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Home My WebLink About4266DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.82 -2 -33 BOX 32 04266 ': .. ,�L IN 16 .. i -e I' r ' ON I' ml IN IL 0 1 ef . LI � .'0 .r�l 04266 SHERLITA AMLER, MD, MS, FAAP Commissioner..of Health . LORETTA MOLINARI, RN, MSN Associate Commissioner of Health January 24, 2005 ROBERT J. BONDI County Executive DEPARTMENT -OF HEALTH 1 Geneva Road, Brewster, New York 10509 Mr. Kevin McCrudden 36 James Drive Putnam Valley, NY 10579 Re: Well Permit Application for McCrudden Property —.19 Chester Place (T) Putnam Valley Dear Mr. McCrudden:, This Department has approved the well permit for Well #W7 -04 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 65 feet from on -site and/or adjacent subsurface sewage treatment system areas. 3: -'I'tie well'shall be- fristallecl witha miniiriurri -of -76' feel -of casing . 4. An ultra- violet light disinfection unit shall be installed on the incoming well line to the dwelling. 5. 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. 6. 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. Michael J. ud Vins i, PE Director o Enging MJB:cw Cc: C. Santos, (T) Putnam Valley Insite Engineering 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 f P IV UTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICA'T'ION TO CONSTRUCT A WATER WELL' t please print or type PCHD Permit # W % — y Well Location: Street Address: Town/Village Tax Grid # Map$3''R Block .`Z Lot(s) Well Owner: Name: Keop z ✓cCru ,W6iJ Address: 3(, T,4/ne,S J)rk-e_ PO a-,*t VWXe 10s7 Use of Well: _Residential 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 5-3 Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason e:::- o -r 7° -Iv �e_W for Drilling Well Type Dri led Driven Gravel Other Is well site subject to flooding? .......... ... Yes No Is well located in a realty subdivision? ..... .. `�yP." .... fi'. ............................ Yes /1� - No Name of subdivision Lot No. Water Well Contractor: Address: Is Public Water Supply available to site? .......j„r.l.�??... °..�...a'. Y ............... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Applicant -Si nature:,- g - 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 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 w ter well driller certified by Putnam County. A . / Date of Issue -0 Permit Date of Expiration Title: _ Permit is Non-Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Wrange copy - Well driller 6 Form WP -97 i G- �,�Pv� �d 4� clo rK tcgfo T-0 LU 01 /Vi w V- L T- T-0 G10 l A-) Ile sic 1 I- C7 O Ve r V'o L-,-�Co T4 ir -e D ouu,,)-eur. rcg,,j . T 1,-J qi,6 � L4 Se O'c- SI,1.4r-ec9 we IS ,JO - F POSS, 91-e 7- -a- -f C, Y Pe�� u 1 PUTNAM COUNTY -DEPARTMENT OF HEALTH 4X)' I DIVISION OF ENVIRONMENTAL HEALTH SERVICES APP,LIC.ATTON...T;O CONS_"TRUCT A- WA'T'ER W -ELL. - please print or type PCHD Permit # W / O y Well Location: Street Address: Town/Village Tax Grid # Mapl3'� Block A Lot(s) J Well Owner: Name: eu(N 14jcCrqca&136 Address: 5'AIn S I)rbv-e— Picr N" VwIfy lv.s7 Use of Well: _Residential .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 !i::�_ 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 e �-� d ,Shc a► y �z a ®.s for Drillings Well Type Dri led Driven Gravel Other .. . ...... .... Is well site subject to flooding? ................... ............... .......... .. .................... Yes No Is well located in a realty subdivision? ......., P..°..' ....,1� ........................ Yes No Name of subdivision Lot No. Water Well Contractor: ,4 6e Address: Is Public Water Supply available to site? ....... ... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. 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 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. Date of Issue Date of Expiration Permit is Non - Transferrable Permit Issuing Official: Title: White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Y re rK 1(9So � l To uj l r /M a � ( 0 /L) (,,- rA) , P Ile fCStCr t ( N,'' /, 1�7 / S I . Ve c- r V'o L-�c9 7-�,e CPO Cc"j,c ,. Cdr T �e C9 We t lici F t s W�L( r �, /Y tN)- IS 9 -� L4See op q T41.,tolz' qc) L'i �GeU J,J IA4 6C rkMP.-) /at..- m 61L_,— PUTNAM COUNTY HEALTH DEPARTMENT :... DIVISLON OF ENVIRONMENTAL HEALTH_ SERVICES SITE LOCATION. OWNER'S NAMI OFFICIAL USE ONLY TM# 30 Z// ; PHONE G-.2- S` MAILING ADDRESS' g 6 X -;g a ?T f.✓ t/r /%�r�� PERSON INTERVIEWED - Q 4tol l P-C-- PCHD Complaint # Name & Relationship i.e., owner, tenant, etc. DATE ADDRESS TYPE FACILITY PHONE REGISTRATION# 0 o a (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system .Different location may require submittal of proposal from licensed professional engineer or registered architect. 60 /,0, Ce X i `S f, as owner, or repo: .114V is stated on tFus dorm. � `" � "� "" Proposal approved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name b. Site Street Name, Town and Tax Map number. C. Location of installed components tied to two fixed points (e.g.,house comers). d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6' deep e. Installers' name and number. 3. System repair to be performed in accordance with the above proposal and conditions. Proposalapproved Inspector's Signature & Title ATE COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99ML PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES : APP741CATION TO CONSTRUCT A WATER IN LL -- please print or type PCHD Permit Well Location: Street Address: /0/,w_Town1Village Tax Grid # Sz Map `T3 Block Z Lot(s) Well Owner: Name: A- Address: l 7 101 c, e_ "10,0el e;1 lJs,e of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1 rimary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought _7 gpm # People Served 3-5-- Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason for Drilling Well Type Drilled Driven Gravel Other Is well site sub'ect to flooding? Yes No Is well located in a realty subdivision? ,. ��/.... '// ................. Yes :. , No Name of subdivision Lot No. '�. z t, 9 70/01 Water Well Contractor: Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: Proposed well location & sources of con provide separ to s ee Date: O Applicant Signature: 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 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. Date of Issue Date of Expiration Permit is Non - Transferrable Permit Issuing Official: Title: White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 BRUCE R. FOLEY Public Health Director LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648 Preschool (845) 228 - 5912 Fax (845) 228 - 6113 Richard Bacerelli 19 Chester Place Putnam Valley, NY 10579 Re: Proposed Well: Bacerelli 19 Chester Place (T) Putnam Valley Dz Wit: Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: 1. Certified Check or Money Order in the amount of $100.00, made out to the Putnam County Department of Health. _ 2� .Site plan .of- property showing locations of proposed well, existing septic.systemy _ � , and house. The proposed well shall be dimensioned from two fixed points. 3. The site plan is to also include location of all existing septic systems and wells within 200 feet of the proposed well. 4. Neighbor notification is required for all properties within 200 feet of the proposed well; Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very truly yours nomj 94�� Daniel Hadden Public Health Technician cc: RM Enclosure: Procedure for Well Permit Application PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES John M. Simmons; M.D. Deputy Commissioner of Health NAME R04nt4 ADDRESS Iq C, Ls PkLe- .- FIELD ACTIVITY REPORT - No. Street Town1 No. MAILING ADDRESS P 060 VC4164' I ( OJ`" -70 P.O.. Box Post Office Zip Code RNDIMDI' *' • i �I' • M elv Name and Title DATE JA L? 2- TYPE FACILITY TIME ARRIVED TIME LEFT Sheet ( of Orig. Routine Orig. Complain Orig. Request Compliance Complaint Canp Final _ Group Illness Construction Reinspection Field, Sampling Only _ Field Conference Other w� 69 1l'C Explain INSPECTOR: � in 1Y�1C _ �Gf �`t' Ter.'k TELEPHONE: 2 ! _SC7) Signature and Title PERSON IN CHARGE OR INTERVIEWED: I acknowledge this Field Activity Report. SIGNATURE: 6/86 TITLE: J 40 /D - --- /w Ixle 43 3 u /w • X I 6 11.11 /p I I s7d - - — — - I s;a nu =- / ,;u. -• - 9 3B / Jig / ✓��fdP> a 4tr rl f' If /l 3T • 37 '43 Z8 fy ` —. _ —/� ' _ _ _ — /J / / / / / / / / A / D IJ1f SLR / � • �J x y IN.•e h / =_1 92 —• r 48. —a I ( 1 \ 9I ! ! I p J /p'� 24 ct 7 '• '— 8.'�l +r/ D 1 \\ `�'A ail 'x 1 "54 °° ^ / Iqq x q° 1 1 x x l '° I 1 I / •.1 I / / / !�" 53:I � I ¢g u a I C I � I I � 1 52 f 1 d l I I 1 �•( 1 i 1 a_ 50 s/ ItYq 1 J 1 1. 1 g l I I 1 1 ` `fqG w X I �� Yl13010 r YLI LEGEND 83.73 83.74 x IZSSO — "a.77 ...( _lp. J 1.—. �' y � !�,. .,��. _ --_•• -.ion �-0 �.. .q 83.83 _ _ /./ 09 AC. s � 9 26 9 x.27 ' msnlR LIK �f :. min Lilt — COLII.•Re IKA LN K [IL nwa ® A°IY D 1 _IWEL IL41IG R Ia ttllF R/K WYIDIpIFS eK IWfS n R[I _47 41_ ` I \ 45 y p •` �I a \ 013 AC. rel =_1 92 —• r 48. —a I ( 1 \ 9I ! ! I p J /p'� 24 ct 7 '• '— 8.'�l +r/ D 1 \\ `�'A ail 'x 1 "54 °° ^ / Iqq x q° 1 1 x x l '° I 1 I / •.1 I / / / !�" 53:I � I ¢g u a I C I � I I � 1 52 f 1 d l I I 1 �•( 1 i 1 a_ 50 s/ ItYq 1 J 1 1. 1 g l I I 1 1 ` `fqG w X I �� Yl13010 r YLI LEGEND 83.73 83.74 x IZSSO N 83.81 83.83 r -. ?w �' .1,.1, fOLIK -- e� °�°° °�° A'gID elKYllm 14010 s � 9 26 9 x.27 ' msnlR LIK �f :. min Lilt — COLII.•Re IKA LN K [IL nwa ® A°IY D 1 _IWEL IL41IG R Ia ttllF R/K WYIDIpIFS eK IWfS n R[I =_1 92 —• r 48. —a I ( 1 \ 9I ! ! I p J /p'� 24 ct 7 '• '— 8.'�l +r/ D 1 \\ `�'A ail 'x 1 "54 °° ^ / Iqq x q° 1 1 x x l '° I 1 I / •.1 I / / / !�" 53:I � I ¢g u a I C I � I I � 1 52 f 1 d l I I 1 �•( 1 i 1 a_ 50 s/ ItYq 1 J 1 1. 1 g l I I 1 1 ` `fqG w X I �� Yl13010 r YLI LEGEND 83.73 83.74 83.75 MAP - PREL I M I NARY SCALE uK uo s eo S 0 83.81 83.83 r -. ?w �' .1,.1, fOLIK -- e� °�°° °�° A'gID elKYllm 14010 TOWN Of PUTNAM VALLEY 50 e L cl 9 , 25 9 26 9 x.27 ' msnlR LIK �f :. min Lilt — COLII.•Re IKA LN K [IL nwa ® A°IY $ C PUTNAM COUNTY, 'NEW YORK ma u m 1µ M/ieNI1B_••Ni1 mn s Wit—VIM elACn IGIOIYf -. - _IWEL IL41IG R Ia ttllF R/K WYIDIpIFS eK IWfS n R[I :a c Y 201 i . " a � r vor i !f 4 � gg' CHES A. �xSfff' Tom' : y� rug Approx. Location Existing Well t� A Oil - Proposed Well . map inform066" from Putnam County Ihese sketches are intended to show approximate lines, dwellings, and septic systems for use in assessing Sub)ect Property Approx. Location ` �YyyJ�i Approx. Location SST 3+ purpose and am not intended to the sealed. Prior to drilling any proposed Existing SSTS Arrow Points Downhill — waft the appropriate surmys, design; end permits must the ahtoined ""LAKE PEEKSKILL CHES A. �xSfff' Tom' LEGEND NOTE: These sketees are Nosed on New York State Nigh Resolution Approx. Location Existing Well t� Statewide OWtal Ortholmogery Program (2000 Plot - Present) and digital tax - Proposed Well . map inform066" from Putnam County Ihese sketches are intended to show approximate lines, dwellings, and septic systems for use in assessing Sub)ect Property Approx. Location property Possible well locations only These sketches ore not intended for any other Approx. Location SST Direction Of Ground Slope SLOPE purpose and am not intended to the sealed. Prior to drilling any proposed Existing SSTS Arrow Points Downhill — waft the appropriate surmys, design; end permits must the ahtoined ""LAKE PEEKSKILL M -MEDs" INS / T E 1 -14 -05 WATER SYSTEM SHUTDOWN ENGINEERING, SURVEYING & SC &L. sc t.a40, LANDSCAPEARCHITECTURE, P.C. t+.accr No: 04183.100 PLOT PLAN 3 Gorrett Place • Carmel, New York 10512 T" MP d 19 CHESTER PL. Phan. (845) 223 -8690 • Fax (845) 225 -9717 www.hs /te- ena•c.m 83.82 -2 -33