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HomeMy WebLinkAbout4291DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.83 -1 -31 BOX 32 Ll or T ons loo. . , loi IN ,` r 7 -61 IN �, 'i Al' Is rffr - — or kP, 04291 °• WO DEPARTMENT OF HEALTH Division of Environmental Health Services COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 AP..PLI,GAT -T0N, _ -'TO,. CON -STRUCT..._,A:: AT "- PCHD PERMIT WELL LOCATION Street Address 7 F_ E_ ' 0CE Town V'llage City Tax Grid Number L.A�t� ' tC lc5 it WELL OWNER Name 16A As J Ar3 Mailing Address R. rivate D Public USE OF WELL & primary 2- secondary N'RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL 0 PUBLIC SUPPLY 0 AIR /COND /HEAT PUMP O FARM 0 TEST /OBSERVATION O INSTITUTIONAL 0 STAND -BY D ABANDONED 0 OTHER (specify 0 AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED C2 OF DAILY USAGE gal REASON FOR DRILLING NEW SUPPLY O PROVIDE ADDITIONAL SUPPLY ❑REPLACE EXISTING SUPPLY 0DEEPEN EXISTING WELL O TEST /OBSERVATION DETAILED REASON FOR DRILLING _�i� �.,a► �l�te.11i,�g WELL TYPE ODRILLED DDRIVEN EIDUG GRAVEL 1:10T HER 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 'Vc9t"ma'4k &N Address:— (eUA.V4164 Q IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE _- TO PROPERTY. EE(1M NE4 EST WATFft LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED a ON REAR OF THIS APPLICATION ON S PA E SHEET d'8 ( ate) (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: Ale✓ 19 F5 C. Date of Expiration: Nov 10, 19 $ � Permit Issuing fficia Permit is Non - Transferrable White copy: H.D. File Yellow copy: Building Inspector 2/87 Pink Copy: Owner Orange copy: Well Driller JC "AIncllolv' TTVT T rnNMT VrrTf)WT VT. DnVrr X DEPARTMENT -OF HEALTH .-Divis.ion Of Environmental He4th'Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION S59,&I'VURESS: TOWNIVILLAQUE11, TAX GRID NUMBER: WELL OWNER )K PQIVATE IN PUBLIC USE OF WELL 1 - primary 2 - secondary A'RESIDENTIAL ❑ PUBLIC SUPPLY .0.1 1 AIR­/CONDdHEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST/OBSERVATION ❑ OTHER (specify) O.INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND-BY ❑ AMO.UNT OF USE YIELD SOUGHT gpm.1N0. PEOPLE SERVED gal. EST. OF DAILY USAGE._��_ REASON FOR DRILLING g--NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST/OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH —ft. STATIC WATER LEVEL 20 DATE MEASURED DRILLING EQUIPMENT ROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE 0 SCREENED. ❑ OPEN END CASING. ;OPEN HOLE IN BEDROCK p OTHER TOTAL LENGTH ft. MATERIALS: OSTEEL ❑ PLASTIC. ❑ OTHER CASING DETAILS LENGTH.BELOW GRADE ft. JOINTS: OWELDED -j0,THREADED OOTHER DIAMETER —in. AL: 0 CEMENT GROUT ❑ BENTONITE MOTHER WEIGHT PER FOOT Ib.1ft. DRIVE SHOE.)&YES_ ❑ NO LINER: ❑ YES')2(NO SCREEN DETAILS DIAMETER (in) SIZE LENGTH (ft) DEPTH To SCREEN DEVELOPED? FIRST 0 YES NO GRAVEL PACK 11 YES 0 NO GRAVEL SIZE: DIAMETER TOP OF PACK in. DEPTH ft. BOTTOM OEM It. WELL YIELD TEST If detailed pumping MPOO: 0 PUMPED 1 tests were done is in- >COMPRESSED AIR formation attached? -Z- 0 BAIL0 0 OTHER 0 YES ❑ No It more detailed formation descriptions or sieve analyses WELL LOG are available, please attach. DEPTH FROM SURFACE Water Bear- ing Well 'Oia- meter In FORMATION DESCRIPTION COCE, It. ft. WELL DEPTH It. DURATION hr, min. DRAWOOWN ft. YIELD 9P Land Surface WATER $CLEAR TEMP. QUALITY 0 CLOUDY HARDNESS 0 COLORED ANALYZED? EYES ONO ANALYSIS ATTACHED? Cd YES ❑ NO STORAGE TANK: TYPE CAPACITY GAL./>-O WELL DRILLER NAME DATEJ// X/S PUMP INFRMATqGN TYPE CAPACITY J MAKER DEPTH MODE VOLTAGEZ10__ HP '-wa ~ I _ 7 . 007433 . orktown Medical Laboratory, Ins LAB N 321 Kear Street' f ' algcktown Hei hts, N. Y. 10598 Date Taken: 7 ll f Time; /O., 8 Date Rc_d Time. /_�� `(9'14j 2�5= 3�i'8s ....�., P _. ...:•a �' D'e`i.,�:��;;t:e;d;�.- r ..0: =7''•1 8& .. Director: Albert H. Padovani M. T. (ASCP) Collected By : r_V,,4JL4 -� Referred By: T =v��fS s Sample Location: � �. /emu= Ny• 10j-27. Phone N 7/ Phone d Sample Type: 1- J Repeat Test? p ( check one) LABORATORY REPORT ON THE B?ICTERIOLOGICAL QUALITY OF WATER GENERAL BACTERIA. Standard Plate Count (CFU /1.OmL) (Agar Plate @ 35 °C) MEMBRANE FILTRATION TECHNIQUE (MFT) / V Total Coliform (CFU /100mL) _ Fecal Coliform (CFU /100mL) Fecal Streptococcus (CFU /100mL) MOST PROBABLE NUMBER TECHNIQUE (MPN) Total Coliform: MPN Index (per 100mL) w" _¢~Fecal OTHER ANALYSES REMARKS.(For Laboratory Use) C/ _ Potable Non- potable _ STP INF _ STP EFF Other: Sample Status: (check each) Outgoing .� Na2S203 Incoming C--*' LE 40C _ GT 40c _ Other: KEY FOR TERMINOLOGY RDS.= Recommend Disinfec- tion of Source TNTC= Too Numerous To Count CON = Confluent ( =TNTC) LT = Less Than ( <) GT = Greater Than ( >) N/A = Not Applicable LE = Less than or equal to THESE RESULTS INDICATE THAT THE WATER SAMPLE (WAS) (WASN'T) (N /A) OF A SATISFACTORY SANITARY QUALITY ACCORDING TO TH NEW ORK STATE DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED,,AT'THE TIME OF COLLECTION. a For Lab Use Only: 1 _ H/C to Albert H. Padovani, M.T. ASCP , Director LAB OFFICE HOURS (Main Lab): 9AN -5PM, Mon. -Fri. `''12 /85(RvsdT /87)RWE 9AM -NOON, Sat. PETER C. ALEXANDERSON County Executive September 14, 1987 JOHN SIMMONS. M.D. Deputy Commissioner DEPARTMENT OF HEALTH JOHN KARELL, Jr., P.E. Director Division Of Environmental Health Services 110 Old Route -Six Center, Carmel, New York 10512 (914) 225 -0310 Mr. Thomas Evans Lee Place Putnam Valley, New York 10579 Re: Proposed well construction Lee Place Lake Peekskill (T) Putnam Valley Application W- 133 -87 Dear Mr. Evans: 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: 1*: Thy cc-b is--presently' suppiieid" may" t2ie"l:ake' P6ek k3ii' Water W6 r. with summer water. 2. The proposed well is located approximately 85 feet from the existing sewage disposal system on your lot, and 80 to 90 feet from septic systems on neighboring properties. Recognizing the above, and that a minimum separation distance of 100 ,few is required between a sewage disposal system and a well, your a p;Lication for .a permit to construct a well on this property is hereby DEht ED. V r 714�1' ours, h Ka recto Environmental Health Services JH ?t cc A rile Ir. Odell (T) Putnam Valley Building Inspector C,4kE ��csn�cl ay � o � 37 tAtz- 4w 1 s ., AC044.4 mrz. 4,,&,+ Le- 4* you- 67, (see 4.MA� Aazrc f , -6 l� %'4wc,.v6 �% ko 40 IOU. wQL( a.CiCO-Oztall I 4f.&.4, wa.L( Il�la-k5 -�& '%14 6e. Comstiue.4 . TY jov, ivwk As%, 7L-As+twzs A daq ml Fw4V i � wA� &v., P! vu OAJJ et4e NWT C d r ©fit et i xv4� g - i� 4.93 -b�R (Ni s�.s - s�, � —'� �+,�. 54 - �3-n 40 - q:149. MARVIN DEQ!< r Inspector TOWN OF PUTNAM VALLEY BUILDING, ZONING, AND SANITARY DEPARTMENT November 4, 1987 Mr. Robert Morris Dept. of''Health 110 Old Route Six Center Carniel, N.Y. 10512 TOWN HALL AUEY (914) 526 2377 RE: Proposed New Well Evans - Lee Place, Lake Peekskill TM#107-1-6 Dear Mr. Morris: The proposed well shown on the site plan dated October 18, 1987 by Mr.Joseph Sullivan,P.E. meets the separation requirements as required. It should be noted, however, a site plan dated April 18, 1983 by Mr. sullivan was submitted for this lot which Mr. Evans had applied for and received a Variance under Local Law #1, 1978 from the Town of Putnam Valley to install this iWell in 1983. It would be suggested that clarifications of the conflicting drawings'be resolved. MOT: es Very truly yours, 46�7 MARVIN OTELL Building Inspector PETER .0 ALEXANDERSOPi M Cuunly Executive r JOHN SIMMONS. MC `10� Deputy Cummiszwner i'. DEPARTMENT OF -HEALTH HEALTH JOHN tuFELI. Jr , P! Ovector Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New, York • 10512 (914) 225 -.0310 October;. 29 19e7. Mr. Frank. Sullivan 2972 Fer.ncre 5t Drive Yorktown Iieiyhts,. NX 105.98 ` RE: Proposed `well Dear Mr. Su11iven: Ple`se. find enclosed your application to construct.a water well. Thi.s application must be submitted to .:Putnam Valley, s ,_Building. Inspector, Marvin Odell, pri.or'to the* review by this Department. dnly.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. . 'Very ruly 'yours,~ 0 Robert Morris ' RM amm Environmental Health Technician •cc:RM File ! JR Enc. TOWN OF PUTNAM VALLEY ZONING BOARD OF APPEALS PUTNAM VALLEY, NEW YORK 10679 . �::o . - - -,� •:��_r w, .r� _ .._ _ ::��rri�twn &r. C�r�rr Name of Applicant: THOMAS J. EVANS File # 107/583/186W Address: 47 Landscape Avenue Yonkers, N. Y. TD1; # _ 107-1-6 Location of Property: Lee Place (�own)Lake Peekskill Zone: RL Nature of Request: Variance to drill well pursuant to Local Law 1 -1978• Date_ of - Advertisement:_ - _5/-.18/1983 ." COMMUNITY CURRENT Date of Public Hearing: 5/Z6/1983 Place of Hearing: Town Hall, Oscawana Lake Road, Putnam Valley, N. Y. MEMBERS PRESENT: HERBERT LEVENSON Chairman FRANK MONACO Member ROBERT MAZZARISI Vice Chairman SAM FRIEDMAN Member SOL LIRTZMAN Secretary The matter having duly come on to be heard before a duly convened meeting of the Board on the 26th day of May, 1983 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: Joseph F. Sullivan, P.E. has submitted an engineering report and a drawing showing the proposed location of the new well as required by Local Law 1-1978, indicating the need for a 15' variance. THEREFORE, based upon the above findings of fact, it is hereby ORDERED, that the application or appeal be and the same is hereby GRANTED subject to all conditions and stipulations of Local Law 1 71978. fhe decision of the Building and Zoning Inspector is hereby reversed. Dated, Putnam Valley, N. Y. this 26th day of May,_ 1983 -- is �.�• �(. � L/ .�t_�i•1:� (L C- �Jhc'c•j�C'll(lll, l( Zoning Clerk I Chairman STATE OF NEW YORK, COUNT)' ON PUTNAM ss: On the day .of before me personally came 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 he a gCYted iif l tt}F�Z i �me. /" X., :.iAI r', r -'V/ 0i,fl // VV %•I .h ltli 111 I'1 :,.:A /.'. ,:'�U:.y t• � I t t ,. 46Q //W Notary commiaiun Q.Pims Morph 3U, IV4�— Filed, Office of the Town Clerk, Putnam Valley, N. Y. on day of Town Clerk PUTNAM COUNTY HEALTH DEPART DIVISION OF ENVIRONMENTAL HEALTH SERVICES John M. Simmons, M.D. Deputy Caemmissioner of Health - FIELD ACTIVITY REPORT - Sheet f of INSPECTION NAME ��� 4 S VANS _ Orig. Routine No. TM No. MAILING ADDRESS P.O. Box Post Office Zip Code TELEPHONE •� �" `� I "} PERSON IN CHARGE' �� oM OR INTERVIEWED 1 S Jg'V,s Name and Title DATE TYPE FACILITY TIME 2 .o d TIME LEFT -2"2U Orig. Camplain Orig. Request Campliance Complaint Camp Final Group Illness Construction Reinspection Field, Sampling Only _ Field Conference Other Explain FINDINGS: 3/1&-c 7&�O 7/6 1?()151 6 16--) WE-Lc INSPECTOR: Signature and Title PERSON IN CHARGE OR IDFPERVIEWID: I acknowledge this Field Activity Report. SIGNATURE: 6/86 TITLE: J TELEPHONE: SS�S fo���'` SSA SS S /?0L) Owv � . 4 iI '16 of NfPi•�ep�. IS • el . 9 PADrfS510h�� � �F iy ,D.- opos�d We %�iom os J F ✓erns ". Exdstag i,: �N.. W40 1 IGO i *. SS. - �� i /O D. . . yl 72. 7.3 :_ �._ -• '' /CIO OJld .E 1 � -.. � . EXiJ /: ng ssosfl�..� ... ce d c " o., •dr7'G Ar 4 _ 1 . 4 iI '16 of NfPi•�ep�. IS • el . 9 PADrfS510h�� � �F iy ,D.- opos�d We %�iom os J F ✓erns ". EU 0. e. .+0: 2450. !ESSI. —4c 41 Oil lie. ZL5 z? -5 We 2 C, ca X, ;7 A. It, a Y, of NEP, Z)a.-le .+0: 2450. !ESSI.