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Home My WebLink About0208DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 4.15 -1 -10 BOX 3 TV xi -. '-' 1 '1 A or ■ �� I'll , f - r 4i r ff 00017 q�� Ingo 7002, R�wp APPLICATION TO CONSTRUCT A WATER WELL please print or type PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Well Location Street Address: Town/Village: Tax Map # 221 Birch Hill 'Road Patterson Map 4.15 Block -1 Lots) -10 Well Owner: Name: Address:. Phone #: Peter Weiss 1221 Birch Hill Rd, Patterson, NY 12563 914 -645 -1118 Use of Well: X Residential _Public Supply Aidcond /heat pump _Irrigation 1- Primary Business Farm Test/monitoring _Other(specify) 2- Secondary Industrial Institutional Standby Amount *of Use Yield SoughL 5 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 Currently shares well with neighbor for Drilling Well Type X Drilled Driven Gravel Other Iswell 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 10509. 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 pro d on separate sheet/plan. Date: Applicant Signature: Christopher 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 Departmei 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 beamended 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 Cgynty. Date of Issue r� Permit Issuing Offci I: Date -of Expiration Title: Permit is Non- Transf ra le White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well .driller Form WP -97 Rev. 3/06 I'/ r ARTESIAN WELLS WATER SYSTEMS JET PUMPS SUBMERSIBLE PUMPS e c P.F. BEAL & SUNS, INC. 4 PUTNAM AVENUE BREWSTER, NY 10509 Esta6fisfied18gj - Over 13,000 `WeC& ComyCeted TEL. (845) 279 -2460 - 2461 FAX (845) 279 -6613 COMPLETE INSTALLATION, REPLACEMENT AND REPAIR SERVICE Peter Weiss 221 Birch Hill Road Patterson, NY 12563 Tax Map #4.15 -1 -10 . WATER TANKS COMMERCIAL WATER SYSTEMS NYDROFRACTURING WATER CONDITIONING EQUIPMENT 170 P & w��u shad I'uC Lu Vve ill UC. i-1 -t � � 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 Weiss 221 Birch Hill Rd. (T) Patterson September 8, 2015 Dear Mr. Beal: MARYELLEN ODELL County Executive A field inspection was conducted on the above referenced lot by Vincent Perrin, Public Health Sanitarian. The application to drill a new well is approved with the following stipulations: 1. The current service line coming from the shared well is to be cut and capped on both ends to permanently disconnect the existing water supply 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 Sanitatrian cc: file ni S BUI Structure located tronif survey by surveyor_ noted tI41owCL Well focalit it b Y: Sam yors surve y. - --- - 0 lr*-�-11— Villillpilftelisms report -- JL engineers mesurismitats.0— Toni, Poxes, pits, galleries a lateral* located by: Contractor. Engeaeers 0 El Field Inspection by; M of h dept2l do a if S BUI Structure located tronif survey by surveyor_ noted tI41owCL Well focalit it b Y: Sam yors surve y. - --- - 0 lr*-�-11— Villillpilftelisms report -- JL engineers mesurismitats.0— Toni, Poxes, pits, galleries a lateral* located by: Contractor. Engeaeers 0 El Field Inspection by; M of h dept2l do a if Engqno*r NOTES: li 4 0J-' x 3 6 T. - 0 1 ME N SION S A A C C Em A D . -9 D IC-A.L- 3 06,-" A E --.6 ---.B E A F A 6 '--- - --B J G A N 9 H APPROVED I,.:- J LAW K -8 9 JUN- 44974., SY-SIE-M DE5]Gbl "AS MaIX ,LOCATION Street-. -Efate: 'DIVIS #.ON'— OIL- ca LOT adder: A avi a Dote: --i4 ISC41611z, POP Ep_t -,.16 I JOHN _11 FIR _NTjISS PE CON NEER RD 6 Box 353 CARVIE L NY 10812 — (914 1 87 8 -617 0: 0% G4 q' 1\00 3 w� o tia,�ti ,pp3 o� o{ yeti �6' ^Cl a overhead utility rive ' y0� —E- ,,ti 0 S 10 °58'05" 3 194 s 71ij ZW 2, lad a8° 4pSy AcRFS u/'llnl�ble g, stone wall l4e r4%,A-4