The URL can be used to link to this page

Home My WebLink About0514DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 15. -1 -31 BOX 6 his is IL R611 T w; Ir Ik 00514 �T Ickc 'AR L� (0-1 W 6365 6 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL � mr4P lease print or type PC i:t1 v. Well Location Street Address: Town/Village: Tax Map # 404 Haviland Hollow Rd, Patterson Map 15- Block - 1Lot(s) -31 Well Owner: Name: Address.. 12563 Phone #: Jane Muqaddam 404 Haviland Hollow Rd, Patterson, NY 45- 878 -3829 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 -10 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 Casing in existing 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 P„1-nnm ayie, Brewster., NY 105 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 provide n separate sheet/plan Date: 9/4/07 Applicant Signature: P lip .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. take appropriate action to assure that any and all water and waste products from such well drilling operationse contained on this property and in such a manner as not to degrade or otherwise contaminate surface or grou ater_-5:= { tq APPROVED FOR CONSTRUCTION: This approval expires Ome N yearifrom the date issued unless constructiR of tlle�, � well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified `Si when considered necessary by the Commissioner of Health. Any revision or alteration of the approved plan reTulres'a- ? new permit. Well to be constructed by a water well driller certified by Putnam Cugpnty. C.0 n i=ri Date of Issue g � 7 Permit Issuing Offici I: � Date of Expiration ® Title: s t 5 t --. Z9,Wc- 1-kc..16 Permit is Non - Transfers le White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 Rev. 3/06 z -- PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO ABANDON A WATER WELL please print or type PCHD PERMIT # AW1 & —O% Well Location: Street Address: TownNillage Tax Grid # 404 Haviland Hollow Rd, Patterson, NY Map15• Block —1 Lot(s) —31 Well Owner: Name: Address: Jane Muqaddam 404 Haviland Hollow.Rd, Patterson, NY 12563 Well Type: X Drilled Driven Dug Gravel Other Depth Data: Well Depth 300 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: P. F. Beal & Sons, Inc., 4 Putnam Ave., Brewster, NY 10509 Contractor: Reason For Casing is leaking and causing contamination. Abandonment: Description of Work To Be Performed: We will remove pipe, pump & electrical components from the well and then fill the well from bottom to top with concrete. Date: 9/4/07 Applicant Signature: Phiald Beal PERMIT ' c m FJ. _ ,M This permit, to abandon one water well as set forth above, is granted under provisions of Article 10 of the htnatri�' . County Sanitary Code, Subpart 5 -2 of Part 5 of the New York State Sanitary Code and/or Part 75 of 101 C and provided that: Within 30 days of the completion of the abandonment of the water well, the applicant Will o;� submit to the Department a certified statement that the information delineated on the application for this permit has been completed. f /9/0-7 Date of Issue Issuing Official Title White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -97 ,j SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Philip J. Beal P.F. Beal & Sons, Inc. 4 Putnam Avenue Brewster, NY 10509 November 8, 2007 Dear Mr. Beal: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Proposed Well Muqaddam 404 Haviland Hollow Road (T) Patterson A field inspection was conducted on the above referenced lot by Mitchell Lee and Brian Stevens, Public Health Technicians. The application to drill a new well is approved with the following stipulations: The well is to be located 100 feet away from the septic area as depicted on the enclosed plan. 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) 225 -5186 ext.2233 if you have any questions. S'ce ely, Mitchell D: Lee Public Health Technician cc: U Enclosure: Well Application Plan Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 P.F. BEAL & SONS, INC. 4 PUTNAM AVENUE ARTESIAN WELLS BREWSTER, NEW YORK 10509 WATER TANKS WATER SYSTEMS COMMERCIAL WATER SYSTEMS JET PUMPS �irla�fr�eorld9l- �uer 1�, STS �eiis Gompleleol' HYDROFRACTURING SUBMERSIBLE PUMPS TEL. (845) 279 -2460 - 2461 WATER CONDITIONING EOUIPMENT FAX (845) 279 -6613 COMPLETE INSTALLATION, REPLACEMENT AND REPAIR SERIVICE Jane Muqaddam 404 Haviland Hollow Road Patterson, NY (Tax Map #15. -1 -31) con • � z �KO?OSe�- ,A)dI 7: -k, 15D r Vt a— e 4/6 btti e� P �s i,/r ��r dap' D-i �S .D 9 D y or- 4�'c doti-� apS y S,ieC S`-r —e5 o4' %,fie!( 6erl��j �rlIIC,) fo ek,Sf,J ^� I.v� P.F. BEAL & SONS, INC. 4 PUTNAM AVENUE ARTESIAN WELLS B BREWSTER, NEW YORK 10509 W WATER TANKS WATER SYSTEMS C �s /a6ir'r6ed1d9� - Uuei- t4, 4TS VeIIS Gomp%/ed N COMMERCIAL WATER SYSTEMS SUBMERSIBLE PUMPS T TEL. (845) 279 -2460 - 2461 W WATER CONDITIONING EQUIPMENT FAX (845) 279 -6613 COMPLETE INSTALLATION, REPLACEMENT AND REPAIR SERIVICE 1 J Jane Mugaddam / V 4 404 Haviland Hollow Road Patterson, NY Tax Map #15. -1 -31) rrn Nyt•'"O N well 1 . a ,� ,�v 5 Pp �► �S btti e� y Y NCcV f /u XD�ro w /C� . nto r44ec- 1-� 4 6'.') "r- Or ,e down, I LA's S, k Svr�'eS 0-r pro per . \ 1 I 0 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 PROPOSED ADDITION APPLICATION (RESIDENTIAL ONLY) BRUCE R. FOLEY Public Health Director / P,I STREET 4D4 %c4v,il/ cin TOWN Po kvso n TX MAP #.. 3� NAME K's h o-S , MUqCL1jQx4 PHONE 17 3 3 $a 5 PCHD # ® G% V 4A MAILING ADDRESS 3 O 4,�' *o,?e s Ale, wlo rK IV DESCRIPTION OF ADDITION zvi c.OS L ,10 a�i 0 V J0 r M g, e NUMBER OF EXISTING BEDROOMS c PROPOSED # OF BEDROOMS (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) *Any addition which is considered a bedroom requires formal approval of plans (Construction Permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health Dept., 4 Geneva Rd., Brewster, NY 10509, Phone 278 -6130. 1. Certified check or money order for $100.00 2. Sketches of existing floor plan (drawn to scale, all living area including basement) * Non - professional sketches are acceptable 3. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map #) * Non - professional sketches are acceptable 4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Cert. of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE Comments Feb 98 704 Off' RAWW)E ON PUTNAM COUNTY 'PATTERSON. NEW YORK 12563 orrrc� or 7dNN i� �;ItC� OY14A:N0 paftHtCTOW Timely Title Services Ltd. 37 Fair Street Carmel, New York 10512 Re: December 9, 19 186 TM 8 -2 -6,1 Susan Golick Wasserman Haviland Hollow Road, Patterson, N. . Title No...TTP 3.656 To Whom It May Concekn: The dwetting on the above,numbeited .to.ta WaA conat tucted pn.ion to' oun Zoning Ud.inance &eq ng a Ceat.i.6.ica.te o6 Occupancy.. At th,ia .t•ixe, the Town'a 8uitd.ing Sep ent 6 itu do not show any. ae4tnlct.ion on v.io.ta..tion ox the above pnopeaty. I we tcome th" oppolktuni ty to be o f A env ce to you. You1Ca tAu.ty, 8 dr.na Indpe on JNC:mc Town Road County Road xX Sate Road . 2 I JOHN N. CA180 Building inspector TOWN OF PATTERSON PUTNAM COUNTY Telephone 878 —.6319 PATTERSOK NEW YORK 12563 December 9, 1986 RE: TM 8 -2 -6,1 Susan Golick Wasserman HavifiAnd Hollow Road, Patterson, N,Y. TO WHOM IT MAY CONCERN: To the best of my knowledge, the above mention d property is not in a flood zone. . Very truly yours, JNC:elz JOHN N. CALBO Building Inspector NJF KEN NE-z>y 2:7- V6- /O'kf THIS 60i.'NL14AY vAot-lu t^E W Te b ce. os,-, I r vi 344-0(e- 'j 2 PW 31 --.2-1 VJ a2.4 $' 3- VW ear-FU - w I L4 49 S:f.-65,-30,C S20 vj loaf HauSE V—D Iii SURVEY OF. PPOPEr--?TY SAL M UQA M E-C M, dANE- tt%- A SITUATE 2: M, OF PAT Ti�PSOM PUTT4AM CO., NY'' SCALE 1"=ICO' dANUARY 20 A G-T FIFBQ(jApty 3.JQS;eCERTIP . CATIONS� Mes, SANF7MtiavNavAt'1 gory p'a'n3�zRcCcw \ r+Y "Tiy hop la 'p j' / -3/ i Noveksl� �Tio �.toa� }��a.i., o� MRS, JANE MuquR0OffM. yay H,9w4A"f) RD. PATI _69SO N NY PArr / 'oF ,S SCALF n h9Rs. �YAUE Jllt4 tIADDAt-j Per e ;�ri NY PHGE of J� 3cA. JE I a as n1• P.�;:�; 111A T',4 Gip ri �F /ijL 4 -•' Q °�197N C I y» "l�fC su -rl,✓G CDC W2gPP�p ARM PS, Sve, Foot �r✓a � OQ14��✓e� �?! _ A1c,sTUAE ]?aRltl6lL.�! �/vr /n•6S H9rZD' �09i3i7 /A/ENA9T/O/li WESY LLLEVAw.Afd E, r-LOSE Pte^ O ^ Pgf7A SL�CT/ON Mies. SANt MuQuAtDp/NM YO-t HA✓IAA qD PD, � P97ffRSON.:.) N.Y PAra 3 eF _5 SCAl -Is 13�o F:rn. �O2J1ER Fl-ooe Norf ; ee,)-1- Dr.PE^i95 GN HF�Cr I'\T for Ce\uug WEST E�EVgrloN _ �oiZM�Jt c�£t�IUN MRS, SANS_ MaOUAD OAM -gziY RAvuAND RD. PAnFRSbn , Ny PAG£ ALE - .2 SH f�Yiri4 �. � SO FF\T e' FF1'IA is MN�Ny Nc�\ A 5' KNE£ la'q— 2,c.6 16 oC -A la t s1.,�„TiNG MRS. -,YANE MtAQLtAO0,9M ,/Oj/ 11,AyjL AN V P1,71-tHSOP PH GE 5- "F S, SCALf I -r-P AP r-Ax CMEMt. WINODWE SAOQ--- AL TL16SE fJLJ Vltcy Fisi)tz- 10-lLr.,06 IF ?'6e-CIULr-- .wcl O3q 'a?� aNwr�nvN tioti WNOONnbhW �NV� 'Sdf(,J Q i i �/ ✓lNG Zvo..� ' fB' „TFE{, LFPS7 :o. ,/ x Cwtraso Pi+r�o /�I TGH 6N New PnQ r LLv,RiG Rol �? L u o°y 2 J.X6 /R. Pic ep V Caseme- WIN�ccu (thci Su o, ✓G GLRrr lb.R Fed. Iw mW,9— 00 vff e60 ATlo MRS. TANS MuQUAOof1M y01/ t{/%✓I,LAUO Rt>. PA1iBfzSoN NY PAGE7 aF SCAa 990 580 ry Ile\ H A V I LAND HOL L-OV J (LOAD 2100% 1