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HomeMy WebLinkAbout1910DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36.22 -1 -33 BOX 17 �I�� J r' � ' I Lm 4 i is Z I I ' �� ■ 01910 SITE MAIL: PERS( DATE PROP( 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. �; j'p-'� 4 • 3 approved s Sirnnature & Proposal Disapproved Date toposal 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 (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diam. x 6' deep drywells surrounded by one foot + gravel). e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. I, as owner,,ev reported agent of owner agree to the above conditions. SIGNATURE � ' ��t: '. , - , � `, �•� -'' TITLE (.;;��r 1/' Gt r;fr�9_ DATE PIES: V&be MD); YeUccw atytn ED; Pink LkjLiamt) COG� PUTNAM COUNTY HEALTH DEPART 4 DIVISION OF ENVIRONMENrAL HEALTH SERVICES 225 -0310 r n. .� ..._ .._ .. �._ _ PROPEL -. FOR '�.Sr'�,GE`.i7ISFOS�i���1°R�IR� r O� S NAME �C /iv /-� �pf PHONE Z SITE I=TION n /,��i /Fv C/ �% _�CrJ. ✓t ZS�� �!# 3 �" (' ��� MAILING ADDRESS / G PERSON INTERVIEWED < < q ro PCHD Complaint # � ` o �f `3 N & Relationship (i.e, owner,tenant, etc.) DATE 3 TYPE FACILITY � � PROPOSED INSTALLER ac, ` /"� PHONE 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. ,� 00,���( fiC4�, t I C ,w — I Proposal approved s Signature & Title k Proposal Disapproved Date '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 (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diam. x 6' deep drywells surrounded by one foot + gravel). e. Installer's name and number. 3. System repair to be performed in accordance with. the above proposal and conditions. I, as owner reported agent of owner agree to the above.conditions. t SIGNATURE' TITm ;L : •q. ATE Z2 0 PgS: Vbite (PQD): Yellrw ('kin HI); Pink (Awlicant) PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WeIIPer � #��W2n2��08 °�� _x WELL COMPLETION REPORT Well Location Street Address: 48 Empire Drive, Town/Village: Patterson Tax Map # Map 36.22 Block 1 Lot(s) 33 GPS :v Well Owner: Name: Address: Matt Caspellano, 117 Tulip Road, Brewster, NY 10509 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 X Rotary _Cable percussion XCompressed air percussion Other(specify) Well Type Screened _Open end casing X Open hole in bedrock Other Casing Details Total Length _32_f t. Length below grade3l ft. Diameter 6 in. Weight per foot 19 lb/ft Materials: X Steel Plastic Other Joints: Welded Threaded Other Seal: X Cement grout Bentonite Other Drive shoe: X Yes _No Liner: _Yes X No Diameter (in) ISlot Size Length (ft) I Dept to Screen (ft) Developed? Screen Details First Second Well Yield Test _Bailed Depth Date easure from If more detailed ft. information Land Surface descriptions or.., - - sieve analyses 16 are available, 32 please attach. IT ylela was Lestea at different depths during drilling list: _Yes _No Hours X Compressed Air (Hours 6 Me 30' rom Surface ft. 16 ons Water Bearing Drilling in over] Hit rock at 16'-- Drilling in ro k Drilling in rock 185' 1 225' I Diameter in Formation Description rden clay. and boulders set casi o grouted ranite rumpistorage i anK intor Pump Type Capacit Depth Model _ Voltage HP Tank Tvpe Volume NOTE: Exact Location of well with distances to at least two permanent landmarks to be provided'on a`gepa4te'sheet/plan. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3/06 n PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES -WELL .r_ NMEWRIEPORT WELL ABANDONMENT CERTIFICATION 1, 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 # AW12 -08 to abandon said water well. Date: 12/12/08 - Signature: Print Name: Philip J. Beal Address: P. F. Beal & Sons. Inc. 4 Putnam Ave., Brewster, NY 10509 kL_ Form WAR -97 PCHD Well Abandonment Permit # AW12 -08 please print or type Well Location Street Address: TownNillage Tax Grid # 48 Empire Drive Patterson Map36.33Block 1 Lot 33 Well Owner Name: Address: Matt Caspellano 117 Tulip 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 Low yield and they kept running out of water. Abandonment Description of We removed pipe, pump & electrical components from the well and then Completed Work filled the well from bottom to top with concrete. WELL ABANDONMENT CERTIFICATION 1, 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 # AW12 -08 to abandon said water well. Date: 12/12/08 - Signature: Print Name: Philip J. Beal Address: P. F. Beal & Sons. Inc. 4 Putnam Ave., Brewster, NY 10509 kL_ Form WAR -97 SBERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI�RN MSN Associate °Commissioner of Health ROBERT J. BONDI County Executive 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 Caspellano 48 Empire Dr (T) Patterson August 8, 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 stipulation: 1. 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) 225 -5186 ext.2233 if you have any questions. cc: file. Sincerely, Mitchell D. Lee Public Health Technician 110 OLD ROUTE 6, BUILDING 3 - CARMEL N.Y 10512 (845) 225 -5186 FAX (845) 225 -5418 f 4 63 yQS PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LICATiON- -Ord *`WATERVVELL.,_ please print or type PCH D erg Well Location Street Address: Town/Village: y� Tax Map # Empire Drive, Patterson, NY Map36.22 .Block 1 Lot(s) 33 >$-43 Well Owner: Name: Address: Phone #: Matt Caspellano 117 Tulip Road, Brewster, NY 10509 845 - 224 -688 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 Existing well has low yield and they kee2 running out of water. for Drilling Well T e 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: P. F. Beal & Sons, Inc. Address: 4 Putnam Ave., Brewster, NY 105M 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 provi d n separate sheet/pl Date: 5/27/08 Applicant Signature: _- P ip 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 Deoartmei 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 bra pp va p te -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 Countv. Date of Issue Date of Expiration Permit is Non - Transferable 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 . �._ ti - ._- ...,....__..._.....__ . _ .... - APPLICATION'TO 'ABANDON A VVAT 12 WELL`.: ` . >._.�.,.......,,.. _ please print or type PCHD PERMIT # Z'd� Well Location: tr t Address: TownNillage Tax Grid # 46 Empire Drive, Patterson, NY Map36.22Block 1 Lot(s)33+,45 Well Owner: Name: Address: Matt Caspellano 1117 Tulip 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: Existing well has low yield & they keep running out of water. Description of Work To Be Performed: We will remove pipe, pump & electrical components from the well and then fill the we1L�,from bottom to top with concrete. Date: 5/27/08 Applicant Signature: P J. Beal 12"011310 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. F/I lo e Date o Issue r Issuing Official M Title White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -97 P.F. BEAL & SONS, INC. 4 PUTNAM AVENUE ARTESIAN WELLS BREWSTER, NEW YORK 10509 WATER TANKS WATER SYSTEMS COMMERCIAL WATER SYSTEMS , ,,.,....,..:a..� - -H YDROFRACTURING' a f SUBMERSIBLE PUMPS TEL. (845) 279 -2460 - 2461 WATER CONDITIONING EQUIPMENT FAX (645) 279 -6613 COMPLETE INSTALLATION, REPLACEMENT AND REPAIR SERIVICE C�u, DVS - zz4 -('8g3 Matt Caspellano 48 Empire Drive Patterson, NY Tax Map # 36.22 -1 -33 0 Q O 5� .7100 . a �� X�j (` �h ®'3 Cl- .... Sire. �� ere- ��G t�e LDVn�r1) rw'r'�� %0 `:j —3G CD rol ` j iS 0 Vf d le t b,\ P.F. BEAL & SONS, INC. 4 PUTNAM AVENUE ARTESIAN WELLS BREWSTER, NEW YORK 10509 WATER TANKS WATER SYSTEMS COMMERCIAL WATER SYSTEMS •`. JET PUMPS;. �.::a . r .. _ ..: ... -,... - lg6 r�eorl�91 O. I QZ .Tlk� ,.� fe% .:. a= HYDROFRACTtiRINQ "'-IS9EiF�IBLE PUMPS TEL. (845) 279 -2460 - 2461 WATER CONDITIONING EQUIPMENT FAX (845) 279-6613 COMPLETE INSTALLATION, REPLACEMENT AND REPAIR SERIVICE Matt Caspellano 48 Empire Dkive Patterson, NY Tax Map # 36.22 -1 -33 0 Q •,fit, Sure W�frt 5 "P1!�G r, J� / S D V d y° ' e � L l t G n '� ► " .