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HomeMy WebLinkAbout4777DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631 - 589 -8100 91.26 -2 -5 BOX 36 I I is I r r I ;r i,yL .i I .;R or i: J or I `'T `� T .' ., FI . ' ti' ♦ j . �� : u 1 .4• T looll �r oil. 04777 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health 01<FET'T'� 4Of;�n'ARI RN; "i�6S�i "<:-� Associate Commissioner of Health June 29, 2007 Saverio Madeo 75 Livingston Street, 20B Brooklyn, NY 11201 Dear Mr. Madeo: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive Director of Environmental Health Re: Well Permit Application Renewal for Madeo Property — 25 Harper Street (T) Putnam Valley This Department has approved the well permit for Well # W19 -05 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 45 feet from on -site and /or adjacent subsurface sewage treatment_ system areas: 3. Tfie'well shall be installed with a minimum of 89 ti. o' f 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. A 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. Respectfully, Michael J. B3u#zinski Director ofineeri MJB:kly Environmental Health (845) 278 -6130 Fax (845) 278 -7921 cc: (T) Putnam Palle Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 ursm Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 C,K-0 .YY /. 0, ..7 V4 S- o PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES r. ...ia- w�y °a..- .•�.^�.:a.`, S7�s �.+s� -�. :-i `.:lm j�.. Fi•, r:. meo-o.nresa pro+.: ,... ia. -.a ,i-.'�:y�6''bw• -. :•vrr .:a.:•ejru r:C:..._r �..�ii i�,. 4. �...woKT�nr�.e: d+- APPLICATION TO CONSTRUCT A WATER WELL please print or type E >n. Well Location Street Address: Town/Village: Tax Map # 2 -� LhA6 " L1( 16 Map Block Lot(s) !Nell Owner: Name: Address: one #: �afwco l:0 [ EU S Lt U Ire �i.S' a� Sc- ZO B t lkLbJ iu V 1 i2v) g 9 a +. 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 gpm # People Served Est. of Daily usage gal. Replace Existing Supply Test/Observation Additional Supply Reason for Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason Iry ('U ti I-Lmm 10 A tom" for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ....................................................... ............................... Yes _ No� Is well located in a realty subdivision? ........................................... ............................... Yes 1C No of subdivision Lot No. q 1 + ,Name Water Well Contractor: VW2-M A-t-) 1VfJ 0 CD S 0 Address: Is Public Water Supply available on ite? ...................................... ............................... Yes _ No Ni 100(a L PTb Name of Public Water Supply: o2 wATMTown/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. tl Date: 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 Departmel 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 Commissioner of Health. Any revision or alteration of the app ved plan requires a X new permit. Well to be constructed by a water well driller certified by PutnarriCounty, Date of Issue ''Z� -a -7 Permit Is ing Date of Expiration - Title- Permit is Non- Transferab e White copy - HD file; Yellow copy - Building Inspector; Pink copy - 0 je copy.- W.ew''Cinner .i Fprm WP -97 = ::Rev. 3/06 1. . 1 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA M"- 0"-LINARI, Associate Commissioner of Health . August 8, 2005 Saverio Madeo ROBERT I BONDI County Executive DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 75 Livingston Street, 20B Brooklyn, NY 11201 Re: Revised Well Permit Application for Madeo Property — 25 Harper Street (T) Putnam Valley Dear Mr. Madeo: This Department has approved the well permit for Well #W19-05 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 45 feet from on -site and/or adjacent subsurface sewage treatment system areas. 3. The well shall be installed with a minimum of 89 feet of casing. ,.. , 4:-1 ult�u violet lighf dsinfectiorZrit.sllall.tie- installed o=n the iricorlingvt?ll 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. Director MJB:cw Cc: C. Santos, (T) Putnam Valley Insite Engineering PE Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 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 Aug-02-2005 02:52pm From- ti T-273 P•002/003 F-733 Ij 3 c) SHERLITA AMLER, MD, MS, FAAP Commissioner of Health - LORETTA MOLINARI, RN, MSN Associate Commissioner of Health March 16, 2005 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10.509 Saverio Madeo 75 Livingston Street, 20B Brooklyn, NY 11201 Dear Mr. Madeo: ROBERT J. BONDI County Executive Re: Well Permit Application for Madeo Property — 25 Harper Street (T) Putnam Valley This Department has approved the well permit for Well #W19-05 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 70 feet from on -site and/or adjacent subsurface sewage treatment system areas. 3. The well shall be installed with a minimum of 71 feet of casing. - - • : '•� .4:, An- altra -vio let -light disinfection unit -shall 6e installed oii:fhe- ifco:niilg -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. xespeciruny, G ichael J. u in ki, PE Director En erinqR 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 P U'll NAM COUNTY DEPARTMENT OF HEALTH IIDffVRSffC N OF ]EIS VRRONMIENTAL HEALTH S ERVR CIES ®F '� O �ONSSTRUCT4A�r- . -.T -, lL, ..: , ,, .) 99 . , LA please print or type PCHD Permit # - ds Well Location: Street Address: Town/Village Tax Grid # ql, `04- •-° q�; 1f4wa- cD- � ' Map Block Lot(s) Well Owner: Name: Address: ./ 6-t gl B J%cu t j N tGr2e3l 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 gpm # People Served Est. of Daily Usage gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drfllllnng New Supply (new dwelling) Deepen Existing Well Detailed Reason o4-u l W14-14--P— : --P S L > 6 �! , 49 id for Drilling Well Type L=1 Drilled Driven Gravel Other Is well site subject to flooding? . ............................... ............. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes �6 No Name of subdivision Lot No. t Water Well Contractor: Address: � ' �%� t 7 ='' ..... Yes No Is Public Water Supply available to site?. J .... /. �. c.au t` ke- Name of Public Water Supply: Zfi G � ^S I t�L L Town/Villa e l�Ld N �� l %tom Distance to property from nearest water main: Proposed well location & sources of contamination o be provi ed on separate sheet/plan. Date. - .. ` Applicant- Sigriataie l 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 ,� ��� Permit Is ing Offi ial: Date of Expiration acl1 -07 Title: Permit is Non-Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 HARM I A STREET ... . ........ eatraV-e.r,r. rsy. ,,,pJy' C,cn.prsls welt =, w y N64-{� ' i LrfC,it p ` `Y'• 3 R: r5,00 ry Frome • ,.6 �.: ' �'• '� ,(�V/ f . / `..1 `--9: itit X11 �T 3!f �6 ^ � • a,ssary n , gel. rptl ! / N(7. 25 / 2,4 � c�tt134C L✓�t1i + s 4P -SB -'" lf' . !T, . .. . fig% i ��' 2s� i 4P ✓ �i ;s d• P l•µ a, w .0 •.'➢'1 �wµf �W, .'Y•'K' n.lr,,. i[,. [ � L .... � ✓. To Wn of Putnam Vaney January 20, 2005 Mr. Madeo 75 Livingston St. Brooklyn, NY 11201 Re: 91.26 -2 -5 Dear Mr. Madeo, I would like to thank you for the patience that you have exhibited during this trying time. I am advising you, that the variance necessary to obtain your well, has been granted by the Putnam County Board of Health. The requirements for constructing a well are listed on the enclosed letter from the Board of Health. In addition to the Board of Health conditions, there is also a well permit application for the Town of Putnam Valley, which has an additional expense of $35.00. Enclosed is both the well constructing permit and the well permit application. ..�.. x .. ... .. ✓.... ... .r .. y. ..., w -b- its .a�sS+... .� _..0 .. ♦ —.. s v�. � �.. .4.. �... .. n.. .. ...m .n .. y r. Your prompt response to the above will expedite you being able to obtain a well, as soon as possible. Respectfully your , Carmelo J. Santo Supervisor Town of Putnam Valley 265 Oscawana Lake Road 0 Putnam Valley, New York 10579 0 (845) 526 -2121 0 Fax (845) 526 -2130 Saverio-F. Madeo 75 Livingston St Apt 20B Brooklyn, New York 11201 Putnam County Dept of Health 1 Geneva Rd Brewster, NY 10509 Dear Department of Health, Please find a cashier's check in the amount of $150.00 per your request for a well permit previously forwarded to your office. The well permit is requested for property at the following address: 25 Harper Street Lake Peekskill, NY 10537 If you need to reach me my home phone number is 718- 858 -0729. Sincerely, Saverio F Madeo .F /j /0 f PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A !MATER WELL - pleaseprintortype I?CHDLPcm[,:- Well Location Street Address: Town/Village: Tax Map # LA-ke T'eei,�4l( t b Map Block Lot(s) Well Owner: Name: Address: Phone #: S Lt u iN �.�'�� �- ZO & bGcl.tVrN N `r' 1►ZV► ��� s� a� Use of Well: Residential ,Public Supply Air /cond /heat pump `Irrigation 1 1- Primary Business Farm Test/monitoring _Other(specify). 2- Secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served Est. of Daily usage gal. Replace Existing Supply Test /Observation ,Additional Supply Reason for Drilling New Supply (new dwelling) Deepen Existing !Nell. Detailed Reason <{'r,W ti on for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ....................................................... ............................... Yes Nom Is well located in a realty subdivision ? ........::..... ..................... Yes Y No Name of subdivision Lot No. q I. `L6 a -S Water Well Contractor: �J62_m A--t-) Xs'j o ews 0 0.j Address: 1,<2, A-/1-G &-1- ST • &- byn-1A UA4 J Is Public Water Supply available on ite ?........ .............................................................. Yes._ No �� 100612 � P.T Name of Public Water Supply: W� Town/Village Distance to property from nearest water main: Proposed well location & sources of contamination to be provided on separate sheet/plan. Date; Q= eX-.6! ;y PERMIT TO CONSTRUCT A !MATER 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 Departmel 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 Commissioner of Health. Any revision or alteration of the apved plan requires a new permit. Well to be constructed by a water well driller certified by PutnanlCounty_ _. D ate of Issue -- (� 1 Permit Is ing Date of Expiration Title: Permit is Non- Transferab e White copy - HD file; Yellow copy - Building Inspector; Pink copy - Own!; Q�e�e.copy':= Uy��c�riller -Rev. 3/06 �F DAVID D. 'BRUEN County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services Mr. and Mrs. J Augustine . 50 Harper Street Lake Peekskill, New York, 10566 Dear Mr.. and. Mrs. Augustine: JOHN SIMMONS, M.D. Deputy Commissioner, RE: Proposed Well Construction Harper Street (T) Putnam Valley Application #51 -86 Review.of an application to constuct a well for potable water supply purposed to serve the above captioned property has been completed. Review indicates as follows: 1. The lot is presently supplied by the. -Lake Peekskill Water Works with summer water. a 2. The proposed well is located.approximatelp 50 feet from ,. -- _ ` ttte-ek:-ati•� sewage -dis�ocai,raysteff* on -your* 1-6 -and 75 feet from a septic system on a neighboring lot. Recognizing the above, and that a minimum separation distance of 100 feet is required between a sewage disposal system and a well, your application for a permit to construct a well on this property is hereby DENIED. /Ve y my yours, n Ka 11, Jr. , P. E. ector, JK:pt Environmental Health cc:JK Services File Mr. Odell (T) Bldg. Insp. P. V. TWO COUNTY CENTER - CARMEL, N.Y..10512 (914) 225 -3641 ._HARPER STREET 26 o U t], T A i 7! . 4 7 1 - �%;�.. r�`�.J''_ .. - ._ �( .� Jam, �'�.��Fli.[r• r, 'F -i: /. � �i _ t•. •R' :� _ Azlf sr �• jsr to g ` I -4 5771�5.'- p -a s. .-O ..z .....•O --- �'rTd•.... o-•.. -r yip^ - Pq!•. C)i I / ?lynr+zs�a loR�! i1`n J t /3GDG j �r a AodcN J i 9 �Ic. JasdA' l't �grseb GV�tG f �d�rV .a J ^ �� t��: ,. t . ... _ :�: utrhrc I ivicrr 1 tJr• MAL I h - Division Of Environmentai Huh Services TWO COUNTY CENTER — CARMEL, N.Y.. 10512 (914) 225 -3641 APPLIGATI:J& GNSTR IC°r p; -V W Tom= E% _S/41 IS WELL SITE SUBJECT TO FLOODING? YES 0 1.t YIt.Ll, 1J .L,Ul.ti1L1j 111 t1 1Czr_ulZ JUDL1 vlJlvlV� lVt'11L .Ut SubDIVISION:1 LOT NO -:. /d WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: _ YES _24_-NO �i It/7na C./ , �� NAME OF PUBLIC -WATER STJPPLY: TOP+ 1 %V: %C DISTANCE TO PROPERTY FROM NEAREST WATER.-MAIN.t LOCATION SKETCH & SOURCES OF CONTAMINATION. (&a tle ) 1� (signat z 1rz►AN EWA, 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 tIe.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: 19_T Permit Issuing Official . Permit is.Non- Transferrable A00RES5. IUWNiVILLAU1C11Y tax 6RW NUM6EA. WELL LOCATION ST-, e kcuu. ,,s_Y• WELL OWNER NAME. • DS C��{ �,/ �C% �..� �%'/f� AOORE S: �( Gi ._ � '� �1« y `` SIVAT[ Sj ❑ PUBLIC e OF WELL RESIDENTIAL C1 PUBLIC SUPPLY .❑ AIR /C0N0. /HEAT PUMP C3 ABANDONED primary ❑ BUSINESS ❑ FARM ❑TEST /OBSERVATION ❑ OTHER (specify) 2 - secondary ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ AMOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE ' oaf. REASON FOR �LEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATIOtV DRILLING ❑ REPLACE 'EXISTING SUPPLY ❑ DEEPEN EXISTING WELL WELL TYPE ILLED DRIVEN DUG GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES 0 1.t YIt.Ll, 1J .L,Ul.ti1L1j 111 t1 1Czr_ulZ JUDL1 vlJlvlV� lVt'11L .Ut SubDIVISION:1 LOT NO -:. /d WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: _ YES _24_-NO �i It/7na C./ , �� NAME OF PUBLIC -WATER STJPPLY: TOP+ 1 %V: %C DISTANCE TO PROPERTY FROM NEAREST WATER.-MAIN.t LOCATION SKETCH & SOURCES OF CONTAMINATION. (&a tle ) 1� (signat z 1rz►AN EWA, 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 tIe.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: 19_T Permit Issuing Official . Permit is.Non- Transferrable PUTNAM COUNTY HEALTH DEPARTMENT =r �.:oi f: � a : e_.oa• vf�F: = < - `":,sa' -. - •. =i- +L,:�'G,p;� :' . :.�i'•....�or.`�v'++a �.a� -�::'i ti.:c� ? •':. �s e'. s r.'�++�' . -'3= %oo«: = DIVISION OF ENVIRONMENTAL HEALTH SERVICES John M. Simmons, M.D. Deputy Commissioner of Health NAME_ ADDRESS Street - FIELD ACTIVITY REPORT - ..�, Municipality (T)(V)(C, MAILING ADDRESS P.O. Box Post Office Zip Code TELEPHONE PERSON IN CHARGE OR INTERVIEWED Name and Title DATE " / � TYPE FACILITY �i t TIME ARRIVED ` TIME LEFT FINDINGS: I ���`9,A MAVANM INSPECTOR: Signature and Title PERSON IN CHARGE OR INTERVIEWED: I acknowledge receipt of a copy of this SIGNATURE: Field Activity Report.................. TITLE: Sheet 1 of INSPECTION Orig. Routine Orig. Complain Orig Request Compliance . Complaint Comp _ Final Group Illness Construction _ Reinspection _ Field, Sampling Only Field Conference Other Explain x.:. _.� .. .- - ro -•,... - ..... ...... ��..o� �.... •e- - ..- .�.t..e......•o..... of TELEPHONE: i4� ga 14 75,�c� vv, eena7,� H.-& 5a DAVID D. BRUEN County Executive r DEPARTMENT OF HEALTH Division Of Environmental Health Services October 17, 1986 Mr. Joseph Augustine Mrs. Harriet'Augustine Harper Street Lake Peekskill, New York 10566 Dear Mr. and Mrs. Augustine: JOHN. SIMMONS, M.D. Deputy Commissioner Re Proposed Well Construction Application #W -51 =86 Review of the above captioned application has been completed. Additional information or clarification is required::as.checked below: 1. A detailed reason for drilling the well is required. A short narrative is required.- For what purpose will the well be used, i.e., drinking, lawn watering,.etc. 2." Is the site presently served by.a well ?:-:Explain. 3 ..Is. the, site pr_ .esently served .b .a sewage disposal system. d .ExjS'3 aiA -a' ... ., �. _ z, � •f - _ ;a a._ -_ r, 4. Is the present.structure to be reconstructed?' Expanded? How: 5. A sketch showing the lcoation of: - the proposed well - the existing sewage system on this parcel - ,existing sewage systems and wells on- adjacent parcels within 200 feet of the proposed well. 6. The sketch provided.is not sufficiently detailed. See #5 above. Upon receipt of the above information,this application will be considered further. �Ohrf Klt+e`i\1 v 7f1. ;"' P. E. irector,.Environmental Health JK :pt 'Services cc :Bldg. Insp. (Put.Valley) TWO. COUNTY.. CENTER - CARMEL, N.Y. '10512 ":(914) 225 -3641 DAVID D. BRUEN County Executive W Y� DEPARTMENT OF HEALTH Division Of Environmental Health Services October 17,-1986 Mr. Joseph Augustine ,-- Mrs. Harriet Augustine Harper Street Lake Peekskill, New York 10566 JOHN SIMMONS, M.D. Deputy Commissioner Re Proposed Well Construction Application #W -51 =86 Dear Mr. and Mrs. Augustine: Review of the above captioned application has been'-completed. Additional information or clarification is required..as:checked below: 1. A detailed reason for drilling the 'Well.is.required. A short narrative is required.'­ the well be used, i:e., drinking,�Jawn'watering;�.etc. 2. Is the site presently .served .by a .welly 4Explain , : 3. Is the site presently served by ,a' sewage ;dispdsa] saystem?, Ek, laih -. a 4. Is the present structure to be reconstructed ?.`'Expanded? How: 5. A sketch showing the lcoation of: - the proposed well - the existing sewage system.on this parcel - existing sewage systems and wells on adj'aceht parcels within 200 feet of the proposed well. 6. The sketch provided is not sufficiently detailed. See #5 above. Upon receipt of the above information,this application will be considered further. u*4'y' `'lYP- . . DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 Mr. Saverio Madeo 75 Livingston Apt. 20B Brooklyn, NY 11201 Dear Mr. Madeo December 189 1951 JOHN KARELL Jr., P.E., M.S. Public Health Director Re: Proposed well Madeo,. 25 Harper Street Lake Peekskill x#106 -1 -6 & 7 I have received and reviewed your application to construct a water well on the above mentioned parcel. Based on a field.inspection by this Department and the Building Inspector, Marvin O'Dell, of Putnam Valley; it does not appear that there is adequate separation distance from surrounding sewage disposal systems to allow for the construction of the proposed .sell. Please submit. a survey., showing the - location -of- the -proposed well- and, the location of 41_l seReg6 Adisposal systems within`20 fset of the proposed site. If you have any questions, please contact me at your convenience. Very truly yours, v William Hedges Sr. Public Health Sanitarian WH/, p cc: Me O'Dell (BI) (T) Putnam Valley DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE'SIX CENTER, CAR L, N.Y. 10512 (914) 225 -0310 sr, APPLICATION TO CONSTRUCT �A' WATER WELL PCHD PERMIT # WELL LOCATION Stre t Address Town V lage City Tax Grid umber WELL OWNER Name Mailing Addre s °2 t .'u sv.,�' rivets ca ­0 Pablic E OF WELL - primary 2- secondary RESIDENTIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED 0 BUSINESS O FARM O TEST /OBSERVATION O OTHER .(spec ify 0 INDUSTRIAL O INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT `j gpm /# PEOPLE SERVED _5`',5__/EST. OF DAILY USAGE C'eystal REASON FOR DRILLING oe O REPLACE EXISTING SUPPLY O TEST /OBSERVATION •ADDITIONAL SUPPLY O NEW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING : d / °� P-� �-. u t✓ !� a a c�.�..4. WELL TYPE B,DRILLED DRIVEN DDUG 0GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: ,C "/X- Lo t No. _S� WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: te"" YES NO VoLl �eA5,oP A41,� NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY 018TANCEr TU <- A09P.TY FROND NFARES`D- WATER• _Y_AIN : �_ . __. ___.......... ; LOCATION SKETCH.,& SOURCES OF CONTAMINATION PROVIDED ON. SEPARATE SHEET (date) Yin ure) 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. 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 a MARVIN O DELL Bldg. Inspector JOHN MAHONEY Deputy Zoning Inspector TOWN OF PUTNAM VALLEY BUILDING, ZONING, AND SANITARY DEPARTMENT November 12, 1991 TOWN, HALL.,, . .:;` PUTNAM VALLEY, N.Y.—* (914) 526 2377 BETTE STOCKINGER Bldg. Dept. Clerk Putnam County Dept. of Health 110 Old Route Six Center Carmel, N.Y. 10512 Att: Wm. Hedges Re: Proposed Water Well Madeo, S. - Owner 25 Harper Street TM #PV 91.26 -2 -5 & 27 Dear Bill: I have reviewed the above noted site and find some question with lot size to provide separation requirements for a new water well. The applicaant should provide a surveyor site plan showing existing SSDS area and location - ot_ propose.d,. we MO °Dees enc. Yours truly, 81.26 —Z, -S— -t- Z7 DEPARTMENT OF HEALTH -.Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. i0512' 716 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT #/I anl, WELL LOCATION Stre t Address Town V lage City Tax.Grid umber �P LAI(e A e r—S iu l l ' G`' 6 ""' � '- X WELL OWNER Name Mailing Addre s ? �'u, ^ 7 s7`o� ., rivate 2 �, "© /,,, ,a r 0[3 :: O Pu lic E OF WELL - primary 2- secondary RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP O ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify O INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED73 -''— /EST. OF DAILY USAGE G"e,'Ltlgal oe D REPLACE EXISTING SUPPLY ❑ TEST /OBSERVATION ADDITIONAL SUPPLY ❑ NEW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING eis c7--, �. WELL TYPE X,3D,RILLED DRIVEN 0DUG GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES �� NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:, X. Lot No. WATER WELL CONTRACTOR: Name Address:. IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: v"' YES NO (D Li 0 AU R' NA :`OF' PUBLIC­ WATEK SUPPLY: TOWN /VIL /CITY.. DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETQH SOURCES OF CONTAMINATION PROVIDED ON SEPARATE SHEET Jj Cic�ti ii (date) (s •gnat ure) 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 thirti� (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: 19 Date of Expiration 19 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller