HomeMy WebLinkAbout2103DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www. sca n yo u rd o cs . co m
631- 589 -8100
36.57 -1 -7
BOX 18
02103
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DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
APPLI.CATZON »: ;TO CONSTRUCT A-° WATER WELL.:,
PCHD PERMIT
WELL LOCATION
Street Address Town/Village/City Tax Grid Number
21 Wesley Road Brewster NY
WELL OWNER
Name Mailing Address OPrivate
Daniel T. Sullivan, 21 - Wesley Road, Brewster, NY 0Public
USE OF WELL
1 - primary
2- secondary
® RESIDENTIAL ❑ PUBLIC SUPPLY O AIR /COND /HEAT PUMP D ABANDONED
0 BUSINESS O FARM p TEST /OBSERVATION O OTHER (specify,
0 INDUSTRIAL U INSTITUTIONAL O STAND -BY p
AMOUNT OF USE
YIELD SOUGHT s gpm /# PEOPLE SERVED o`L /EST. OF DAILY USAGE IS2 gal
REASON FOR
DRILLING
® REPLACE EXISTING SUPPLY ❑ TEST /OBSERVATION GIADDITIONAL SUPPLY
O NEW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL
DETAILED
REASON FOR
DRILLING
Existing supply is from neighbor who keeps turning ofL the
water, etc.
WELL TYPE TMDRILLED
DRIVEN
DDUG
[]GRAVED
0
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES )�' NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION:
Lot No.
WATER WELL CONTRACTOR: Name P . F. Beal & Sons, Inc. Address: 4 Putnam Ave. , Brewster
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
DISTANCE TO_PROPERTY.FROM NEAREST WATER MAIN: - 1
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
SON SEPARATE SHEET
(date) /Ah
11
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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
thirt, (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
any and all water or waste products from such well
property and in such a manner as not to degrade or
Date of Issue: Gl 19
Date of Expiration 19�
shall take appropriate action to assure that
drilling operations be contained on this
otherwise con ace or groundwater.
Permit Issuing Official
Permit is Non - Transferrable White copy: HD File Pink copy: Owner
3/89, Yellow copy: Bldg. Insp. Orange copy: Well Driller
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P.F'..BEAL .& SONS, INC.
4 PUTNAM AVENUE
ARTESIAN WELLS BREWSTER, NEW YORK 10509 WATER TANKS
WATER SYSTEMS � Ci4lced %P91, � / __ CQMMERCIAL WATER SYSTEMS.,
.:�.� .w�,�ET.��.�PSy,.::.. .. -:a, �., - _..�..�.., ., ...�a _ � • ^. >, ..: : >._,:,,,...,,iiYDROFRACTURING •..
4 SUBMERSIBLE PUMPS TEL. 279 -2460 - 2461 WATER CONDITIONING EQUIPMENT
FAX 279 -6613
COMPLETE INSTALLATION, REPLACEMENT AND REPAIR SERIVICE
July 15 1996
Putnam County Health Dept.
Attn: William Hedges
4 Geneva Road
Brewster, New York 10509
Dear Mr. Hedges:
Enclosed is a permit application to drill a well for Mr.
Daniel Sullivan, 21 Wesley Road, Brewster, (Putnam Lake), NY.
This man's house and property is adjacent to the property of
Mr. Schira where I met with you to discuss the drilling
location. At that time, we looked at Mr. Sullivan's property
with the intention of drilling a well for him in the corner
of his property furthest away from his septic system. If you
will recall, both Mr. Schira and Mr. Sullivan get water from
their neighbor who periodically turns the water off, the
Sheriff's Department is called, etc. If there is any way
that this permit application can be approved so that we can
drill both wells at the same time this week, it would be
greatly appreciated.
Please- call me with 'your approval "of comments.° -_ Thank you for
your attention to this matter.
PLB /mm
enclosure
Very truly yours,
Inc.