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Home My WebLink About0268DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 5. -1 -42 BOX 3 00077 tHt IL -r 4. Li 1 �'ti r1 �, �r . r - 1 00077 4 PUTNAM COUNTY DEPARTMENT OF HEALTH �. DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # )A ) 0 1-o Well Location: Street Address: Town/Village Tax Grid # 5. -1 -42 550 N. Birch Hill Rd Patterson Map Block Lot(s) Well Owner: Name: Address: William Bostick 1550 N. Birch Hill Rd, Patterson, NY 12563 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+ gpm # People Served Est. of Daily Usage 110 a gal. Reason for X Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason Existing well is dry. for Drilling I 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., Brewster, NY 1050 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 pr ' ed ep a sheet/plan. Date: 12/18/01 Applicant Signature: Perr LE 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. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a wate a driller certified by Putnam County. Date of Issue 13/6 Z Permit Issum icial: Date of Expiration ' ' 13 b z Title: Permit is Non - Transfer White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 r { ARTESIAN WELLS WATER SYSTEMS JET PUMPS SUBMERSIBLE PUMPS P.F. BEAL .& SONS, INC. 4 PUTNAM AVENUE BREWSTER, NEW YORK 10509 rla6f rfied/e9l - Ouee- /3, 21i &eif Coiao %led TEL. (845) 279 -2460 - 2461 FAX (845) 279 -6613 COMPLETE INSTALLATION, REPLACEMENT AND REPAIR SERIVICE A-14 ban• 3eele- WATER TANKS COMMERCIAL WATER SYSTEMS HYDROFRACTURING WATER CONDITIONING EQUIPMENT 4�401'f( g9S. % `°O rte- SAS _ - William Bostick PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL please print or type PCHD Permit # Well Location: Street Address: TownNillage Tax Grid # 5. -1 -42 550 N. Birch Hill Rd Patterson Map Block Lot(s) Well Owner: Name: Address: William Bostick 1550 N. Birch Hill Rd, Patterson, NTY 12563 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+ gpm # People Served Est. of Daily Usage 1-0 0 gal. Reason for x Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason Existing well is dry. 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., Brewster, NTY 1050 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 pr ed dp a sheet/plan. Date: 12/18/01 Applicant Signature: Perr Beal PERMIT TO CONSTRUE 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. 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 Date of Expiration Permit is Non - Transferrable Permit Issuing Official: Title: White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Fnrm WP -97 P.F. BEAL & SONS, INC. 4 PUTNAM AVENUE ARTESIAN WELLS BREWSTER, NEW YORK 10509 WATER SYSTEMS JET PUMPS fit /a6l r�iea� /B9/ - Over 1.3,21J &)e//r GiomPl /et" SUBMERSIBLE PUMPS TEL. (845) 279 -2460 - 2461 FAX (845) 279 -6613. COMPLETE INSTALLATION, REPLACEMENT AND REPAIR SERIVICE Cr��olj va� 1\.14 Wrj WATER TANKS COMMERCIAL WATER SYSTEMS HYDROFRACTURING WATER CONDITIONING EQUIPMENT /s /If fo 1 4,0�,,1,o S9S- Na`' W �� X00 No . ArCA P. /r 4 1, 60041 P. F. BEAL & SONS, INC. ARTESIAN WELLS - PUMPING EQUIPMENT WATER CONDITIONING EQUIPMENT BREWSTER, NY 10509 50- 235768 DATE /°2 � / 2t9 PAY TO THE ORDER OF T'�!�- (a9 �ti �Lk�Q 1� .CY 9 �C2 t • $ /OO • lI7� DOLLARS U BANKOF NW 700 Ck k T- Comma% RT:: YORK e--- m josm ii'06001, 1118 1:0 2 190 2 3 5 2l: 1'500 78 20 2 3 ?811' 0 . a a P.F. BEAL .& SONS, INC. 4 PUTNAM AVENUE ARTESIAN WELLS BREWSTER, NEW YORK 10509 WATER SYSTEMS JET PUMPS 1is1a61r6'ed1a91 - Over- 13,21J Dells Gompfeled SUBMERSIBLE PUMPS TEL. (845) 279 -2460 - 2461 FAX (845) 279 -6613 COMPLETE INSTALLATION, REPLACEMENT AND REPAIR SERIVICE February 11, 2002 WATER TANKS COMMERCIAL WATER SYSTEMS HYDROFRACTURING WATER CONDITIONING EQUIPMENT Putnam County Health Dept. Attn: Daniel Hadden Public Health Technician 1 Geneva Road Brewster, New.York 10509 Dear Mr. Hadden: The enclosed was submitted December 18th and we have yet to hear anything whatsoever, and during my meeting last week with Bruce Foley and Mike Budzinsky this particular permit application was brought up and they agreed it must have been misplaced due to the fact that we have not received an answer by now. Very truly your P. F./1$eal/jvins, /Inc. a PLB /mm enclosures t is P P'AWLING DUfCNESS CO. PUTNAM Co 3 31 R 7Y— 'tp�ER R m : ` 7 rCORE..//• 31d 16.94 AC. CAL. F DISPUTE r ' �• u F A 1 G 30 al.w PUTNAM COUNTY HEALTH DEPARTMENT o DIVISION OF ENVIRONMENTAL HEALTH SERVICES 4 PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR 'ES N Internal Use Only ❑ Repair Permit issued in last 5 years VD'e f in Watershed ❑ Repair within Boyd's Corners, W. Branch or Croton Falls Res. le gated ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetla;;:;) ❑ Joint Review SITE LOCATION 550 2J, �.V6_1 yly-\\ OWNER'S NAME PHONE # MAILING ADDRESS SSp APPLICANT old , Q, l Name & Relationship (i.e., owner tenant, contractor) DATE °�,l -off FACILITY TYPE PCHD COMPLAINT # PROPOSED INSTALLER PHONE # `;;`l� .��1k,001� O ADDRESS Q 0 _6Ok `n �kQ REGISTRATION /LICENSE # W%S_ Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed trenches) NOTE: Repair must be in same location and of same type as original sewage disposal system. Different location and proposed pump systems will require submittal of proposal from licensed professional engineer or registered architect. I, as owner, or reported agent of owner agree to the conditions stated on this form SIGNATURE _ L1�.!,a,, l �j 7i�) TITLE m/, M ekJ Proposal 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 d. System description (e.g., 1250 gal. Concrete septic tank, etc.) e. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and condition s. Proposal Approved Proposal Denied Signature & Title �1 =--- COPIES: White (PCHD); Yellow (Town BI); Pink (Installer), Orange (Applicant) PC -RP 99ML Rev. 8/05 DATE �-3 - \Y�� kz��C) yoy& co N m a c O Ln N Q N O W U) It w c� z H m e J a- fr . W H O O ..P m C N ,'oann VVi]l:am Bostick 550 N.Birch Hill Road Patterson NY 12563 INDIVIDUAL SEWER LIME LATERALS 7M HOUSE SEWER MAIN SEPTIC TANK 1� * ABOVE GROUND GLEAN OUT R -234 -08 SITE LOCATION OWNER'S NAME MAILING ADDRESS 9!2412005 550 N. BIRCH HILL ROAD BOSTICK, WILLIAM 8 JOANN 550 N.BIRCH HILL ROAD PATTERSON NY 12563 AS Built Drawi,pq C� Sent By: MR ROOTER PLUMBING; 845 635 1173; Sep -25 -08 10:27AM; Page 3/3 a O 4' PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR YES ND Intemal Use Only ❑ f Repair Permit issued in last 5 years I I Not in Watershed n Ld Repair within Boyd's Comers, W. Branch or Croton Falls Res. El' 'Delegated ❑ ( Repair within 20o ft. of a watercourse or DEC- mapped wetland -'--, '; ❑ Joint Review SITE LOCATION. _ y rWY.1 �rs,� '' TM # OWNER'S NAME . { PHONE # MAILING ADDRESS r �. �.,;, + +� , ` �. ti --•ice, r � ' � I �+ ` APPLICANT 1,�il g Name & Relationship (1.9 -, owns t8 ant, contractor) DATE FACILITY TYPE , J� PCHG COMPLAINT # PROPOSED INSTALLER PHONE # ADDRESS �,� "'ZSiwY� REGISTRATION /LICENSE # �" Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed trenches) NOTE: Repair must be in same location and of same type as original sewage pgsal system. Different location and proposed pump systems will require submittal of proposal ' n licensed professional engineer or registered architect. L♦ ` ' .i "` N.. `i ,Y„Y!t'•i .Y.-:i YN rr+rR% 1+e0: ="�:►� -' \e.. i •ti1 = ri-�"•- �'Y -i+Y_ Mi ' R t �RiRrl1�1, ■ �1�� { �M-K r J 1. 1, as owner, or reported agent of owner agree to the conditions stated on this form SIGNATURE ,; ��•., T TITLE "":.� , ` ;16e. rig i' /� _- DATE Proposal apcl`o..ved 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 d. System description (e.g., 1250 gal. Concrete septic tank, etc.) e. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and conditions. . , . Proposal Approved �P Proposal Denied inspector's S.ignatur & itle Dogs COPIES: White (PCHD); Yellow (Town 81); Pink (In6tailer), Orange (Applicant) PC -RP 99ML Rev. 8/05