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04264
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9
DEPARTMENT OF HEALTH
Division of Environmental'Health Services
4 Geneva Road, Brewster, New .York 10509
(914) 278 -6130
r _ AP - PLICATION TO CONSTRUCT A WATER-FELL.-
PCHD PERMIT "!
WELL LOCATION
Street Address Town Vilage City
7 C 1 r T P L L�
Tax Grid Number
WELL OWNER
Name Ma' li Address
OPrivate
O Public
�E OF WELL
primary
2- secondary
rBUSINESS SIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP O ABANDONED
.0 FARM O TEST /OBSERVATION O OTHER (spec ifq
O INDUSTRIAL U INSTITUTIONAL O STAND -BY O
AMOUNT OF USE
YIELD SOUGIiT_gpm /4i PEOPLE SERVED 3 -S /EST.' OF DAILY USAGEgal
REASON FOR
DRILLING
EXREPLACE EXISTING SUPPLY O TEST /OBSERVATION
O NEW SUPPLY NEW DWELLING O DEEPEN E ISTING WELL
Q ADDITIONAL SUPPLY
DETAILED
REASON FOR
DRILLING
dug_:, Lf /e [&_ /UC i �7 . J'ToLG'�✓�-
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ATZ r- G -,o rC G r )I-- C0.9 T
WELL TYPE
DRILLED.
QDRIVEN DDUG
OGRAVEL
0OTHER
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 _rd b Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: i YES NO
NAME OF PUBLIC WATER SUPPLY: (� /T" �Olferf s 4,,t t _ TOWN /VIL /CITY
DISTANCE TO PROPERTT FROM NEAREST_:WATER.MAIN:..
LOCATION SKETCH 6 SOURCES OF CONTAMINATION PROVIDED
ON SEPARATE SHEET
(date) ignature)
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
any and all water or waste products from such well
property and in such a manner as not to degr a or
Date of Issue• 19
Date of Expiration s Z 19
Permit is Non - Transferrable Whi/
3/89 Yelloi
sha take appro 'ate action to assure that
dr 1 g per: o s be contained on this
of a wi con a ate s fa a groundwater.
ermit Issui g 0 ficia
copy: HD File Pink copy: Owner
a copy: Bldg. Insp. Orange copy: Well Driller
To Who It May Ccm ' ~
- _ m ^ - .
lake peekskill in 1986 with my emidiate family. the
origional owner of this property was dr john and marie
zarcone. in 1988 I purchasted this house and have lived
there over since.My family and I have beenhere for over 10
years.I ask that a well permit be granted for a new site on
a emergency and expedient basis based on the following
reasons '
the house is resided in year round and only during
the summer months do we receive water from the town.our
neighbor was granted a well permit due to the fact there
well, which is 10 yards from ours ran dry in october.he has
now completed a new well.the shallow well we receive water
from is fed by the stream from lake peekskill and since the
water table was lowered it cut off our only supply of water
which currently we have been without for 2 weeks Aue to the
location of our well there is no current excavation
equipment that can deepen the exsisting well.It is located
behined the house in woods at a 45degree angle.therefore a
new site is needed in order for my family to have water.
thank you for your attention in this matter
mark zarccme
:.;•..�,_ ... �Ai1Afi�/IN'O'DELL`; ... R.. x;,-' w'- ;- o;s;��.vz•... ... r.
Bldg. Inspector
_ TOWN HALL .
. :.• �- ...,..K • �= . � >`"• "PL��NAM'VALCEY;'N.Y. `.'" •,��.�
(914) 526 2377.
BETTS STOCKINGER
JOHN MAHONEct TOWN O F P U T N A M VALLEY Bldg. Dept. Clerk
Deputy Zoning Inspector
BUILDING, ZONING, AND SANITARY DEPARTMENT
March 4, 1994.
Putnam County Dept. of Env. Health
4 Geneva Road
Brewster, N.Y. 10509
Att: Robert Morris
Re: Proposed Water Well
Mark Zarcone - T*83.82 -2 -30
7 Chester Place
Dear Mr. Morris:
The above noted request has been reviewed with the following
observed:
There presently exist a shallow surface well located adjacent
to a stream at the rear of this property. The property slopes
from front to rear. No survey of this lot has been presented.
- The site plan (Tax Map Co y) indicated the new well is proposed
approximately eighty (80'� feet from the Sewage Disposal Aj;ea
on this property.
Adjacent sewage disposal systems within 200' not shown.
Very truly yours,
MARVIN 0 DELL
Building & Zoning Inspector
MO'D:es
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_ To Whom It May Ccmcern __ .
�~re� 7j
lake peekskill in 1986 with my emidiate family. the
origional owner of this property was dr john and marie
zarcone. in 1988 I purchasted this house and have lived
there ever since.My family and I have beenhere for over 10
years.I ask that a well permit be granted for a new site on
a emergency and expedient basis based on the following
reasons
the house is resided in year round and only during
the summer months do we receive water from the town.our
neighbor was granted a well permit due to the fact there
well, which is 10 yards from ours ran dry in october.he has
now completed a new well.the shallow well we receive water
from is fed by the stream from lake peekskill and since the
water table was lowered it cut off our only supply of water
which currently we have been without for 2 weeks Aue to the
location of our well there is no current excavation
equipment that can deepen the exsisting well.It is located
behined the house in woods at a 45degree angle.therefore a
new site is needed in order for my family to have water.
thank you for your attention in
mArk zarcone --�/--~
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