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HomeMy WebLinkAbout4220DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.81 -1 -51 BOX 32 04220 .. 0. Y IN �. Ir i NIN NNS �. 0 NN NN R.4 a . T 04220 DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) APPLICATION TO CONSTRUCT A WATER WE/ 225 -03.10 PCHD PERMIT # WELL LOCATION Street Address r� o u r o ca.-d 4 Town Village City Tax Grid Number aok-, k s' l l WELL OWNER Name M 6 r-!A c ilipg A ress , „K4 m rivate ii v"E s "¢ �=1V 1! ° � PYIDPublic USE OF WELL 1 - primary 2- secondary triESIDENTIAL O PUBLIC SUPPLY Q AIR /COND /HEAT / c ei 6 ABANDONED O BUSINESS O FARM O TEST /OBSERVATION 0 OTHER (specify O INDUSTRIAL 0 INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT, gpm /# PFOPLE SERVED_,?_ /EST. OF DAILY USAGE ,gal REASON FOR DRILLING MfEPL ACE EXISTING SUPPLY O NEW SUPPLY NEW DWELLING O TEST /OBSERVATION GI ADDITIONAL SUPPLY & DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING ed a red n ,. z fe r /f v e Y k1d Aas keel • P1 a. 11-S, . ,WELL TYPE DRILLED IDDRIVEN ODUG OGRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES 1/ 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: ©a16y / r) m �1e YES" Bf NV v` e- IZtCBp NAME OF PUBLIC WATER SUPPLY: �F!g���Ic (,% TOWN /VIL /CITY DISTANCE- TO'-PROPERTY -FROM NEAREST WATER MAIN: - LOCATION SKETCH &,SOURCES.OF CONTAMINATION PROVIDED�� BON SEPARATE SHEET e� j-u ate) / (sig ature) 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 -y. (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 take 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: Date of Expiration Permit is Non - Transferrable 3/89 19 19 Permit Issuing Official White copy: HD File Pink copy: Owner Yellow copy: Bldg. Insp. Orange copy: Well Driller 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 3, 1990 Abe L Frances Kaiman c /o.charles,Kaiman Apt. 1020 463 West Street New York, New York 10014 Res Proposed well W -62 -90 Kaiman, 25 Laurel Road Lake Peekskill, NY Dear Mr. & Mrs. Kaiman s a JOHN KARELL. Jr., PZ, M.S. Public Health Director I have received and reviewed your application to construct a water well on the above mentioned parcel. The residence is currently served with summer water, supplied by Lake Peekskill Water District. Current code requirements state that all new wells must be a minimum of 100 feet_. from_ all.. sew.$ge_., disposal. systemq. downhill ( 150 , ieet.. from ;pits_ or. _ dal-l=eyer) - and-200 —feet -fro'm -al,l• `sewage` vPhi2- ­ai d irf° di'1�6dt line of drainage. It does not appear that the parcel is capable of meeting these requirements. However, if you wish to pursue this matter, please submit a sketch showing the proposed well site, and locate all sewage disposal systems with 200 feet of the proposed site. If you have any questions please contact me at your convenience. Very truly yours,' William Hedges Sr. Public Health Engineer WH /jp cc: BI (T) PV