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HomeMy WebLinkAbout1372DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.79 -1 -50 BOX 13 01372 - T T 01372 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORET TA i 011Il AR-Ij 7 NN, NITSN Associate Commissioner of Health ROBERT J. BONDI County Executive ROBERT P4ORRIS. PE-' -7 -.--: Director of Environmental Health DEPARTMENT OF HEALTH DRINKING AND RECREATIONAL WATER Philip J. Beal P.F. Beal & Sons, Inc. 4 Putnam Avenue Brewster, NY 10509 Re: Proposed Well Bronner 25 Gates Drive (T) Patterson November 5, 2008 Dear Mr. Beal: A field inspection was conducted on the above referenced lot by Mitchell Lee, Public Health Technician. The application to drill a new well is approved with the following stipulations: 1. The well is to be constructed with a minimum casing length of 70 feet. 2. All future well application plans MUST BE SUBMITTED on a SURVEY PLAN or TAX MAP. These items are obtainable from either the property owner or Town Building Department. 3. A Well Completion Report (WC -97) shall be submitted no later than 30 days after the well completion by the permittee. Please contact me at (845) 22.5 -5186 ext.2233 if you have any questions. cc. ale Sincerely, itchell D. Lee Public Health Technician 110 OLD ROUTE 6, BUILDING 3 - CARMEL MY 10512 (845) 225 -5186 FAX (845) 225 -5418 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO ABANDON A WATER WELL PERMIT This permit, to abandon one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code, Subpart 5 -2 of Part 5 of the New York State Sanitary Code and /or Part 75 of 10 NYCRR and provided that: Within 30 days of the completion of the abandonment of the water well, the applicant shall submit to the Department a certified statement that the information delineated on the application for this permit has been completed. I ( <- ,--A Date of Issue Permit Issuing Official White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well dri Form WA -97 please print or type Well Location: Street Address: TownNillage Tax Grid # 25 Gates Drive Patterson Map25.79Block -1 Lot(s) 50 Well Owner: Name: Address: Frank Bronner 25 Gates Drive, Patterson, NY 12563 Well Type: X Drilled Driven Dug Gravel Other Depth Data: Well Depth 98 ft Static Water Level ft Date Measured Use of Well: X Residential Public Supply Air /Cond/Heat Pump Abandoned 1- primary Business Farm Test/Observation Other (specify) 2- secondary Industrial Institutional Standby Water Well Name: Address: Contractor: P. F. Beal & Sons, Inc., 4 Putnam Ave., Brewster, NY 10509 Reason For Abandonment: NO WATER Description of Work To Be Performed: We will remove pipe, pump and electrical components from the well and then fill the well from bottom to top with concrete. Date: 10/16/08 Applicant Signature: Phili PERMIT This permit, to abandon one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code, Subpart 5 -2 of Part 5 of the New York State Sanitary Code and /or Part 75 of 10 NYCRR and provided that: Within 30 days of the completion of the abandonment of the water well, the applicant shall submit to the Department a certified statement that the information delineated on the application for this permit has been completed. I ( <- ,--A Date of Issue Permit Issuing Official White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well dri Form WA -97 716 300 C,K `� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES i / APPLICATION TO CONSTRUCT A WATER WELL 12 -: P.CHD Permlt # . 65 Well Location Street Address: Town/Village: Tax Map # 25 Gates Drive Patterson Map 25'79 Block - 1Lot(s) -50 Well Owner: Name: Address. Phone #: Frank Bronner 25 Gates Drive, Patterson, NY 12563 279 -6877 Use of Well: X 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 Est. of Daily usage gal. X Replace Existing Supply Test/Observation Additional Supply Reason for Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason No water for Drilling Well Type X Drilled Driven Gravel Other Is well site subject to flooding? ....................................................... ............................... Is well located in a realty subdivision? ........................................... ............................... Yes — No Yes No Name of subdivision Lot No. Water Well Contractor: P. F. Beal & Sons, Inc. Address: 4 Putnam Is Public Water Supply available on 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 p o on separate she pl Date: 10/16/08 Applicant Signature: hi J. Beal PhKMI I I U UUMP I KUL, I A V11A 1 tK YYCLL 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. _- -..... 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 PIteration of thAapproved plan requires a new permit. Well to be constructed by a vy�ter well driller certitied by Nutnam county. %!b/ Date of Issue 'S Permit Issui Offici Date of Expiration ✓I o Title: A it Permit is Non -Tra White copy - HD file; Yellow copy - Building Inspector; Pink copy - Ownev Oka4e copy - Well driller r D 1 J., j Form WP -97 ell V n r l/(� ��, W ) 1� fl 0\ j n i ,tAtA (A Rev. 3/06 60,5 t�q- je^qr t� of 70 ARTESIAN WELLS WATER SYSTEM- . JET PUMPS SUBMERSIBLE PUMPS P.F. BEAL & SONS, INC. 4 PUTNAM AVENUE BREWSTER, NEW YORK 10509 his /a6lrFieo�l891- Over .14,4.7j G0,2301eled TEL. (845) 279 -2460 - 2461 FAX (645) 279-6613 COMPLETE INSTALLATION, REPLACEMENT AND REPAIR SERIVICE Frank Bronner 25 Gates Drive Patterson, NY Tax Map #25.79 -1 -50 c� ff.;ri,,elf WATER TANKS COMMERCIAL WATER SYS: EMS HYDROFRACTURING WATER CONDITIONING EQUIPMENT j N please print or PUTNAM CIOUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL Irve Sireet.Addr-ess:..... - -.:- Town /Village::: `. 25 Gates Drive Patterson Well Owner: Name: Frank Bronner IUse of Well: 1- Primary 2- Secondary Amount of Use r ax-map w..__...- _ - Map 25.79 Block - 1Lot(s) -50 Haaress: Phone 25 Gates Drive, Patterson, NY 12563 1279-6877 X Residential _Public Supply Air /cond /heat Business pump Irrigation Farm Test /monitoring Other(specify) Industrial Institutional Standby 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 No water i 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 Water Well Contractor: P. F. Beal & Sons Inc. Lot No. Address: 4 1'urr,a� Av 1V incur Is Public Water Supply available on site ?.... ..... i .......... ............................... _ Name of Public Water Supply: ....... Yes No TownNillage Distance to property from nearest water main:! Proposed well location & sources of contamination 4po on separ to she pl Date:_ 10/16/0,9 Applicant Signature J. Beal PERMIT TO.CONSTRUCT P ! ^LATER WALL i "}iis pe�mft 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 w II 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. 4) The well driller shall abide by all conditions ofithe permit. 5) During 1611 well drilling operations the 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 �s not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This appro;Val 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 Commissioners of Health. 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 - Transferable Permit Issuing Official: Title: White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Rev. 3/06 P.F. BEAL & SONS, INC. 4 PUTNAM AVENUE ARTESIAN WELLS BREWSTER, NEW YORK 10509 WATER TANKS WATER SYSTEMS CQMMERmALWATER. SYSTEM,*,.. HYDRi6FRACTURINd PUMPS'-* SUBMERSIBLE PUMPS TEL. (845) 279-2460 - 2461 WATER CONDITIONING EQUIPMENT . FAX (845) 279-6613 - COMPLETE INSTALLATION, REPLACEMENT AND REPAIR SERIVICE lb t� Frank Bronner 25 Gates Drive Patterson, NY Tax Map #25.79-1-50 01 ss rs a PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES NVeIIP :.rm�t�# WELL COMPLETION REPORT Well Location Street Address: 25 Gates Drive Town/Village: Patterson Tax Map # Map 25.79 Block -1 Lot(s) -50 N410 28.75 W7.30 33.61 Well Owner: Name: Address: Frank Bronner, 25 Gates Drive, Patterson, NY 12563 Use of Well: 1- Primary 2- Secondary X Residential _Public Supply Air cond /heat pump _Irrigation Business Farm Test/monitoring —Other(specify) Industrial Institutional Standby Drilling Equipment XRotary _Cable percussion X Compressed air percussion _Other(specify) Well Type _Screened _Open end casing X Open hole in bedrock _Other Casing Details Total Length 72 ft. Length below grade7lft. Diameter 6 in. Weight per foot 19 lb/ft Materials: X Steel Plastic Other Joints: Welded X Threaded Other Seal: X Cement grout Bentonite Other Drive shoe: X Yes _ No Liner: _Yes –)LNo Screen Details Diameter (in) Slot Size Length (ft) Dept to Screen ft [Developed? First _Yes _No Hours Second Well Yield Test _Bailed X Pumped __X._ Compressed Air Hours 6 Yield 60+ gpm Depth Date Measure from an surface-static (spec 30' unng y e test 280' Depth o compete we m . 360' Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter in Formation Description ,..._ ft. ft. Land surface 10 Drilling in overburden, clay, and boulders Hit rock at 10' 10 72 Drilling in rock, set casi routed 72 360 Drilling in rock granite If yield was tested Feet Gallon r Minute- Pump /Storage Tank Information at different depths <i4 "'• ° Pump Type _ca.j,_ Capacity 7gpm during drilling 1�" Depth! Model 7GS,0-7 12 list: Voltage 230 HP 3/4 Tank TvpeWX251 Volume 67 oat - NOTE: Exact Location of well with distances to at least two permanent landmarks to be provided on a separate sheet/plan. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3/06 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL ABANDONMENT REPORT IN Do 6 NJ M1 YI, undersigned, hereby certify that the abandoment of the above - referenced water well has been accomplished and completed in accordance with the methods described in Permit # AW25 -08 to abandon said w well. Date: 12/9/08 Signature: Print Name: Philip J. Beal Address: P. F. Beal & Sons, Inc. V.i 4 Putnam Ave., Brewster, NY 10509: CID Form WAR -97 PCHD Well Abandonment Permit # AW25 -08 please print or type Well Location Street Address: TownNillage Tax Grid # 25 Gates Drive Patterson Map25•79131ock -1 Lot -50 Well Owner Name: Address: Frank Bronner 25 Gates Drive, Patterson, NY 12563 Well Type X Drilled Driven Dug Gravel Other Depth of Well Well Depth 98 ft Static Water Level ft Date Measured Reason for Abandonment No Water Description of We removed pipe, pump and electrical components from the well and then Completed Work filled the well`�from bottom to top with concrete. ; IN Do 6 NJ M1 YI, undersigned, hereby certify that the abandoment of the above - referenced water well has been accomplished and completed in accordance with the methods described in Permit # AW25 -08 to abandon said w well. Date: 12/9/08 Signature: Print Name: Philip J. Beal Address: P. F. Beal & Sons, Inc. V.i 4 Putnam Ave., Brewster, NY 10509: CID Form WAR -97 APPLICATION - ADDITION - (RESIDENTIAL ONLY) 7 2 -Y�l -�� 8 77 Year of Original Name: —Phone; �; // a:t�.� � /.c.lr: ST. �'' © TM i --- cons t. ;.,n.. /. . Mailing Address4h / —A Town ,�'Z� - c�,•1L3i,J.� Tc.,►JO �O /�,Di�Oe''�5 ��iG [. !2 , 9'0 Description of Addition,!r,2ou�X&Ti,062 Please submit this form and the following to PUTNAM COUNTY HEALTH DEPARTMENT, 4 GENEVA ROAD, BREWSTER, NY 10509, Phone 278 -6130 with the following information. Number of existing bedrooms_ PropgUd number of bedrooms 701— 4 A j Square Footage of existing house B7 Square Footage of Proposed Addition % increase in floor area ( A divided by B) X 100) =�`� IF THE PROPOSED ADDITION IS GREATER THAN 15ti 1. CHECK for $100.00 2. Sketch of existing floor plans (all living area including basement, i- any) Non- professional drawing 3. Sketch of proposed floor plan. Non professional drawing 4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of installation if kncwn. Any questions please contact William Hedges or Robert Morris. IF THE ADDITION WILL RESULT IN AN ADDITIONAL BEDROCM THAN 1. CHECK for $100.00 2. Sketch of existing floor plans (all living area including basemen., if any) Non - professional drawing 3. Sketch of proposed floor plan. Non professional drawing 4. Plans for the Sewage Disposal System prepared by a Professional Engineer meeting present code requirements, may be required. PUTNAM COUNTRY HEALTH DEPT. APPROVAL IS REQUIRED. OFFICE USE Comments and /or conditions Approved by Date: cc: BI (T) TITLE 7`/L �7� 43F I r I -p A , , r) FTI ; -,T R 1131 P-P q r; •^ JA; ECG Fw� EQ I -p A , , r) FTI ; -,T R 1131 P-P q r; •^ 1l� I Sr FLOOR PLAY NOTES 1) CHANGE BATH TD LAUNORY 2 ) r Yi,57 —In/('r PfrnROOM +N :�asF.nnrnlT 'r'n op 1-5 I, C-ecwP6 B455-►1 azrebl e>•z 7; 2 ol S-z2GLD OUF- i5rTO01/ 00 e plZC::, rF--- LCfl UO"7. 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I , &1. a f Z ;�4 (i , MAILING S i , , , :, i ;,+ rCLU7VL� 11 \lJt'Y \11� ,,, �{� . ^. .. �,'w:. - ' "- - ` -_ -" jP�`iyiyY�WiY��YY�ril.�rrra,�. hl� • tt r Name E' , �.,- IVi1011 ie/ Q�er�te�t/ QKi.) }t't r *. i t� � a{.€F v� t !€! i,! {� �I}1�, p S e I. f.a'aaC+ ..4 . , . ; , t 9.. ' -- -- — — $LLii �....1�.:� ' `.�Ir�Or.a.�.��.. tS , 11 T . w -11 i[RJrVV7� ,� /Y ii .�J /�I • i 7 - f 1r} '� I�� r� ��. 715 t, s, y J r'. r a �!, t r �c F fiy i jp!'jt¢, E ! a I .. , } j _ .. 1 i �' y - c t' hat}I , }� 5 'S• ,sdiq s i �� P { r ! } ' ._.. ... .. t - t t�q 1. w' ,,L��,y f _ adjacent . `� 1 r+ r q' _, 3 i + t u a ,a,.7+c?" yt,fiI �•�f , t :fft � 1, Proposal _( roll DJ�IC1.b7I ° 1o�t1IJg N1CL18� i '2i 1 , i11 4��i h "•1 '7 i ? ; I, NOTE: Repair must be iii same location and of same type SA iginal aemge ° dispaesL' !�yrt�em. ;� f Different lotion may require submittal of proposal from licensed pr+ofessiannl eet n. 'oacz ,�, P�7d t ynt " ry Fl in, r, r t rc?ity�ja ail - ' }d�(ii #k dY{ {P 1[ registered ardhiteCt. 3F t c Y k v 4 {., 7lai hKi y {ti47 f tAl R r. t €• I .. L - 4i;, r 4� R 1 �t , f 1 t.: I P r t t, r,',: p "� Y,". a._ �Y"�`. ', IV "ItYF ad { 1 S ? I { i . -1 I -.1 ♦� _ _...: _ BQB, BRILL Owner R. F. BRILL EXCAVATING Land Clearing • Drainage • New Septic & Repairs Drive Ways New & Repaired • Large & Small Deliveries of Sand, Stone & Gravel ® Snow Removal & More Visa. .& Mastercard Accepted •. Over 15 Years, Experience Y RD 2 Box 506, Pawling, NY 12564, 7 i (914) 655.5610 �ei'is9i/�." I 0 2 5 6w-fes ,Dr. f3 �'o C 20.6 tv 1? "30'6� �} �o D r► o �r = i t LN 0 �f PUTNAM COUNTY HEALTH DEPARTMENT . DIVISION OF ENVIRO*SWAL HEALTH SERVICES PROPOSAL F OR _ SE. A2G�5- 0310......_. -_ ...._- _.----- - - - - .. ... ........�_�_ ... _...._.. .__.. . DISPOSAL SYSTEM REPAIR _ r v� V OWNER'S NAME 1:� /'' y t2 13Ns9 .N.Nu - PHONE SITE LOCATION �. !�` /« rL 5 /- A,- f eg, `Sri A-7 TO MAILING ADDRESS PERSON INTERVIEWED PCHD Complaint # Name & Relationship (i.e, owner,tenant, etc.) DATE TYPE FACILITY PROPOSED INSTALLER �v �t'i ¢ �'. ! l PHONE S' -6 5 ' 5 ",d� /p Proposal (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. Ga . Proposal approved G "v e01- Proposal Disapproved _ Inspector's SWmture & e roposal 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 d. System description (e.g., 1250 gal. concrete septic tank, drywells surrounded by one foot + gravel). e. Installer's name and number. e (e.g.,house corners). three precast 6' diam. x 6' deep 3. System repair to be performed in accordance with the above proposal and conditions. I, as owner, or reported agent of owner agree to the above conditions. SIGNATURE `, ', ;� TITLE u W I.1 DATE 3 / /C/ / 97 CPIES: ftte (P HD); YeUc w ('m EI); Pink (Aa hint)