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Home My WebLink About1834DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35.06 -1 -14 BOX 16 .. IL J, ri ., ., o J L ir r .. I ` ,'L , I 1' J rr 01834 4 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location Street Address: Town/Village: Tax Map # 41 °2�'S2 "V 43 Big Elm Road Patterson Map35•6 Block -1 Lots) -14 7303511511W Well Owner: Name: Address: George Wiegand, 43 Big Elm Road, Brewster, NY 10509 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 Drilling Equipment XRotary _Cable percussion XCompressed air percussion _Other(specify) Well Type Screened _Open end casing X Open hole in bedrock _Other Total Length _5.3_ft. Materials: X Steel Plastic Other Joints: Welded X Threaded Other Casing Details . Length below grade52 ft. Seal: X Cement grout Bentonite Other Diameter 6 in. Drive shoe: X Yes _ No Liner: _Yes X No Weight per foot 191b /ft Diameter in Slot Size Length ft Dept to Screen (ft) Develo ped? Screen Details First _Yes _No Hours Second Well Yield Test _Bailed _XPumped _X Compressed Air Hours _b— Yield 5+ gpm Depth Date Measure 1rom land surface static specify ft) During yield test (ft) Depth of completed well in ft. 40' 200' 285' Well Log Depth From Surface Well Diameter ft. ft. If more detailed Water Bearing in Formation Description Land Surface __ ' -d Prs information hit rock a - - - descriptions or' 38 53 Drillin in ro k set casizR. arou ed sieve analyses 53 285 Drilling in rock granite are available, please attach. If yield was tested Feet Gallons Per Minute Pump /Storage Tank Information Pump Type s,h _ Capacity 5 ogm at different depths during drilling Depth 220' Model Frankli. list: Voltage 230 HP — 112 Tank Type Volume Date Well Completed 9/17%13 WeIlzDflller PCKKCertificate�# - "NY State #� ;T�r ��;� E 13019 Pump rastaller PCCertlfcate# s NYR 1010 *1/9/13 NY State # Date ot^Report x { e y , . P F . Beal $� Sans Inc 4 Putnam Ave Brewster 1VY ,1g509ha l�:1.Br Pump nstaller'Name 8►�Address� � � > x ,��, , ,�� , ��;� P `Fr Bear &Sons tnc fs 4Putnam£Ave $rewster NY xl®5'Cl9 �� P r IN NOTE: Exact Location of well with distances to at least two permanent landmarks to be provided on a( separate sheet/plan. PtITINAM COMP White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller OCT Q X013 Form WC -97 Rev. 3/06 DEPARTMENT OF HEALTH PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL ABANDONMENT REPORT WELL ABANDONMENT CERTIFICATION I, 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.# AW10 -13 to abandon said wate;4 eq. Date: 10/9/13 Signature: Print Name: Philip J. Beal Address: P. F. Beal & Sons, Inc., 4 Putnam Ave. Brewster New York 10509 PUTNAM COUNTY OCT 1.0 2013 Form WAR -97 DEPARTMENT OF HEALTH PCHD Well Abandonment Permit # AW10 -13 please print or type Well Location Street Address: TownNillage Tax Grid # 43 Big Elm Road Patterson Map35.6 Block -1 Lot -14 Well Owner Name: Address: George Wiegand 43 Big Elm Road, Brewster, NY 10509 Well Type, X Drilled Driven Dug Gravel Other Depth of Well Well Depth ft Static Water Level ft Date Measured Reason for Well is dry. Abandonment Description of We removed the pipe, pump, and electrical canpenents from the well and then filled the Completed Work well fran bottan to top with concrete. WELL ABANDONMENT CERTIFICATION I, 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.# AW10 -13 to abandon said wate;4 eq. Date: 10/9/13 Signature: Print Name: Philip J. Beal Address: P. F. Beal & Sons, Inc., 4 Putnam Ave. Brewster New York 10509 PUTNAM COUNTY OCT 1.0 2013 Form WAR -97 DEPARTMENT OF HEALTH ALLEN BEALS, M.D., J.D. Commissioner of Health ROBERT MORRIS, P.E. Director of Environmental Health P.F. Beal & Sons, Inc. 4 Putnam Avenue Brewster, NY 10509 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 Subject: Proposed Well Wiegand 43 Big Elm Rd. (T) Patterson September 4, 2013 Dear Mr. Beal: MARYELLEN ODELL County Executive A field inspection was conducted on the above referenced lot by Vincent Perrin, Public Health Technician. The application to drill a new well is approved with the following stipulations: 1. The current well must be properly abandoned and filled as described in the Application for Abandonment. 2. 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) 808 -1390 ext.43131 if you have any questions. Sincerely, Vincent Perrin Public Health Technician cc: file @i 1190" please print or type PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL )PCHDmPmmew� A, s . Well Location Street Address: Town/Village: Tax Map #� ~ 43 Big Elm Road Patterson Map 35.6 Block -1 Lot(s) -14 Well Owner: Name: Address: Phone #: George Wiegand 43 Big Elm Road, Brewster, NY 10509 845- 279 -442" 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 5 -1 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 Existing well is dr . for Drilling Well Type X Drilled Driven Gravel Other Is well site subject to flooding? ....................................................... ............................... Yes _ No Is well located in a realty subdivision? ........................................... ............................... Yes _ No Name of subdivision Lot No. Water Well Contractor: Address: 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 provided on separate hee an. Date:. - .8/21/13 Applicant Signature: f ,. 9 - Xdam L. Beal 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 Countv Health DeDartmei 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 approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue - Permit Issuin Offici �� Date of Expiration ! Title: . mep Permit is Non - Transfdrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Rev. 3/06 PUTNAM COUNTY DEPARTMENT OF. HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO ABANDON* WAtE`a'WELL d_..:...v :_.._.. please print or type PCHD PERMIT # l W)CI-4 Well Location: Street Address: TownNillage Tax Grid # 43 Big Elm Road Patterson Map35.6131ock -1 Lot(s) -14 Well Owner: Name: Address: George Wiegand 43 Big Elm Road, Brewster, NY 10509 Well Type: X Drilled Driven Dug Gravel Other Depth Data: Well Depth 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 Avenue, Brewster, NY 10509 Reason For Abandonment: Well is dry. Description of Work To Be Performed: We will remove the pipe, pump, and electrical components from the well and then fill the well from bottom top with concrete. Date: licant Si Signature: ' £� /21 /t _3 A Applicant 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. 46. z Date o Issue P mit Issuing Official Title White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -97 ARTESIAN WELLS " WATER SYSTEMS JET PUMPS SUBMERSIBLE PUMPS George Wiegand 43 Big Elm Road Brewster, NY 10509 Town of Patterson Tax ID #35.6 -1 -14 P.F. BEAL & SONS, INC. 4 PUTNAM AVENUE BREWSTER, NY 10509 Esta6Cishedi8gi - Over 15,000 'WeCCs Comyteted TEL. (845) 279 -2460 - 2461 FAX (845) 279 -6613 COMPLETE INSTALLATION, REPLACEMENT AND REPAIR SERVICE WATER TANKS COMMERCIAL WATER SYSTEMS HYDROFRACTURING WATER CONDITIONING EQUIPMENT lam( 1'P o�r� 4 002 08/27/13 TUE 10:10 FAX — — — -- — -- — F.F. BFAL & SONS, INC. 4 PL►Tf -Ml: - VE1 UE, .,., _... � a •. _ �.: � _ ... ..._ BREWSTER, NY 10500 ARTESIAN WELLS WATER TANKS WATER SYSTEMS Established ag1 - Over 15,0001Wefs Comyreted COMMERCIAL WATER SYSTEMS JET PUMPS HYDROFRACTURING $UIIMER$IQLE PUMPS TEL. (849) 279 -2460 -2461 01 WATER CONDITIONING EQUIPM$NT FAX (845) 279 -6613 COMPLETIS INSTALUTION, REPLACEMENT AN tP�Il3i.•SERY V George Wiegand 43 Big Elm Road Brewster, NY 10509 Town of Patterson Tax TD #35.6 -1 -14 C3 J S G 5 e �• `i� }, d) A►II,