The URL can be used to link to this page

Home My WebLink About2032DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36.40 -1 -39 BOX 18 02032 IrM , • IN - _ ,,., - , III Ir , .� ir �`r4 r r yo . y �I ,` NINE ` ' `; ,. . � ,, 02032 M PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION_T_O. CONS.TRU �1,WATR WI, _ please print or type PCHD Permit # Well Location: Street Address: Town/Villag Tax Grid # 14 Academy Road - grewstei- Nag r9 nMap 36.4 Block -1 Lot(s) 39 Well Owner: Name: Address. George Stipak 14 Academy 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 Amount of Use Yield Sought 5_t o_ gpm # People Served Est. of Daily Usage gal. Reason for X Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason Shares well with neighbor 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: P. F. Beal & Sons, Inc. Address: 4 Putnam Ave., BrE?wetPr� WV 10509 Is Public Water Supply available to 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 provide4 on separate eet/plan. Date= 3019004 Applicant Signature: Ph li 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 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. revision or alteration of the approved plan requires a new permit. Well to be constructed by a wate ell revision rtified by Putnam County. Date of Issue Permit Issuing O i Date of Expiration/ 0 S Title: Permit is Non- Transfer abl White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 ARTESIAN WELLS -WATER SYSTEMS -- "Jetpumot - SUBMERSIBLE PUMPS P.F. BEAL & SONS., INC. 4 PuTNAm AVENUE BREWSTER, NEW YORK 10509 TEL. (845) 279 -2460 - 2481 FAX (845) 279-6613 COMPLETE INSTALLATION, REPLACEMENT D REPAIR SERIVICE Y SZ)f George Stipaic . 14 Academy Rd, Brevster, MY Tax Grid #36.40-1-39 WATER TANKS COMMERC4AL WATER-SYSTEPAS HYDROFRACTtMNO WATER CONDITIONM EQUIPMENT tb '44 t r0 w bc fro 0 r (7 U col ;mac rn 17 till 52 C—) =C) 4f Cn.(=a) C-)-< Co Sheet of PUTNAM COUNTY DEPARTMENT OF HEALTH w DINVISION OF ENVIRONMENTAL HEATLH SERVICES FIELD ACTIVITY REPORT Anngipsq: F "v ./c. Street Town State Zip PERSON IN CHARGE nu YNTF.UvrFwvrn: nate. Y/30 Name and Title TYPE OF FACILITY: FINDINGS: Wu '_ Ty a . Signature and Title- 'n T-n ^T's IV 'n T- nr.T1 rr r'i nva I acknowledge receipt of this report: SIGNATURE: 02 /96 Title : — P.F. BEAL SONS, INC. 4 PUTNAM AVENUE ARTESIAN WELLS BREWSTER, NEW YORK 10509 WATER TANKS -COMMERCIAL WATER SYSTEMS_-,.;.:.'_;:. JET PUMPS �irfa�fsiiedla9! - �uer f 3, 2%S 7J`GoirtP %feo� HYDROFRACTURING SUBMERSIBLE PUMPS WATER CONDITIONING EQUIPMENT TEL. (845) 279 -2460 - 2461 . FAX (845) 279 -6613 COMPLETE INSTALLATION, REPLACEMENT AND REPAIR SERIVICE George Stipak 14 Academy Rd,'Brewster, NY Tax Grid #36.40 -1 -39 w� 0-0 �+ as S�5 1 AWe , _�' 3M _k _s :c 1A) RETTA , Public Heizi DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (945) 278 - 6678 Fax (845) 278 -.6095 Early Intervention/Presch.001 (845) 278 - 6014 Fax (845) 278 - 6648 P.F. Beal & Sons, Inc. c/o Philip Beal 4 Putnam Avenue Brewster, NY 10509 March 23, 2004 Re: Proposed Well: Stipak 14 Academy Road (T) Patterson Dear Mr. Beal, ROBERT J. BONDI County Executive I have received a well permit application (WP-97), a site plan, and a certified check in the amount of $150.00 for the above referenced proposed well. Comments are offered as follows: 1. The site plan is to also include the location of any existing septic systems and wells within 200 feet of the proposed well, in addition to all possible sources of contamination within 200 feet (i.e., salt storage, oil tanks, land Please dimension the location of the proposed well from two fixed points. A copy of your submitted plan has been included for your use. If there are any questions please contact me at (845) 278-6130 ext. 2235. Upon receipt of a site plan amended to address the above noted comment, this application will be considered further. Very truly yours, Brian R. Stevens Public Health Technician cc: RMAe 61758 P. F. BEAL & SONS, INC. ARTESIAN WELLS - PUMPING EQUIPMENT WATER CONDITIONING EQUIPMENT BREWSTER, NY 10509 5 5768 219 DATE —� PAY TO THE 1 l ORDER OF — $ /. • t�o Q . IEJ UI�iZ r 1� (29 DOLLARS B BANKOF YOM R Clock Y 10 Commom, RT 22 lOi�[\ Brewnes, NY 10509 , T—Z Ar Disclaimer: PRINT Page 1 of I 'K6 http://imsserver.putnarncountyny.comIFreeancelClientILandRecordslprintFrame.htrnl 4/21/2004 Parcels Old Parcel Lines Streams Lakes and Ponds Wetlands Carmel Road Names Kent Road Names Patterson Road Names Philipstown Road Names Putnam Valley Road Names Southeast Road Names Disclaimer: PRINT Page 1 of I 'K6 http://imsserver.putnarncountyny.comIFreeancelClientILandRecordslprintFrame.htrnl 4/21/2004