WD 1 yv .16'20 _ � q � 4.15 L C A 0 = 5616'00" R = 53.00' L = 52.05' N42'28 00" W 3.07' r Y or ROM FIMPAIMP FOR I fl N 15 0 TL -.0 BEING AKV LOM NO. 2*6 TM 1�8 A5 91COVN ON MAP E T=12 " LAKE MV-%LL " 5EC110N A, DA1Et7 5 -28-29 FILED NO. 165 TOM / `' f511UA -M MIN/ CO N.Y. 5C&F.i P 20' AM 257, (, 19 / GOl'YRk5W Q 1997 1EMY BER2EN1709" GOLLIN5, AX laatr5 M5ERVED — I U. UU' Z C 114-58' A1,9218'00"E q,61-04'00 25-00 C/ J9.17' W FRAME RESIDENCE ENCLOSED PORCH N-) 0.269 VfL All KFWA 204 R 51 18/Q N O� d� sec 1 % D, PUTNAM COUNTY DEPARTMENT OF HEALTH 1 Geneva Road -- Brewster, New York 10509 _. - Date C� a zo T0: ... For your information For signature For your files Referred for handling Attached as requested Returned as requested ✓ Please see me Read and return COMMENTS: i Karen Rub�stello 50 -1139/219 ' 1177 George :; tj Astello Lake Peekskill NY 10537 (f� a 2.1, AYyT 'THE 0- Mahopac Natid` haLBank OscaWaMa.Leke Rd � „ Putnam Valley; NY 10579 - � 4 � C -OIYv . -: .... .. ` 400 2 b 9 1 b 980.0 0 5 5 S 20 7 2anr31113 L b 7 Putnam County Dept of Health 23 June 2005 1 Geneva'Road - Brewster,.NY 10509 Attention: Mr Michael Budzinski Subject: Request for Well Permit for 20 William St, Lake Peekskill Tax Map Number: 83.66 -2 -26 Dear Mr Budzinski, Enclosed please find our application for a well permit, diagram showing surrounding septic systems and their distances to our proposed well location, a survey for 16 and 20 William Street and a check for the permit fee. Mr Norman Anderson is our well driller. He stopped by the house and suggested the location that we have marked on the diagram. The survey is the only original copy I have if it was possible to get it back at some point I would appreciate it. If you have any questions please feel free to contact me at: 845 528 4682. Thank you for your help. 4eT, ruly Yo s, Karen Rubistello 16 William Street Lake Peekskill, NY 10537 845 528 4682 enclosure(s)