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DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.82 -2 -52 BOX 32 04274 pr J 11 90 :1 I , i ra 04274 19 DAVID D. BRUEN County Executive ZC JOHN SIMMONS, M.D. Deputy Commissioner DEPARTMENT. OF HEALTH Division Of Environmental Health 'Services August 22, 1986 Mr. Albert Golub 57 Harper Street Lake Peekskill, NY 10537 Re: Proposed Well Construction. Harper Street, (T) Putnam Valley TM 106-1-18, Appl.. #W15-86 Dear Mr. Golub: 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: 1. The lot is presently supplied by the Lake Peekskill Water Works with summer water. 2. The lot area is.approximately 10,000 square feet or h acre. 3. Field inspecti4, on indicates the proposed well is.located apZ.roximate.lv..9.Q'.,fee.t..,f-rom.t.he.--e-xisti..ng-.sew.a-qe�--d= sp- -sy5tem"on,-Yblyf.-lbtaH(i"75'fii6-C-iiw rom an adjacent sewage disposal system .both of which consist.of seepage pits. Recognizing the above and that a minimum restrictive distance of 150 feet is required between a sewwage disposal system consisting of seepage pits and a well, your application for a permit to construct-. a well on this property is hereby DENIED. r tr y your r john Karell, Jr. P.E. Director Environmental Health Services JK: a CC: Mary O'Dell, P.V. Building Inspector JK File a TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225-3641 i} + q�Y.i z d r:' >'Y' s�47�.' is f l rd, i rt f4 t v 4 9 Ca qt �t':Vfy,y , _ 'S. i " ,� d 'r - ,[ t ,5t .* iS il> _. 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I, t !3, t! r s f 1 v xtr { i Y�r 4 1 cJS j I {r , r ,,t .f4 :�R i ,t h > :i r , ,P. r a t t Irk i '':' , �.TS N ' A � It ttla . ft idual' water supply indicated above me iNtall}ed ae ., I. b 4Y �. � � • v 1 'c atia�ae af; 9allit3a woo; of .the Watclratelr mtr Dspattrai at , a -404" • x i i fi I,_ " 1'.dtyf rCvri tl k h i .c tr .• t '.1 UL :'. . '' .; • r 1� I` k 1 t. fottaa", Olic 9 VostctioeLar,_ CeW►t , - . 1: .. DEPARTMENT OF HEALTH Division Of Environmental Huh Services TWO COUNTY CENTER - CARMEL, N.Y.. 10512 (914) 225 -3641 U) ,,.,�.... -- _ __ _ �_ -- __ - :+:�e+''e��:i+ar•'f•eo orsa �� �i�!�i�:ax+'�S.o�.v: v:- iz�.•�_:::,.M7'-- �,•'_- - • -+-� WATER WELL_ WELL LOCATION STRECI ADDRESS. 1UWN/V1LLAGE/G11Y _ IAx GM MWE-R: -'"" �S 7 {fA�P�-� 1'T LAxLC P .skILL WELL OWNER NAME.. �L$ -�i �° AOORESS: v DCv� �' �- st- � �c� s,����[ PEIVATC FoofUBOLIC .USE OF WELL Q RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /CONO. /HEAT PUMP ❑ ABANDONED 1 - primary ❑BUSINESS ❑ PARM ❑ TEST /OBSERVATION ❑ OTHER (specify) 2 - secondary ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ AMOUNT OF USE YIELD SOUGHT gpm. /NO. PEOPLE SERVED °` / EST. OF DAILY USAGE oaf. REASON FOR ❑ NEW SUPPLY Pr PROVIDE ADDITIONAL SUPPLY ' T STIOBSERVATION , DRILLING ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELLXI,, %' ? . rway p °F7--� al DRILLED F__j DRIVEN DUG GRAVEL F-1 OTHER WELL TYPE IS WELL SITE SUBJECT TO FLOODING? — YES. X NO IF WELL IS LOCATED IN A REALTY 'SUBDIVIS ION, NAME OF SUBDIVISION: LOT NO_: WATER WELL CONTRACTOR: Name No�vq f., A-,r'UCVS °t✓ tddress : ru;n/Z IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES =ENO Su %h/9e4F Svlpcy NAME OF PUBLIC -WATER SUPPLY: TOWN1 /V /C _ D.IS.TANCE- TO-.PROPER'hY .., FROM- N•EA,.1?EST : WATER. ..MAIM •LOCATION SKETCH & SOURCES OF CONTAMINATION. 1 (date) 1 (signa re) - - - 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 2. Disinfect the of the Putnam permit. 3. Submit a Well the Putnam Co, until the water is clear. well in accordance with the- requirements County Health Department attached to this Completion Report on a form provided by anty Health Department. 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" t y a tr�C� � n`� �•rrx•S` pRrr r�:. - st ! .. *r�li2�yVr ±4 !t r :i;�',�E .._ ~� 1 � \ t'� s tt �T"t1 "" , � t e�t�.•f � "* �c � ?.en{�:'�'S'�it o y_ - 0�.,•1\ !9 .T 11 ey k . ;+ ' n� � r� yt"t} ,.r , ti f v 1 J. � ..•r.a"¢Lh _ j ' � �+ ���1�r � �t +iY� . b� 1 �..r £ ¢ , r e � - - 1 3a 1" i! i .- ""?""� �?� t ,t r _.�r�'� Y °r� U`v.fA, � ,r, _,rM,as�s r•+"'`" '3"� � �, �z'..� {t r v-,?`� � fit'.'.-' ,t, - r .5::'' jj %-' a �•-r - -' �,R� ; t �.b+• —" . r �t 7x � ` ..�• r;, is,y', f t �! ��' � \- , �,W �*�{,'� # :... • . r. . ' .:. ..:1 �t: i , t.K Y•°At..7��d�'•�':Ji�.'. `''st� -' \2pkil����r;�'i�6a ... I.,�k - #'Y '<*Fst ...� .e i. .r..,. � � � ^' v�• I �6 �P s., 1 rJ 1 OfSo po oG ►, 7Jc 3 5 O i� S Ps # OoC T hoc - u (3 T-7 f)Ar' L-. A �/. Lr -�a�= �,'X^ S•,CJ L L JU �l � Ur:3 , :j - DAVID ^ ~D. BFUEN County Executive DEPARTMENT OF .HEALTH Division Of Environmental Health Services September -17,--1986. Mr. Albert Golub. 57 Harper Street Lake Peekskill, New York 10537 Re:. Variance Request Well Permit Golub Harper Street (T) Putnam Valley Dear Mr. Golub: Please be advised that your request for a variance from the minimum well to sewage system separation distance will be considered at the next meeting of the Board of Health on October 20, 1.986:at 7:30 R.M., Room 315, County Office Building. You or your representative should be present to discuss your reasons and usti.ficaon_•fa recarcln t#e� -va c "n®:. If you have any questions, please contact me at Ext. 241.. JOHN SIMMONS, M.D. Deputy Commissioner JK :pt cc:JK File Jthn Karell, Jr. ,° 17.E. D rector, Environmental Health Services TWO. COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 2 GOLUB Recommendation Disapprove variance request .... lot cannot support well and SSDS by todays standards. Lot was developed and approved many years ago based.upon summer water. Psubmitted Aj Jr., P.E. Director Division of Environmental Health. Services .-Z -. ..'. .. - ` /! �' ..stfL� •. t.i .4-Y' - _ Kf4 iT'• 'i�.:a- U1r. ^,u�. -J ` .. .... .L Oct �iCT a�ur�dyt,2, . �L >L ��7'2 i'v LF1�/c: -, �Q.��Z�r.Z�q�/ � ���G • --�r— r_ `.. J/P Apt 'e46 Z�` 1`YJ ��Cs DYt/ ��.� f�1.�s�ii�S y2 �sL/� � LLL•dl/J� �' ,�i�- c�'Z�L•✓ . /2��,�M..�i , �'L:.,� �Lrt�- ,�(�y�Gi��• L°�L�jp� �u Gt���f/�i�ra, i.�t.�?s'�' y✓ �0 ..La ��-� a-.�v �2�i�L.P�Ld�� �' �' .�ir.� 4� ��G ,� a�-v ,imp -�✓ �vz� .�-��� l� Mr. Albert Golub 57 Harper Street Lake Peekskill, NY 10537 Re: Proposed Well Construction Harper Street, (T) Putnam Valley TM 106 -1 -18, Appl. #W15 -86 Dear Mr. Golub: 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: 1. The lot is presently supplied by the Lake Peekskill Mater Works with summer water. 2. The lot area is.approximately 10;000 square feet or ; acre. 3. Field inspection.indicates the proposed well is located approx m to-ly 9 :feet" :f±.b _- .the_ex st ng : sewage t.di•sposael .- -: system on your lot and 75 feet"away from an adjacent sewage disposal system both of which.consist'.of seepage'pits. Recognizing the above and that a minimum restrictive distance . of 150 feet is required between a . sewwage : disposal :system -. con_ si.sting of seepage. pits and -a .well, '`your :application for a ` permit `•to construct a well on this property is hereby DENIED. V, r tr y yon , ;t - 4�i iohn Karell, Jr. P.E. Director Environmental Health Services JK, ;amm cc: /Mary O'Dell, P.V. Building Inspector v JK File TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -36411 Oaae.1 IM-C 0 ce� ell 4 _tv� all/lnlcia pkr-� A 1 l ULl llf\ I IV LLJ 1 1 \/1 1 IL/-1L t f i Division Of Environmental Huh Services - ° TWO COUNTY CENTER - CARMEL, N.Y.. 10512 (914) 225 -3641 tU _ f r•' =^ 1" - -� `APPLICATION TO CON:STRUCT'- A`WATER 7,q- WELL LOCATION STREEI AUURE55. 4kUWNIV1LLA / I T s- 7�Kpc� �5t /C L Jy , /alp IaX GAiU NUAt6ER. ���� /. WELL OWNER NAME.. ,,4L B�R�'. , ADDRESS. �D C.O (3 �'�'f%12FL�s1 S1' L �XS����_ V ® PsiVATC ❑ PUBLIC USE OF WELL R RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP p ABANDONED 1 - primary ❑ BUSINESS O FARM ❑ TEST /OBSERVATION ❑OTHER (specify) 2 - secondary ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /NO. PEOPLE SERVED EST. OF DAILY USAGE aal. REASON FOR O NEW SUPPLY Or PROVIDE ADDITIONAL SUPPLY f 76T; ST /OBSERVATION DRILLING ❑ gEPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELLMrti ,17ew . sa ?V'- 7uadel, oF�� WELL TYPE DRILLED DRIVEN DUG GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: ' LOT NO WATER WELL CONTRACTOR: Name Yae pw tddress- , tv!n IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _--ar.-V0 50�Ml►el� $v,pr_ 8N . NAME OF PUBLIC -WATER SUPPLY: : ; wer"\' VA LA-et TOWNL /V /C DISTANCE TO PROPERTY FROM NEAREST WATER -MAIN .•LOCATION SKETCH & SOURCES OF CONTAMINATION. (date) t (signa re) - - -- - - PERMIT TO - - 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 2. Disinfect the of the Putnam permit. 3. Submit a Well the Putnam Coy until the water is clear. well in accordance with the requirements County Health Department attached to this Completion Report on a form provided by inty Health Department. Date of Issue: 19 ,ea T Permit Issuing Official Permit is Non-Transferrable- ef� A s'?t+ltC+'k+i'1',L pbAs•i 9\y...k - .. `�. - 2� ; 1+: �; i t � .: -f�! �.li� t� -tS � �P'Qy� t� �'t•�� � r����� �� r '+'�.1��1•ar i. ._ tr° .. � \ ti/ �r � � ` > t Pa ,�• pce'� -. "� { 4 R'- r :} > F' R` rcf.9M+^MAN, m 7 yyis ,y ( F S rb r � �4r ,� F`r �, x tax ,.�k�4✓�t7s1:17[i#� � La ;' � ` : F¢J"�,t�i ..� a \ . iI $_1.� -k' - } rf.. M::� r•; .� �t : i �' 3 < ,�� ,�� .i'° ti f`r' *T ? � t4 :•�, f v+ '4'1,''1" `#°NY�'r"���"z" � , a ,..'tf . .4+ J. A'S: •(.1 ,� t- i �'�s�. t 4. .� 'tid�L LS f3j , N I :k. Y,: SS'M J,! �° Y'd �i m�.t[31f 4 ,r}y .t �{:Oi k �tri t? 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': �3y{ •d:� �, .' �—�'. �. `.. .....71, :..... ,s _ � �'�X�i t�r 1�i ��� • r } s w, ?+' � � {gip :•.r -'�, a° $ "� -.. ri � t'�ii; }#sw _ ;'`Y m rt _ �'� ::�. ./ / , _,•r � ^' �� e F :.',,,1 s Ys�� �e:.r • - .. ..? '. �' � i -•.'.� � ..... �... 4x'.._ Y .,A.1- ..1 +6'� -.A, t.. d- Q' 1 � L'Ll rU\ I IYILI \ 1 V► I IL' %L I I I Division Of Environmental Hoa,4h Services TWO COUNTY CENTER - CARMEL, N.Y. • 10512 (914) 225 -3641 APPLICATION-TO COINSTRUCT WAi'ER WELL . _.. _ ....._ _... .. .. q, WELL LOCATION SIRErl AUORESS. IUWNI ILLA / I T 1AX GROU NU&WER. 7 �4RP�6 ST L/4kc -Sk /�L 11�. WELL OWNER NAME. • , At- D v ADORES& 5T- _ ® ITE O P-USLIC USE OF WELL ® RESIDENTIAL . ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED 1 - primary ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑OTHER (specify) 2 - secondary ❑ jNDUSTRIAL O INSTITUTIONAL ❑ STAND -BY p MOUNT OF USE YIELD SOUGHT gpm. /NO. PEOPLE SERVED / EST. OF DAILY USAGE ozl. REASON FOR O NEW SUPPLY IV PROVIDE ADDITIONAL SUPPLY i• TEST /OBSERVATION DRILLING ❑ gEPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL2rJ.,, r9 ? . S�PP� 7'W(7dft DF'F--I WELL TYPE DRILLED F_� DRIVEN DUG GRAVEL _ OTHER IS WELL SITE SUBJECT TO FLOODING? _ YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: LOT NO -: WATER WELL CONTRACTOR: Name Yaq f,r 4,y',0eCSor✓ ddress , tu/r IS PUBLIC WATER SUPPLY AVAILABLE TO SITE:. ✓ YES PTO S,- MM K $IVRV G � : O lvz_��•. NAME OF PUBLIC-WATER SUPPLY: 41 N� j/r¢;� TOWN1 /V /C DISTANCE TO PROPERTY FROM NEAREST WATER. -MAIN .LOCATION SKETCH & SOURCES OF CONTAMINATION ��✓ s'r '►� r Sts- . (date) t� (signa re) - - -- - - - -- 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 2. Disinfect the of the Putnam permit. 3. Submit a Well the Putnam Coi until the water is clear. well in accordance with the requirements County Health Department attached to this Completion Report on a form provided by inty Health Department. Date of Issue: 19 Permit Issuing Official Permit is Non-Transferrable- 16 -6Q) '!C.0 PUTNAM COUNTY HEALTH DEPARTMENT . - d �� � 4 �..• t _ .-, . - e" gyp. • -w . .y..�...:�., :+� r�K4 �1 .. A :.. Q��.� • �C�A /�.JR..A G.. ewe... - : ' �i' . v .. • •� � DIVISION OF ENVIRONMENTAL HEALTH SERVICES " John M , M.D. Deputy Commas'ioner of Health — FIELD ACTIVITY REPORT — NAME T0" � ADDRESS No= ",.'Street -Municipality (T)(V)(C) MAILING ADDRESS' % 4ARPC- Z S l ; P:0. Box Post Office Zip Code TELEPHONE PERSON. IN CHARGE. OR INTERVIEWED `; , GOL.O> Name and Title B_`2I DATE ,' TYPE FACILITY TIME ARRIVED (Q ; TIME LEFT (( '00 M, x Sheet of INSPECTION Orig. Routine Orig. Complain Orig. Request Compliance _ Complaint.Comp _ Finale Group Illness Construction Reinspection Field, Sampling Only Field Conference Other k�GLL .APPI_tL:�rl N ,FINDINGS IF s =' ti YS ,n i ?T _ INSPECTOR 3� iti `ZA A TELEPHONE: Signature and rT' tle PERSON�_IN CHARGE :OR INTERVIEWED: �1 I acknowledge ,receipt of a copy of this SIGNATURE: Field Acts i ,,ty..,Report .................. TITLE: Explain PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEAL'T'H SERVICES APPLICA'T'ION TO.CONSTRUCT. A WATER W_ ELIL, af,: :.: rlt-,.': =.a'' iti�e,. .•+i>'.. v r F r.s -`! ,.:.. = '.'._: w .. r +ii� please print or type VCfHIJ permit #- Well Location: Street Address: Town/Village Tax Grid # L a)ee 2eeJc.SQkJ Map83.82 Block 7 -52- Lot(s) Well Owner: gn% ♦Kiµ1��'1� Address: acr -irz a�• �� 5A- Use of Well: A_ /Residential 2 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 6 —/O gpm # People Served Est. of Daily Usage ST gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling s7 New Supply (new dwelling) Deepen Existing Well Detailed Reason pad ok oz4 ,,ens olF Vs +� b,-A- r1�w w J<L. V"'AC2 o IAO, r utir�w+ S, 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 1CW mow- -1 -g�e6 Lot No. ,p�+ .�r� Water Well Contractor: Address: .-I Marsh 1r %kk la - 'VLk4,arnybi� Is Public Water Supply available to site?.. ............................. Yes &,-' No Name of Public Water Supply: Z,p I . D Town/Village L2 k4 fgcl " Distance to property from nearest water main: APIA Proposed well location & sources of contamination to be provided on separate sheet/plan. Datte-: -. 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 Go taminate s ace or gr. and ater. �l %VmVAV\k �k AZ i ee W CC''SIVI �ut6� IaC pftu)d APPROVED FOR CON TR CTION: This royal expires two years from the date issued finless 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 t ,`j �Z 2 -0 Permit Iss ' g Official: t Date of Expiration mac, . ZZ Title: Permit is Non- Trainsferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 ae�nowledge ,receipt Hof this report - SIG 2 /96 BRUCE R. FOLEY Public Health Director NAME: ADDRESS: SITE LOCATION: DATE: STAFF PRESENT: S Cl) --/Y' �3 +._sap ;•. y ♦ '.F rn w .. r r.,,,. .. .. r1. . V . 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 (914) 278 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085 Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648 WIC (914) 278 - 6678 Fax (914) 278 - 6085 PUTNAM COUNTY DEPARTMENT OF HEALTH SPECIFIC WAVIER �OVlU11P ��-v���'✓'I� vie S /-71o3 SPECIFIC WAVIER Pao REQUEST: r I Mill! 11 2 SS K DOES THE.. PROPOSED VALIANCE .,OQWT _BASF 4 HEALTH HAZARD OR NVIRONM ENTAL CONTA�� FEIN PROBLEM? S WILL DISSAITP,0VAX. RESULT IN A;,StCrNIFICAN ,f HARDSH(P? +_+ YES NO DIS�N. DENIED SW-- /9 u3 NEW YORK STATE DEPARTMENT OF HEALTH Specific Waiver Bureau of Community Sanitation and Food Protection _ ..from Requirements of Part 75 and Appendix 75- AJONYCR; qn "a� :r.'n �: a:.�::".y�. n:, <�'3_:c . ,. •.::,;r'- . +._ew _ : -�•i •�.rs- '....!;a =•ice+ _.. = �. . from. Requirements .... -..._ .. .. forTfn Piifiivaf Housefnotil`aewag6 Treelrn°erit Sysfems 1. Reason why site does not meet 10NYCRR Appendix 75 -A (check appropriate box(es)): '8eparation distance cannot be achieved. Excessive slope. High groundwater. Inadequate depth to bedrock or impermeable layer. Soil unsuitable. Lj Other (explain) ... :.................................................................................................................. 2. Proposed design or conditions of waiver; P ... .. ........flS is....... ✓®�.e5 ...... ............. ....... a....... ..... : .......a . ...............yo. ... ..eo s '� ... ... . .I �r.....n . Q. ,Q CkP.......... ?; .. ik .......... 3. The proposed design may have the following limitations (check appropriate box(es)): Increased risk of well or spring contamination. Increased risk of surface water contamination. Expected design life of the system will be diminished. Operation of sewage. system is subject to mechanical problems Other (explain) ....... ............................... Additional information attached Construction pursuant to this waiver request should not pose any foreseeable health or-environmental problems. In accordance with New York State Department of Health Administrative Rules and Regulations, Part 75.6 (b), a waiver is hereby granted. This waiver may be revoked by the issuing off icial for a change in conditions for which this waiver was granted. ��. RE RESENTATIVE OFCO I 0 HEALTH .......... DATE.. 2� ............................ ............................... ORIGINAL - Local Health Agency COPY - Applicant/Design Professional DOH -1326 (7/92) (GEN -152) Acting 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 /Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Norman Anderson Well Drilling, Inc. 152 Barger Street Putnam Valley, NY 10579 Re: Proposed Well Guerra 22 Harper Street (T) Putnam Valley 83.82 -2 -52 May 14, 2003 Dear Mr. Anderson: ROBERT J. BONDI County Executive On April 11, 2003, a field inspection was conducted on the above referenced lot by Daniel Hadden, Public Health Technician. The application to drill a new well is approved with the following stipulations: 1. The proposed well location is within 15 feet of a property line. Therefore, the well location must be staked by a licensed New York State Land Surveyor prior to any drilling. 2. A minimum of 127 feet of casing must be provided for well protection. As -built plan, Well Completion Report (WC -97), Well abandonment, if applicable, and water quality analysis shall be submitted no later than 30 days after the well completion by the permittee. Please contact the writer at (845)278 -6130 ext.2235 if you have any questions. Sincerely, Daniel Hadden Public Health Technician cc: MB, file .Top . � r �T � ��' ��. — a ... .. d '7 .� . ".w. �. _� •..f •^.. � .. e•Yr F ^'`�P TT+M... -. s .c ��K •- -S c Frey «•. Ar t ,�, f 333 1 1 a � ` 1 ov I c f 4w '~ Old • +` i4`� a $ •r. Ar 10 20 Ar• ! 1 18 i� &TREET I i i r J �• - -- -.-7 — 'j--�-- -� —�r— 1 t:t I IR Q !' Q / n P JJ // / I? 1 / of of Of 10 Of Of Of AOA hr of Of Of 4A —'+Q ♦ .�3 sties E�/ / ff Of R ` 103 10 0 A l p 21 _ 1 ti 0 i21.% .99 ^;1� ... .. � ' —�_ ...5 —•� � 23,911; 21.M 21. JI r t•'� r�� � Q r� / � � � Q � 1 4 �, i V ` !,`1 1 t. zt r /tat r It'� .Fau 14 Of r .. „ ^. r _. _� - ti-- 'r..4,r...... -., - .. e,: .. v ..r '.a ^.. . Y,_ ..a ~-•-_ .- s :eat e�.!G'4� �.. p �,�. ,r. Iwo .�.....� �.2 = z4-L ► ! � low- , ! j !4 ! r i 1 ArI � AV rW- .400 rVol JO .00 � 1a1" � � W iC t � t 1 40 At ► .n�' � �' �t,1� xr Gl 20 ' Ar V 7 x DAVID D. BRUEN County Executive DEPARTMENT. OF HEALTH Division Of Environmental Health Services August 22, 1986 7 7 JOHN SIMMONS. M.D. QisI:iuty Commissioner 7 Mr. Albert Golub cc 57 Harper Street Lake Peekskill, NY 10537 Re: Proposed Well Construction. Harper Street, (T) Putnam Valley TM 106-1-18, Appl.. #W15-86 Dear Mr. Golub: 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: 1. The lot is presently supplied by the Lake Peekskill Water Works with summer water. 2. The lot area is.approximately 10,000 square feet or 4 acre. 3 Field inspect indicates the proposed well isjocat ti ----- ------ .&XI-sting, s a dxspos�a!7 .app�ro: system on your lot and 75 feet away from an adjacent sewage disposal system .both of which consist.of seepage pits. rt Recognizing the above and that a minimum restrictive distance of 150 feet is required between a sewwage disposal system consisting of seepage pits and a well, your application for a permit to construct-- a well on this property is hereby DENIED. V,r tr y our r q 4 john Karell, Jr. P.E. Director Environmental Health Services JK:a CC: ✓✓ Ma ry O'Dell, P.V. Building Inspector JK File TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225-3641 :ilL %ci. LC)fVlfvta ulta•arl4! 1fi' F�i'�''i:i4LJ ..,. . OWN OF PUTNAM. VALLEY, PUTNAM COUNTY, NEW YORK. DECISI.QN & ORDER Name of Applicant or Appellant. CHARLOTTE UNDERBERG i s Address: P.O. BOX 131 LAKE PEEKSKILL, N.'Ye Date of Request for Hearing. form: 7/28/72 j Date of Advertisement: 8/9/72 in PUTNAM COUNTY COURIER. ' Location of Property: Block 13 — D & 1/2 of C — Zone: R -2 57 Harper St. � - Lake Peekskill, N.Y. Nature of Request: Variance to drill a Well on property according to Local Law #4 -1971. Date of Public Hearing: ` 8/17/72 Place of Hearing: Town Hall, Oscawana lake Road, Putnam Valley, N. Y. TOWN* OF PUTNAM VALLEY; IRVING LABIS PRESENT: ....... .... •...••......•....•., Chairman of the Board HOWARD D..ARONOW. , Vice — Chairman MORRIS GOLDSTEIN It Secretary . Members:. .. JOHN.. O.�..HANL--ON .................. • ................... •. ......... ................................ MORRIS AXELROq °. Members . ......... AMES... GRIFFI.................................... ;.,.....••...•.... ............. The above referred -to application or appeal having. been duly advertised for public hearing at the Putnam Valley Town Hall in the Putnam County Courier, the official paper of the.Town, in the issue thereof published on the 9Lb day of August , 19 7? and the matter having duly come on to be heard before a duly. convened meeting of the Board on the 171b day of AUgtst 19 72 and all the facts, matters and evidence produced by the applicant or appellant, and by the �-- l 4' a-oa dar s da:deiiberinag " hm e zloning=Inspeefor,� u , n v sett', �d `;the,(olldworig -: decision is hereby made: ORDERED, that the application or appeal be and the same hereby is Granted. RqQbQ* fj A.x (The decision of the Zoning Inspector is here6yAfk9rAl. Reversed. lAgdjfiig4jx Therefore, it is ORDERED, that a permit as applied for be issued provided thal'application for the permit as applied for is made to the Zoning Inspector within one (1) year from the date hereof. Application may be made within thirty (30) days after the expira- lion of said one (1) year period, to the Zoning .Board of Appeals to extend the provisions of this order for a further period of one (1) year upon payment of a fee of Ten ($10.00) Dollars. �. Issued on condition as follows: tha t a lobPrta oar. h1�ac erbifa sample r,�poyt tie filed with the Inspector between pp y o ui dtKg inspector s ore pros mg wi an wor . Sept. 1st and Sept.. 30kb in each and . every year following date of granting variance; said test shall be made.no earlier than 60 days prior to Sept. is Dated, Putnam Valley, New YorkZ�xQC�NCt11� The vote was as follows: AYE — Mr. Labis this 21 day of August , 1972 Mr. Aronow Abstain: Mr. Goldstein Mr. OtHanlon FILED: Office of, the Town q'lerk, Mr. Axelrod Putnam Valley, Putnam County, New York, ................................ ••••• •Mrs' .. G'r'if'f'in' °"" " "" On the o��-4 day of � e s�" 197a Q � Chai' . -� -�-u• ...... ..... ........ Town Clerk 7/ Zoning Clerk , (OVER) nwr�ga►IR�� „ IW 14 -16-4 (2187) —Text 12 _ PROJECT I.D. NUMBER 61T.21,v SEAR ." State Environmental Quality Review " SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART 1— PROJECT INFORMATION (ro be completed by Applicant or Project sponsor) 1. PLICAN /S ONSOR VJzvt wi e- �N1rpl 2. PRO�D1�1cT vj(?Ak NAME 1 dViI W �b '05 3. PROJECT LOCATION: �\SVU4MV /p p�f�- Municipality ttlI County 4. PRECISE LOCATION (Street address and ro If Inters ti )ns, prominent landmarks, etc., or provide map) 5� 2Z PAS Pev 5. IS.P�R, OSED ACTION: U New. ❑ Expansion ❑ Modification /alteration 6 DESCRIBE PROJECT BR`` FLY: 'P,ro ose �t i.5 50144 � M ©%n S51-5 co VIs I5� ir)� a 'S v o �v'ov� 4�►� Jtie'r 551 �. cov)51 Vq f `J f7. AMOUNT O LAND AFFECTED: O Initially o acres Ultimately °� acres 8. WIjL( PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? LJ Yes No If No, describe briefly 9. WH¢T IS PRESENT, LAND USE IN VICINITY OF PROJECT? Residential ❑Industrial ❑Commercial _ ❑ A riculture : er - == - -- g DPar,X/ForesUOpenspace• - -• Qjh :... -- Dsscribe: ,:.,,.;`..- ,�'.'�� -_.�- ,.v _..v. �> '..�, -. . - -_ _— ...47.,._..... -a -o- "m - . -��• ;- .�.;:_.: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? WNo El Yes If yes, list agency(s) and permit/approvals 11. DOES ANY ACT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes No If yes, list agency name and permlVapproval 12. AS A RESULT OF/ PROPOSED ACTION WILL EXISTING PERMIT /APPROVAL REQUIRE MODIFICATION? .❑ Yes U No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE. �10 V iAv` e Applicant/sponsor name: Date: i4diolto Signature: If the action Win the Coastal Area, and you are a state agency, complete' the Coastal Assessment Form before proceeding with this assessment OVER \00 \ 1 1 \ 60 \160 \ 1 % 1\ \` I/ \ \\ Iz \ ` Is \ `\ 26 ` \�L \ 0 \ \ 0 as x J o ,\� \ 1 ae \ 16•L•64 o ��\ \ \ 0 1 ''— 22 \II 16? \I 60 a 80 \BI 1 142.66 '.9 ° , L, ''p 4 \ \ 9 /I AC. CAL. \ ._.:ac+.sa> .me—:. a. -.e _ .fie, _ �' v ! •• _,.,. 4�1 ....n�q•�F A -.r, too i. / J ,L /o/ Ov US Ce,% g' STS .\ � � ' J zo 50 06 6 ?9 26.06 ZfoJ2.. 162' a 1 ` ` Oa ZT 6-04 titi v l AJD es - 9 ......_. 9 .. 10 =Z 1. --- - =2 - -- 66 .6 �� �� 16.6 � --^'- �� ��� � � ' � ` �' 1 1 --�- \ --' �_•.,,�_ 46.6 —` �l SSREE7 �---• �� .\ mot! 160 \ I 1 \ �. '� T. +s 114 1, 11 ` " �\ . '•• �• +S \ as 1 1 1 �• 1' 1 1 ss ' 1 l 1 1 1 11 1 as 1 so t lost 1 se• I 1 SP 1 !S I 1 1 Ills / II av 11 ; ' 4e 1 1 1 1 ` 160.08 9.65 I I NI•Y• • I u �. • l s 67 1 66,1 65 1 6 +..1, -.BJ I •, I 1 I ,•, �� , »a P.V i I 19 n 1i I3 ;I