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631- 589 -8100
83.72 -1 -35
BOX 31
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CONSULTING ENGINEERS
1065 SPILLWAY ROAD
SHRUB OAK, N. Y. 10588
(914) 245 -6320; Fax (914) 245 -6335
Vincent A. Ettari, P.E. Licensed Professional Engr.
June 2, 1995
Putnam County Department of Health
Division of-Environmental Health Services
4 Geneva Ro d
Brewster- - ,--New York 10509
Attention: Larry Werper, P.E.
Re: WELL PERMIT, 7 PLEASANT ROAD
PUTNAM VALLEY, NEW YORK - TM 83.72 -1 -35
Dear Mr. Werper:.
In accordance with our several telephone conversations with
respect to the above referenced site I am, at this time,
submitting this report to you for your review. Also
accompanying this report are the plans and application required
for the project. The site, which is located at 7 Pleasant Road
in the Town of Putnam Valley, is presently owned by Mr. Charles
Fowler. The dwelling on this site is currently supplied with
water by both a summer municipal water supply and an individual
well. The sewage flows from the dwelling are dispersed into the
subsurface waters by way of an on -site septic system.
The existing well was drilled subject to a permit issued by
your Department on October 17, 1988, a copy of which is attached
at the end of this report. That permit was issued with several
qualifications, among which that the current connection to the
1
v
- rundYci pa3 ter `syai eit; be - nidiifita,ir ed "arid' Lha . `tile 'vigil -be• -dd b16
cased. Additionally, periodic bacterial analyses were required
to ensure that the well water remained in a potable condition.
Shortly 'thereafter, Norman Anderson, Inc. was retained by
Mr. Fowler for the purpose of drilling the well. His bill (a
copy of which is attached to this report) indicates that the
well was double cased and had a yield of 8 gallons per minute.
There is no indication as to whether Mr. Anderson conducted a
nitrate analysis as per the permit letter of October 17,_
Moreover, the record is silent concerning the installation of a
grit /particle filter or an ultra violet light disinfection
system. To the best of our knowledge, such items were not
installed. This fact is significant as will be discussed later
in this report.
Recently, your Department revoked the above referenced
permit, despite the fact that the ,.well had..already _been_ drilled. _... .
As I understand the matter, two separate site plans had been
submitted to your Department for the placement of this well on
Mr. Fowler's property. `While one of the plans showed the well
in the front left corner of the property, the other drawing,
apparently, showed the well in the rear left corner of the site,
which is where the well was ultimately drilled. Moreover, it is
my understanding, based upon our telephone conversations, that
s �eral:�a�'a�r- i,ances .��shouldha�been� obtained �befor- e {theAperm.t
.a is�_s`ueWhle �I am in ,ag,re�._ ementy :wyouon`this3 rpoint,Pl
ti° ..4
fl that it rs .unfa.rto pna- lei =zeMr. Fowl.er�foran�ove �ght
on the�Jpart•of . ;yourDepartmeri.' . In either case, the permit,
2
h
Za
��,:::;.=..: �. �,::.:_• ��.. p. p��re, �: t. l�;:-. �,. „...wa,�. °._;4- •r��ok��d.:..:; - �. Su. l�sequ• ee' t-°- �tE::.: �h. a. t;.... �r•• ec +o.c.�•t�i�.on�.,,:..,��.:.�:. «- .:..•.,.:_;�•.
Mr. Fowler attended several meetings with your Department. It
is my understanding that he was informed at the last meeting he
attended that your.Department was now requiring him to retain
the services of a Licensed Professional Engineer to prepare all
of the documents necessary to secure a new permit for the well.
To that end, this firm has been retained by Mr. Fowler.
As of today, June 2, 1995,(K 1 which now services
Mr. Fowler's dwelling has been in�exstence -for over:6.5: years
During- „� thatp_er—od of�ti�me-at R1eas4t~�one bacteria test :ways
�conduc_ted'on- -t'he. weK . That—�tsest was taken ,on . May. 2-f” , 1 °9'9 '2 ' by
the e =- Home Buyers L:ns,pectiori'-'Servrc (-The dl o ,'that I .tes
�ih'ich- ar•e,- a- tt-ac�hed--to zt�h-is repor:t,n, >s;how :t-ha�t:° -no bacte it a w_e_�e
p es.erit —` n th el ter ate that timea This^ f mri als.o-
conducteda_ bacteria testorr. t, 7ter from AMr;_-Fowle:r s we11'.'
Th=at. --` 'es = was= -n , taken "on ,.May, 2'6, 1995,° and also. showed`—tha -t no
batter, a are preseffV7- n the welll water Y. Since the uTt3a viole
light disinfection system was -;rie eer i- nstal]:ed> these tests were
definitely conducted on "fresh" water from the well. Based on
the negative results of both tests, it is apparent that the well
has not been subject to any contamination since it was first
drilled over 6.5 years ago. This fact is significant since it
establishes the evidential basis for the issuance of variances
with respect to the location of the well.
The site plan, as prepared for Mr. Fowler by this firm,
shows that several septic systems are within the drainage zone
of influence of the well. The current codes'of the New York
3
K.'1
h
. .;- °.;..... e. mar U �ySg:5.��rt
foot offset— d- ista- neefromMr- .Eowl:er' S well; ;though it could be
construed °has l'ay_ingfin - a_drect line; of drainage to.. ;the_:w.ell
Howeve,r,,. =Nir. 'Foialer'�sdwel- 1irngli:es' b.eetween;fth�s sepatics stem
a_nd It-l%e we_1.1 Consequently, any subsurface septic waters from
this system which were moving through the soils toward the well
would be intercepted and diverted by Mr. Fowler's dwelling.
Therefore, in the opinion of this firm, Mr. Fowler's house
blocks the direct drainage of septic effluent from this system
and, therefore, interrupts any direct line of drainage that
might have existed between this system and the well. Therefore,
under this argument, it is the position of this firm that the
septic system on this property is not in a direct line of
drainage to the well.
Finally, part of the site designatedcas: 8_3 2 1c284cou_.l -b
construed��a;s la�,yi�ng�in a°�,dir =ect, lei e fcdrain ,rage- .��_,to..��thP well': -
However.c there yj aretwo dwellings which �s'erve, `'to tcu off "ariy'
s, ubsurf�ace flows from �th�.s s�- i�te--�F�irst; �rther =e� isv��ther- .__d_�well ";ng
on�. 8,3,,.72 1 (29:_:732 ) Second, t-herers Mr.Eowl :e.r'.sdwellri_g1.
Urifortunat:e y - c� 'th.er are no.�r ce ords -�'on ale 13th_= �a'h °e Town -of
Eutna Vm alley nor�t?he Co tnu y of Putnam w.kt rh eg ra d�..to :the septic
Ff'ac�li�t=ies on 1 -ot 83= 72 8 Therefore, it is very possible
that the septic system servicing this site does not lay at all
in the theoretical direct line of drainage to Mr. Fowler's well.
Unfortunately, this can not be determined with certainty at this
time without excavating the septic facilities on that site.
However, since the subsurface sewerage flows would be cut off by
5
of - t*1-7ii��i-�-'-�-'L-i:r-fil-',-
that the direct line of drainage from this lot is interrupted
anyway, and that this lot is, therefore, not in a direct line of
drainage to the well.
The practical proof of these theoretical discussions is
obvious. The well water contains no coliform bacteria.
Therefore, septic effluent is not flowing into the well at this
time, nor has such effluent flowed into the.well during the last
6.5 years. Consequently, it is the contention of this firm that
these test results support and validate our opinion that the
septic systems of lots 83.72-1-(36-37) and 83.72-1-28 are not in
a direct line of drainage to Mr. Fowler's well. Moreover, the
absence of bacteria from the well's water further demonstrates
that the septic effluent from the other three systems (namely:
83.72-1-33, 83.72-1-(29-32), and Mr. Fowler's lot) are not
flowing into, nor contaminating, Mr. Fowler's well either. Were
the well not in existence in excess of 6.5 years, one could
argue that there was no rational on which to base the idea that
variation from the codes would not result in a detrimental
situation. However, we now have 6.5 years of physical proof
that variation from the codes did not, in this case, result in a
detrimental situation, namely, contamination of Mr. Fowler's
well. Therefore,. there remains no compelling reason not to
grant any of the variances and interpretations required to allow
a new permit to be issued for Mr. Fowler's well.
Finally, it should be noted that this f-krm-c-ond-u-c-ted-a
S Cp"
t7i
y-- MA�y-72-6-1 {9.95. ,-
R
k
. ...•! W- .r ..1.» . a.. . pe • -.6' . ,... .. t'y •, n T:. .✓.v., t. N ♦.'.y .. ••�•• ... •... .... .. - . ... a.. 'r.• f: • :P1•:•/. " .-
4. That a determination be made that the septic co
system on lot 83.72- 1- (36 -37) is not in a direct line ��$ °
of drainage to Mr. Fowler's well and that, therefore, eoi
no variance reduction is needed since this septic
system is over 100 feet from Mr. Fowlers well.
5. That a determination be made that any septic
facilities located on lot 83.72 -1 -28 are not in a
direct line of drainage to Mr. Fowler's well and that,
therefore, no variance reduction is needed since that
lot is over 100 feet from Mr. Fowler's well.
Should these variances not be granted, the hardship that
will be incurred by Mr. Fowler is very serious. The dwelling is
approximately 40 years old and was constructed as a summer
residence. It remained a summer residence up, to 1988, at which
time the Putnam County Health Department granted a well permit.
Pursuant to that permit, a well was drilled on the property on
November 14, 1988. The total cost for that well, with the
pertinent plumbing apparatuses, was $5303. Once this well was
drilled,.._,the. house. became a permament, "year- round. ",dw.elling,. _
Consequently, the value of the house rose $80,000. That is, its
value increased from $40,000 to $120,000 based on an appraisal
of the house dated March 21, 1992, a copy of which is attached
to this report.
In addition, Mr. Fowler has made capital improvements to
the structure since it was converted to an year -round house.
Those improvements included the installation of Thermo -pane
storm windows, the installation of insulation in the exterior
walls of the structure, the installation of an electric heating
system in the dwelling and the installation of insulation in the
attic. The approximate cost of these improvements is $12,500.
E:1
U
required to keep this existing well not be granted, Mr. Fowler's
economic losses and damages would be the total of these three
figures, or $97,803. With such a drastic and sudden economic
loss, Mr. Fowler would certainly be forced into bankruptcy.
mu-s't-bo, Rept-in mind, that s .well
w�rthout the benefit of —et I—t-from-tTe-
--
- County Ht-ffh
per -in -it Th-ere-f
a.,-s- �tua'ti on which
f—I-�d-f � r - over g h-,tl 7, (5 -ff --X I �=4F,f .of Ve -- o f h "e-
Health,.- Dep*ar,,tmbnf,—w�i-t-tf-7,r.,e— d,f' •the m
per--ft-:�L=�,--J
0:9:-88',) Therefore, it is requested that the Board take into
account these facts and the economic damages that would result
if they choose not to grant the required variances and
interpretations. Moreover, it is the further request of
Mr. Fowler and this firm that the required variances and
interpretations, as outlined in this report, be granted as soon
as possible.
9
Sincerely Yours,
Vincent A. Etta(ri, P.E.
.... _
r:. r
,
PETER C. ALEKANDERSON
County Executive
Mr. Charles Fowler
P.O ' Box 407
Pee-KS 'it i11, Ni
Dear Mr. Fowler:
ENID L. CARRUTH, M.P.H.
Oigecto,. .-
JOHN SIMMONS, M.D.
Deputy .qQmmissioner
JOHN KARELL Jr.. P.E.
DEPARTMENT OF HEALTH Director
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512.
(914) 225 -0310
October 17, 1988
10537
Re: Individual W.S. Program
Pleasant Road
(T) Putnam Valley
This correspondence is based upon your request for ,a well permit due to your water .
quality and quantity concerns, relative to use of the Public Water Supply deriving.its
source from Lake Peekskill. Please be advised that your request to drill a well is
hereby approved conditional upon the following:
1. That you install and maintain a grit /particle filter and ultra violet light EA-A•J M07'
disinfection system to treat the well water. 406
2.
3
4.
That you collect a sample for bacteriological analysis on a quarterly basis, bo-V&
and collect an initial sample for nitrate analysis. 7w�44J'ev�(�
That the well be doubled cased,
That the connection to the public water supply be maintained for future use in the
event of well contamination or major improvements to the public water system occur.
If you have any questions or comments concerning the above, please contact this writer
at extension 316.
Very truly urs,
J mes A. Luke
sst.Public Health Engineer
JAL /jz
•
lam Q '� [����(:�.SS{ ' ��Ts''�!�ixu g r t c t. • � �r� i{S� pA'1�iet1.ae3� X34, 1�P .i -
^.,�;,R
- Pa •�'t.w�}acY
i ,Sw:',r •...€ KE�St £:'tisd�as'"k,...x,P.•r;a t..l to .l si.
. :a,f'9.l�lVrnit,d. �.0
BALANCE FORWARD
_
400' @.. $7. ner .foot_ .' - .: -... - ¢: . •. _. _
$' , ;..�8�?0 �.. •
°.. 'r:..:: .,::.::..
T.�. „ . ;,� .. ;.;;,. ,•,�:..
p ...:
casing @ $8. per foot
168.
--
25' 4" " . & well seal <5�,,.,,r.2��
150.
135.
--
Cement O
--
8 gallons per minute 11/14/88
$
3253.
--
RECEIVED ON ACCOUNT•$ 1000.- -
PUMP:
`
el�e�trici
RUNDFOS 3/4h p 3 wire 230v w /box
.pump
pitless adapter, well cover
380' SCH809 couplings, hiflex 180' offset
390' wire (10) + offset UF10
torque arrestor, tape, clamps, connectors
`
splicers
.. ..:.:
labor
WELL- X -TROL # 250 tank & fittings
equivelent to 120 gallons
$
.2050.
--
-------- - - - - --
$5303. -- TOTAL
-----
--- --
- - - - - --
- 1000. -- BALANCE
NORMAN, ANDERSON,. INC. VLV
P LAST
IN COLUMN
IN THIS COLUMN
:;" `: YML Environmental LAB NUMBER 32 -3255
. f... >;
o _
Services
:;,••,>` DATE /TIME TAKEN 5- 2'I_�2 --'IPM ,
ar wAils 321 Ke!s ?� NY 10598.
-• ELAP a10323 (9I4) 245 -2800 � T '- = w 1
DATE REPORTED —f-----RAY 26 1992
Kitchen tap
SAMPLING 7 Pleasant Rd,
SITE hake Peekskill NY
For Lab Use Only
Potable — HNO3 _ pH LT 2 _ <4C
_ Nonpotable _
COLD BY Nathan Riei " STAT!
RESULTS OF WATER TESTING
X
ANALYTE
RESULT
UNITS
ALKALINITY
mg/L
AMMONIA
n-g/L
ARSENIC
mg/L
CHLORIDE
mg/L
COLOR
Units .
CONDUCTIVITY
umhos /an
COPPER
mg/L
DETERGENTS
mg/L
.FLUORIDE _
rrg/L ..
HARDNESS
mg/L
IRON
mg/L
LEAD
mg/L
MANGANESE
ng/L
MERCURY
mg/L
NITRATE
mg/L
NITRITE
mg/L
ODOR
TON
pH
S.U.
NaOH — pH GT 9 )� <20 >4C
HCl _ Na2SO3 —>.20C.
_ H2SO4 _ ZnOAc
r.
COI,i RM RETx DJ US L7 � ]
RESULTS OF WATER TESTING
X
ANALYTE
RESULT
UNITS
PHOSPHOROUS
mg/L
SILVER
mg/L
SODIUM
mg /L
SULFATE
mg/L
SULFIDE
mg/L
SULFITE
mg/L
TURBIDITY
NTU
ZINC
mg/L
SPC
per 1.0 mL
TOTAL COLIFORM
per 100 mL
FECAL COLIFORM
per 100 mL
E. COLI
per 100 mL
FECAL STREP.
per 100 mL
These results indicate that the water sample [WAS] [WAS NOT] [NA] of a satisfactory sanitary quality according to
the New York State Sanitary Code, for the p a ers tested, at the time of sample collection.
These results indicate that the ater m le [WAS] [WAS NOT] a a satisfactory chemical quality according to
the New York State Sanitar Co or a parameters tested, at of sample collection.
NA = Not Applicable N = Not Present (Negative)
SUBMITTED BY: P = Present (Positive) SA = See Attachment(s)
° = Also done because Total Coliform was present
Albert H. Pa ovani, M•T, (ASCP) TNTC = Too Numerous To Count
Director > = GT = Creater nan < = LT = Less Than
YMi FNV7RqNMEmTAi SFRVTCFq
321 Kear Street
`.
Yorktown Feiyhtg, N.Y. 10591"',
(914) 245_2500
Alhe't H, .PAd^vani, T)irerto'
^ |'A8 #: 32.4073R0 CLIFNT Of 2 2 3 .2. K'D. STAr PHD[ PA6E
� �
' ~~~~~~~p~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~^~~~~^~~~~~~.-'~~~~~~~~~'^~....
FTTAR7, VINCENT A. ' DArF/TTMQ. TA(�N: 1:?
10652PIU'WAY RD. DA0"�/T7ME MOD: 05/26/9M I3:\
SHRUR OAK, 05/31/0-1 NY 10588 REPORT DATE: ;�/31/9
! ` PHONE: (914)-245-h320
�.� SAMP( 7NG SrT& 7 F1'EASANT RD K7TCHFm TAP . SAME TYPE..: RQTAB|'E
. :' LAKE PEB<g<TLi, NY PRFSFRVATTVFS: NOM:'
C
�
| 'T-i RY: V7NCENT FTTAR} TEwPFRAT||RE.,; < 4C
, NOTES,.,;
DATE FLAG PROCEDURE RFS|xT mO��N. -�AN�E
05/27/95- MF T. COiIFORM ABSFNT /100 Mi' ABSENT
COMMENTS: '
BACT THEM RESULTS 7NMCATF THAT THE WATF (WA2 NOT) OF A
� SATTSFACTORY SANTTARy QUALITY A[CORDT (!:;!!!HQ NFW YORK RTATE
_
AND FpA FFDERAL DRINK7N6 WATER STANDARDS, FDR THE PARAMETFRS
TESTED, AT THE TIME OF COLLECTION.
'
SiMMTTTED BY:.__ J�--------------------
A\;ert H. Movani, M.T.(ASCP)
Dir+ctor
MAP# 10323
` r Friddle Mao Form 70 10,98 .(12 oh.)
_ Lane AppraisaPSss mu.
�ll.1 B■ oCtII1ncu Al ADDRAICAI RFPnAT FIIA Mn-2031901C '
MCS, Richardson, TX (211) 690.7183 ! Fanolo- Mai, Form 1004 10,05.1
I t Ilm• • • dNn 1 rl ic 1 1•t.m 1 Imkl ndalon
BKEf01 (SH DROSS IHD E D D
ESTIMATED REPRODUCTION ODST- NEW-OF IMPRCJEMENTS:
V for Freddie Mac or Fannie Mae, •tow only square fool csbrtlalbns and cost approach
D«alling 873 Ft. ®895.00 .6
commends In this •Data.
27 X 26 — 702
BSMT 260 —Sq. Fl. a SM.OQ_ 7,800
19 X 9 - 171
"ram -
a TOTAL GLA - 873
Special Energy Efficient Items -
Porches, Patios, rota. -
oarageXotporl Sq. Fl. ® 8 -
Total Estimated Cost New ................ • 8
Physical Ex1arMl
lFunclionall I
Lose
THE ESTIMATED LAND VALUE TYPICALLY EXCEEDS 30% OF
Depreclalbn 22 •a
THE ESTIMATED TOTAL PROPERTY VALUE IN THIS AREA DUE
D•ptaclelrod Value of Improvements .......... • e'
TO THE DESIRABLITY OF THE AREA COUPLED WITH THE
she Imp. 'es is• (drNeway, landscaping, a10.1 • e'
LACK OF AVAILABLE BUILDING SITES.
.ESTIMATED BITE VALUE ............... 40,000
(11 leaseheW, show only leasaheW value.)
y°
+s
VALUE
Yes No
(Not Requited by Fuddle Mac and Parente Mu)
YDoes HUDNA standuds7 ❑ Yee ❑ No
Consuuelbor Warrant
Y
Name of Warranty Program
properly conform to applicable property
tl No, expleDl:
Wunrcy Oovar•pe Expires NIA
Thhya undmIdnwd has rrocBsO three ream sales of proDerlles moll ekntlar yard Drodmal� to *etre. and her i onslderrod Inds! In the market anaNsls The dnarlplbn
dchat rotlecUnG market react n to thou hems of • W vu ion el sere 1 subject and eompua le prova11le. S a flgrybad Yem N IM
'
lose as a adjustment,
eompFuable pr pally M wperbr lo, o more favorable Then, the aub)rod pro ally, • mDlw (•► djustmerc le made, thus wdueko IM Indio toe , o1 wbl•el• tl a
pour Bem In Ihi comparable b lZubr to• or Ws favorable than, the sub; of properly a plus (H adjustment b made, thus YkuuDp 1� Indicated vahhNN o� IM
do
e jest.
`
ITEM
SUBJECT
NO, I
COMPARABLE NO, 2
COMPARABLE NO. 3
23 CHESTER PL
7 PLEASANT
19 SPRUCE ST.
28 PINE ST,
Address >
ftw to
1AKE PEEKS.
'a
price
..`s: K
"Wo, 124.902
Y .
6
Ice rose Lly. Art*
1
k::
9Aa
K.
S C
ADJUSTMENTS
E
41,111 Adlualment
I
DESCRIPTION
Bales or FDMneing
`2
NONE
NONE
NONE
Orinceartions
a
KNOWN
10-91
KNOWN
KNOWN
10-91
10-91
AC/A1.1G.
7,
G
AVERAGE
AVERAGE
AVERAGE
I
5
Ouralky of Construction
y,
Q
VFAAaE
Above or•d.
1
Room Count
3
to Lkkw Area
•
Basement • Finished
Room. arim atmod,
PARTIAL
PARTIAL
ER
-6.000
NONE
+3,000
PARTIAL
UNFINISHED
-UNFINISHED
NONE
1 CAR GAR
-3,000
NONE
Porches, Path.
NONE
LM ITS,
PATIO
LAKE ITS,
-3,000
DECK
1AKE RTS,
-3,000
PNONE
t
BpacW Ena,gy
Elficlant "cook
NONE
NONE
NONE
s
Flosolmorriel
NONE
1 FIREPLAC -2.000
1 FIREPLAC -2.000
NONE
Oth er (..g. kitchen
STANDARD
STANDARD
STANDARD
STANDARD
+ _ 11,700
♦ _ _
Indicated Valve
SO'
, ac x'.2u n e: 0 0 .
Comments on Bales Comparison: Q 0
TRANSACTIONS WITHIN CLOSE SUBJECT
INDICATED VALUE BY SALES COMPARISON APPROACH ............................................ t -
>s1
INDICATED VALUE BY INCOME APPROACH (If Applicable) Estimated Market Rant x Gross Rent Muh[pBer • 8
` u
®' ❑ 1 paDS, atlaratbro; Inspections or conditions peNd below completion par plans and specifications,
This appraisal is made a W •uD eel to the re
sCommerce
and Conditions of AppralesC THIS APPRAISAL IS HOE "AS $ S r r
{
Final Reconciliation: S BEING PIACED ON THE DIRECT SAUS COMPARISON APPROACH TO VALUE,
N €<
THE COST APPROAGH SUPPORTS
To THE JACK OF SUFFICIENT SIMILAR 0 EA S
'q
This appraisal Is baud upon the above requkromercs, the csnldkalbn, corcNtord and hmking conditions, and Market Value definition that are staled In
FmHA, HUD 8fbr VA Instructions.'
8 Freddie Mac Form 439 (Rev. 7,88) frannis More Form 10040 (Rev. 7,98) filed *On c0erc A 18 ® attached.
{ .�.
I (WE) ESTIMATE THE MARKET VALUE, AS DEFINED, OF THE SUBJECT PROPERTY AS CA 0 10� to be i 0
3:
1 (We) sort : the to the best of my oar knowledge and belief the facts and data used here a true a rrecq that I (we) personally Inspected the subject
properly, both WWa and old rid M • an axlerbr IneFaclbn of as comparable ..les trees In this pat that I (we) have no undisclosed Werest, present
of plospeclWa Ihegln.
Apprabyp) I N T R Review Appraiser SIGNATURE D1WyNol
.14422Ikab4l NAME F.D{I•AAIi, ,r•. FERRARONFy NAI �_IM _Ropt(y:.�� «.
MCS, Richardson, TX (211) 690.7183 ! Fanolo- Mai, Form 1004 10,05.1
J �
DEPARTMENT OF HEALTH
Division of Environmental Health Services
110 OLD ROUTE SIX CENTER, CARNEL, N.Y. 10512 (914) 225 -0310
APPLICATION'TO CONSTRUCT A WATER WELL
PCHD PERMIT #_
IS WELL SITE SUBJECT TO FLOODING? YES NO
IF WELL: S LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: L tctE s i�
Lot No. A f�-►�� .� �_
WATER WELL CONTRACTOR: Name blvk 4w I�i✓ eZS'D1 Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: V7 YES NO sk m
ON /7
NAME OF PUBLIC WATER SUPPLY: G,E . A a J /c ��f TOWN /VIL /CITY A.74W,1 7n
DISTANCE TO -RROPERTY•11ROM -NE ?.REST WATE°
- - -- z 7
LOCATION SKETCH SOURCES OF CONTAMINATION PROVIDED
ON SEPARATE SHEET
dat) (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
thirt�. (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.
During all well drilling operations, the applicant shall.iike 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.
Date of Issue• 19
Date of Expiration 19 Permit Issuing Official
Permit is Non - Transferrable White copy: HD File
3/89 . Yellow copy: Bldg. Insp.
Pink copy: Owner
Orange copy: Well Driller
Street Address Town Village Cit Tax Grid Number
WELL LOCATION
WELL OWNER
Fame Ma ling Address'
:9WAA A�c e-/cs �
rivate
O Public
C_h4Ale-
USE OF WELL
RESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP o
ABANDONED
1 - primary
O BUSINESS O FARM ❑ TEST /OBSERVATION
O OTHER (specify
2 - secondary
0 INDUSTRIAL t]INSTITUTIONAL O STAND -BY
O
AMOUNT OF USE
YIELD SOUGHT gpm/ 4E PEOPLE SERVED /EST . OF DAILY USAGE o D gal,
0 REPLACE EXISTING SUPPLY ❑ TEST /OBSERVATION ADDITIONAL SUPPLY
REASON FOR
DRILLING
❑ NEW SUPPLY NEW DWELLING O DEEPEN EXISTING WELL
DETAILED
e i c s wr �.✓
3
tea, e
REASON FOR
o G iv
DRILLING
WELL '•. TYPE
57DRILLED
[]DRIVEN
ODUG a GRAVEL
0 OTHER
IS WELL SITE SUBJECT TO FLOODING? YES NO
IF WELL: S LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: L tctE s i�
Lot No. A f�-►�� .� �_
WATER WELL CONTRACTOR: Name blvk 4w I�i✓ eZS'D1 Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: V7 YES NO sk m
ON /7
NAME OF PUBLIC WATER SUPPLY: G,E . A a J /c ��f TOWN /VIL /CITY A.74W,1 7n
DISTANCE TO -RROPERTY•11ROM -NE ?.REST WATE°
- - -- z 7
LOCATION SKETCH SOURCES OF CONTAMINATION PROVIDED
ON SEPARATE SHEET
dat) (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
thirt�. (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.
During all well drilling operations, the applicant shall.iike 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.
Date of Issue• 19
Date of Expiration 19 Permit Issuing Official
Permit is Non - Transferrable White copy: HD File
3/89 . Yellow copy: Bldg. Insp.
Pink copy: Owner
Orange copy: Well Driller
a
... ,:- .,r . ,_. - '- PU'$NAI�! COUNTY `HEALTH - _- - ::�. . "_ +. :a <�... . _. �.- .., • ..-: __ .. �,•'* -••
DEPARTNIEI� F
DIVISION OF ENVIROIAL HEALTH SERVICES
John M. Simons, M.D.
Deputy Commissioner of Health
FAM� ,
- FIELD ACTIVITY REPORT -
/C
TM No.
MAILING ADDRESS
P.O. Box Post Office Zip Code
l• zoP'�� D'DDI•
Name and Title
DATE �� TYPE FACILITY
TIME ARRIVED ®o TIME LEFT ®o
FINDINGS:
Sheet of
Orig. Routine
Orig. Complain
Orig. Request
Compliance
Complaint Comp
Final
Group Illness
Construction
Reinspection
Field, Sampling Only
Field Conference
Other
Explain
� -... ....... .. .. c .- u.. -..._ �.+....,. .. ... .. ... .o ..�-., o a .. _._.. ..: a -..- .�_� ..-.. .. ... o.a .-w• ..- .-._ -. '.. .., - e ..... *. _r.s .o
Signature and
PERSON IN CHARGE OR
6/86
6
Report. SIGNATURE:
TELEPHONE:
,.o
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
October 17, 1988
Frank Fowler
386 Main Street
Ridgefield, Connecticut 06877
Re: Individual W.S. Program
Pleasant Road
(T) Putnam Valley
Dear Mr. Fowler:
ENID L. CARRUTH, M.P.H.
Public Health Director
JOHN SIMMONS, M.D.
Deputy Commissioner
JOHN KARELL Jr., P.E.
Director
This correspondence is based upon your request for a well permit due to your water
.quality and quantity concerns.relative to use of the Public Water.Supply deriving'its
source from Lake Peekskill. Please be advised that your request to.drill a well is
hereby approved conditional upon the following:
1. That you install and maintain a grit /particle filter and ultra violet light
disinfection system to treat the well water.
2. That you _collect a..s.ample . for bacteriological analysis on a quarterly, basis,
ior� itaand -collect an- ibitieL-sample'. "nrte' analysis.
3. That the well be doubled cased.
4. That the connection to the public water supply be maintained for future use in the
event of well contamination ..or:.ma_jor.improvements to the public..water...system occur.
If you have any questions or comments concerning the above, please contact this writer
at extension 316.
Very truly yours,
James A. Luke
Asst.Public Health Engineer
JAL /jz
j
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO OUNTY CENTER CARMEL, N.Y. 10512 (914) 225-3641
10
PLICATION TO CONSTRUCT A WATER WELL
PrT4T) PVRMTIP 40
;,.,.%WELL LOCATI6k
Mreet Address
e4_ izl>
Town/Village/City T i
Z-W-4'
&-- t;2r _L
Grid Numb r
U-3-V
ELL OWNER
'Mailing
e—
Address ATrivate
CName
4 ce-i V—
toy *57
OPublic
E OF WELL
91RESIDENTIAL ❑ EIPUBLIC SUPPLY (JAIR/COND/HEAT PUMP
0ABANDONED
V§. primary
0 BUSINESS 0 FARM
0 TEST /OBSERVATION
[I OTHER (specify :
secondary
13 INDUSTRIAL OINSTITUTIONAL
0 STAND-BY
13
AMOUNT OF USE
YIELD SOUGHT gpm/#
PEOPLE SERVED /EST. OF
DAILY USAGE 00 gal
...REASON FOR
ONEW SUPPLY
0PROVIDE ADDITIONAL SUPPLY
OTEST/OBSERVATION
`,DRILLING
13 RE PLACE EXISTING SUPPLY
0 DEEPEN EXISTING WELL.
AILED
a 4z-(- /f VffL-C$6(-j
;REASON FOR
DRILLING
�";WELL TYPE
DRILLED 13DR
IVEN
ODUG
OGRAVEL
OTHER'
jS WELL SITE SUBJECT TO FLOODING? YES _x _NO
f
I (.,g
Z,,:jF WELL IS LOCATED IN A REALTY SUBDIVISION NAME-OF SUBDIVISION: _
, .41
Lot No.
WATER WELL CONTRACTOR: Name -7,oi 4".Lr P,6- In F/V/:: Address:
PUBLIC s IS WATER SUPPLY AVAILABLE TO SITE: YES NO 1501-1. 154
y NAME OF PUBLIC WATER SUPPLY: 4,14 1k 6 /' TOWN/VIL/CITY
FRWNEAREST WATER MAIN:
,"DISTANCE TO PROPERTY
SKETCH & SOURCES OF CONTAMINATION PROVIDED
,7 []ON REAR OF THIS APPLICATION ON SEPARATE SHEET
(date) —(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 rovided b Putnam County
Health j Department.
Date of Issue: 19
7 '
k"M mit -Ir s ut ng 'Offidil
Date of Expi ration: 19
Permit is Non-Transferrable Mi copy: H.D. File
Y low copy: Building Inspector
2/87 Copy: Owner
Orange co=
WPI 1 nri 11 P-r
X0.
�71
Id
X0.
�71
' I
TOWN OF PUTNAM VALLEY ti I
%ZONING BOARD OF APPEALS
PUTNAM VALLEY. NEW YORK 10679
Name of .Applicant: CHARLES AND DIANE FOWLER File #
Address: RD 1, tbrthway, Lake Peekskill, taw York 10537 TM # ( 93 -3 -4
Location of Property: Plesant Road (Town road) Zone: R -L
Nature of Request: variance to drill well as per LL 1 -1978.
Well plan by Joseph F. Sullivan dated February 25, 1986.
Date of Advertisement: March 26, 1986 COMMUNITY CURRENT
Date of Public Hearing: March-31, 1986 and April 9, 1986
Place of Hearing: Town Hall, Oscawana Lake Road, Putnam Valley, N. Y.
MEMBERS PRESENT:
HERBERT L,EyINSON Chairman SAM ERIE MN Member
RDBERP Mi1ZZARIS2
Vice Chairman Member
SOL,LIRT ,W Secretary
The matter having duly come on to be heard before a duly convened meeting of the
Board on the 9th day of April 1986, and the facts, matters and evidence
produced by the applicant, the Zoning Inspector and interested parties having
been duly heard, received and considered and due deliberation having been had,
the following are the
FINDINGS OF FACT:
The applicants oanply fully with the requirements of Local Law 1 -1978.
A short EAF has been subui.tted as per SEQR requirements and a negative
declaration is in order since it appears that there will be no major impact on
the envirowent.
h
I
THEREFORE, based upon the above findings of fact, it is hereby ORDERED,'that the
application or appeal be and the same is hereby (RANTED, subject to all conditions
and stipulations of Local Law 1 -1978.
The decision of the Building and Zoning Inspector is hereby reversed.
Dated, Putnam Valley, N. Y.
this 28th day of April 1986.
P)011WA.) &�&J - ACh �Zo ning Clerk an
STATE OF NEW YORK, COUNTY OF PUTNAM as:
On the 28th day of April 1986, before me personally came Herbert Levenson,
Chairman of the Zoning Board of Appeals of the Town of Putnam Valley, N. Y., to me
known as the individual described in and who executed the foregoing instrument, and
acknowledged that lie executed the same.
ANNA N• BURNS
NOTARY PUBLIC, STATE OF NEW YORK _
QUALIFIED IN PUTNAM COUNTY N tary
No. 4607700
Commission expires March 30, 19
Filed, Office of the Town Clerk, Putnam Valley, N. Y.
on 6th day of Mav 1986,
Town Clerk
.l�
HAND DELIVERED
to
ea:ed Pu:=a= CC-z=tV
E -2 S 1 -, 'a D.e :) a :- t -a e n
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road. Brewster, New York 10509
*91•
278-6130
JOM KARELL Jr- PL. its
Public M"th Clireclo►
I acknowle--E-ze rec=--:Dt c5 the ha=--' clel i-,ered Nati=e
�QMKI)
a : e
W7-TNESS:
Laa
Sig- �_ —n
o
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Vate signatUA
Title
B.7:mbt 6188
N
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92
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s.
-PRELIMINARY MAP _93 -
TOWN OF PUTNAM VALLEY SCALE
PHOTO NO, 21
PUTNAM COUNTY, N.Y.
DATE, AERIAL PHOTOGRAPHY 4-29-63CATE,MAP 917-64
LEGEND
--E 2.5,..cr L-111
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-PRELIMINARY MAP _93 -
TOWN OF PUTNAM VALLEY SCALE
PHOTO NO, 21
PUTNAM COUNTY, N.Y.
DATE, AERIAL PHOTOGRAPHY 4-29-63CATE,MAP 917-64
_,P
-PUTNAM Q3UNTYJ1Ei<H.DY
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
John M. Simmons, M.D.
Deputy Camissioner of Health FIELD ACTIVITY REPORT - Sheet - of
INSPECTION
NAME 6 UJ./- 8►?, Orig. Routine in
ADDRESS V1,
Street
6"
IMOW597
MAILING ADDRESS
P.O. Box Post Office Zip Code
WN"Dizil. •
PERSON IN CHARGE
OR INTERVIEWED
Name and Title
DATE /1 / I � � � .1 TYPE FACILITY
rig. %A.ALV.L
Orig. Request
Cmpliance
Canplaint Ccmp
Final
Group Illness
Construction
Reinspection
Field, Sampling Only
Field Conference
Other
TIME ARRIVED / Z', 3 6 1 TIME LEFT I Z ", v 1:: Explain
. FINDINGS: &P 03 &0 1176 WLELC, �1 - Z- 81,L)
o'4
V e. .,P /L & LA J e5l, /Q W,1
A* A I* I r-
INSPIDMR: n r C -
Signature and Title
PERSONIN CHARGE OR
I ackrwU_xjg�ethis Field Activity Report. SIGNATURE:
6/86 TITLE:
TELEPHONE:
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
December 8, 1987
Mr. Charles Fowler
PO Box 407
Lake Peekskill, New York 10537
Re: Proposed well
construction
Fowler
Pleasant Road
Lake Peekskill
(T) Putnam Valley
Application W -80 -87
TM 93 -3 -4
Dear Mr. Fowler:
JOHN SIMMONS. M.D.
Deputy Commissioner
JOHN KARELL, Jr., P.E.
Director
Review of an application to construct a well for potable
water supply purposed to serve the above captioned property
has been completed.
Review indicates as follows: _.:.._�. ... ... _ -_ ....,....: .- .... -.a �..... _._ - __ .... .,..,....:
1. The lot is presently supplied by the Lake Peekskill Water
Works with summer water.
2. The proposed well is located approximately 80 feet from
the existing sewage disposal system on yotnrlot.
Recognizing the above, and that a minimum separation 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.
tAUTYTY yousns,
hn Karell, Yr. , PL E.
rector,
vironmental Health Services
JK:pt
cc:JK
File
DIVISION OF ENV I R_ONMENTAL HEALTH
.�/SERVICES _
r- tl' aa- f1- �• Vf" ��V�iYAi�l 'w- • <:ij�AYE ^�ii�''.'NC"7W'�'T a�`ei �9\. •:'a.'�i ._ID _, ....� �. ae:, .la:.. ,. . . -'wv: -.r ..._��r i.•
IN THE MATTER OF THE COMPLAINT AGAINST,
Charles Fowler
Respondent(s),
Arising out of the .Al :leged Vio.l.ations of the
Public Health Law of the State of New York,
the Sanitary Code of the State of New York,
the Sanitary Code of the County of Putnam,
and Administrative Rules, Regulations and
Standards Promulgated Pursuant Thereto.
._ NOTICE. OF
HEARING
CASE NO: 84 -95 -20
TO: Charles Fowler PREMISES: Fowler Residence
7 Pleasant Road 7 Pleasant Rd, Lake Peekskill
Lake Peekskill, New York 10537 (T) Putnam Valley
TM #83.72 -1 -35
PLEASE TAKE NOTICE THAT CHARGES have been preferred against you to the effect that
you have violated the health laws as more fully set forth on the reverse side of
this notice:
YOU ARE HEREBY SUMMONED TO APPEAR at a hearing to be held under the provisions of
the Putnam County Sanitary Code and Public Health Law of the State of New York
before Earle Warren Zaidins, Esq., an Administrative Hearing Officer of the
DEPARTMENT OF HEALTH of,the County of Putnam on the 5th day of April 1995 at 10:15
AM., in the Hearing Room, located at Route 312, 4 Geneva Road, Terravest Corporate
Park, Brewster, New York, at which time the charges will be informally discussed,
and such adjourned dates as may be designated.
-•A-T "kLiL -: T I-MES •YO-U -- 'tI LL- HAVE i TrE: - R i GHT to -be - repi -escn ..ed by counsel- and = the -r g t tb-
deny the charges, in whole or in part, following which the matter will be
rescheduled to a date certain and a Formal Hearing will be conducted thereon, and a
record of all the proceedings wi:ll.be made, witnesses will be sworn and examined
and cross examined, and documentary evidence may be offered and received, and you
may produce witnesses and evidence in your behalf;
IN THE EVENT YOU WISH TO ADMIT TO THE CHARGES, the Hearing may be terminated by
written stipulation of discontinuance provided the violations have been corrected;
UPON YOUR FAILURE TO APPEAR, a warrant compelling your appearance may be issued or
an Inquest Hearing conducted and a determination made,
CIVIL PENALTIES up to $500 for a single violation, per day, may be assessed against
you, and such further orders may be made herein as the circumstances may warrant;
THE BOARD OF HEALTH may issue a warrant to any Peace Officer of the County,
pursuant to Section 309 of the Public Health Law, to bring to its aid the power of
the County whenever it shall be necessary to do so, with the same force and effect
as if such warrant had been issued out of a court of record.
WAU OARD OF HEALTH
DATED: March 2, 1995 BY: Brewster, NY 10509 , R,.S.
Acting Public Health Director
PETER C. ALEXANDERSON
County Executive
Charles Fowler
P.O. Box 407
( Pleasant Road
Lake Peekskill,
DEPARTMENT OF HEALTH
Division Of Environmental . Health Services
110 Old Route Six Center, Carmel, New York 10512
(914) 225 -0310
September 14, 1988
Dear Mr. Fowler:
New York 10537
MNID�L: GARRUTH, -M.PA'
Public Health Director
JOHN SIMMONS, M.D.
Deputy Commissioner
JOHN KARELL Jr., P.E.
Director
Re: Proposed.Well Construction
Pleasant Road
(T) Putnam Valley
TM #93 -3 -4
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:
p r -e=s-e n t1 s u p p l'i'e d- -U t•h e=�- L-:a-k --& P ew l: s?: z X --we t.e:tz
works with summer water.
2) The lot area is approximately 12,000 square feet or 3/10
acre.
3) The proposed well is located approximately 80 feet from
the existing sewage disposal system on your lot and 80
feet away from an adjacent sewage disposal system.
Recognizing the above and that a minimum restrictive distance
of 100 feet is required between a sewage disposal system and
well, your application for a permit to construct a well on this
property is hereby DENIED.
Very truly yours,
C
Lawrence C. Werper
Assistant Public Health Engineer
LCW /jz
cc: PV. BI.
co DEPARTMENT OF HEALTH
Division of Environmental Health Services
t TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
. m .� :fa� i- 1 .M, -1 M.:.f ,. �: ','„'.° ':;, '. _,..`:.0 c., -t: Via. :.. 'e. ea ';. .. «:. ,n. n. r. ;r.:,,, •r ..r .. ;,i%- ..q,' k ,. ... n ..� r.;
APPLICATION TO ^ CONSTRUCT 4A WATER WELL
PCHD PERMIT #/
WELL LOCATION
Street Address
Lr /7.s 41Y11 if
Town/Village/City Tax
64 C-
Grid Number
3
WELL OWNER
Name Mailing Address
C P4.44r I CjQ- PO e, &Y Y67 L eA 6A[= fkZLG
Wrivate
O Public
USE OF WELL
1 - primary
2 - secondary
,RESIDENTIAL
(3 BUSINESS
® INDUSTRIAL
O PUBLIC SUPPLY Q AIR /COND /HEAT PUMP
O FARM ❑ TEST /OBSERVATION
O INSTITUTIONAL ❑ STAND -BY
[3 ABANDONED
❑ OTHER (specify
AMOUNT OF USE
YIELD SOUGHT
gpm /# PEOPLE SERVED :1, /EST. OF DAILY USAGE gal
REASON FOR
DRILLING
91NEW SUPPLY O PROVIDE ADDITIONAL SUPPLY
❑ REPLACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL
0 TEST /OBSERVATION
DETAILED.
REASON FOR
DRILLING
NO 15110A4 90040 W 4 74C IZ so 1PYL
WELL TYPE
DRILLED
®
DRIVEN ODUG
®
GRAVEL
®
OTHER
V
IS WELL SITE SUBJECT TO FLOODING? YES _ NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No.
WATER WELL CONTRACTOR: Name Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES %( NO lfor /;z.,- ve+g,
NAME OF PUBLIC WATER SUPPLY: P071trwfA TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
®ON REAR OF THIS APPLICATION 8 ErOLzzimq��
Z
618,0
(date)' (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 is Non - Transferrable
2/87
Permit Issuing Official
White copy: H. D. File
Yellow copy: Building Inspector
Pink Copy: Owner
Oranap mnva Wall nri11cr
7
a
561
1
t
PETER C. ALEXANOERSON
County Executive
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(91 k) 225 -0310
Mr. Charles Fowler
Pleasant Road
P.O. Box 407
Lake Peekskill, New York
Dear Mr. Fowler,
10598
RE: Proposed Well
July 8, 1987
JOHN SIMMONS. MO.
Deoucy Commissioner
JOHN RARELL. Jr, PE.
Director
Please find enclosed your application to construct a water
well. This. application must be submitted to Putnam Valley's
__...g-u.ildi zg _ I.: ,pectc , - = Piar vin CdEll; = ,r or to thef revie w b�y thi-:3"
Department. Only after Mr. Odell's written comments are received
by this office can the approval process continue.
Upon receipt of a submission revised to reflect the above
comments, this application will be considered further.
Ver my yours,
Robert Morris
Environmental Health
Technician
RM:pt
Enc.
cc:RM
File t/
JK
lti
•^--'-'° DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
,... ate. AYP1,1CATION TCT* "CONS' R—OCCT *.P;,.p- vgA!rl 1R' WEI;f:..'
PCHD PERMIT
WELL LOCATION
Street Address Town/Village/City Tax
t li s 4iv r c.�4�
Grid Numb r
WELL OWNER
Name / Mailing Address ZTrivate
•�� / 0c-)L- -v- CSC y `Y67 �,4iL�_ / °E,�:,YS,[�£CC OPublic
SE OF WELL
I - primary
2- secondary
FJ RESIDENTIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP
0 BUSINESS O FARM O TEST /OBSERVATION
0 INDUSTRIAL U INSTITUTIONAL O STAND -BY
O ABANDONED
O OTHER (specify
O
AMOUNT OF USE
YIELD SOUGHT gpm /# PFOPLE SERVED ? /EST. OF
DAILY USAGE 90 gal
REASON FOR
DRILLING
ONEW SUPPLY O PROVIDE ADDITIONAL SUPPLY
O REPLACE EXISTING SUPPLY O DEEPEN EXISTING WELL
O TEST /OBSERVATION
DETAILED
REASON FOR
DRILLING
Ne to 6z-L bALIr$ C.
WELL TYPE
DRILLED
O
DRIVEN
DDUG
CI
GRAVEL
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES _ X NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: 1_ -4/CC7
Lot No.
WATER WELL CONTRACTOR: Name to 4.,t5 P, E' ; " c 14 1- /V /= Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO
NAME OF PUBLIC WATER SUPPLY: Li�k6 TOWN /VIL /CITY
DISTANCE TO"PROPERTY FROM NEAREST "WATER MAIN:
LOCATION SKETCH & SOURCES OF CONTAMINATION
_ ❑ ON REAR OF THIS APPLICATION
(date)
PROVIDED
®ON SEPARATE SHEET
`.
(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 s.hall:
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 is Non - Transferrable
2/87
Permit Issuing Official
White copy: H.D. File
Yellow copy: Building Inspector
Pink Copy: Owner
Orange copy: Well Driller
_ 1 z TOWN. HALL
YMARVIN90'DELLC~ - T ✓ r, a x. i" .<= u�plitNAiVi'�VALLEY,'N-Y. Q .
Inspector o (914) 526 2377
TOWN OF PUTNAM VALLEY
BUILDING, ZONING, AND SANITARY DEPARTMENT
Mr. Robert Morris
Department of Health
110 Old Route 6
Carmel, N.Y. 10512
Re: Fowler - Northway, Lake Peekskill
TM #93 -3 -4
Dear Mr..Morris:
The proposed well shown on submitted drawings does not
c6nform to the necessary separation requirements.
It should be considered, however, that a Variance under
Local Law #1, 1978 had been granted with conditions by the .
Zoning Board of Appeals.
y -
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Very truly yours,
MARVIN O'DELL
Building Inspector
MO'D:es
enc. Copy of Decision and Order
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