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Home My WebLink About1005DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.47 -1 -29 BOX 10 S9 1 4 `. 01005 Well Permit #W -15 -93 WLLL UUr1rLL11UN rrLzruZl � Office Use Only DEPARTMENT OF HEALTH Division Of Environmental Health Services - W Y 4 PUTNAM COUNTY DEPARTMENT OF HEALTH STREET ADURESS: TOWN/ViLLACLIERY TAX GRID NUMBER: WELL LOCATION 34 Sanborn Road Patterson, New York WELL OWNER NAME: ADDRESS: Frank DeBetta 34 Sanborn Road, Patterson, NY PRIVATE ❑ PUBLIC USE OF WELL 1 - primary 2 - secondary WXRESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED 2 / EST. OF DAILY USAGE gal. REASON FOR DRILLING [—]REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION ❑ADDITIONAL SUPPLY XEYEW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 245 ft. STATIC WATER LEVEL 22 ft. DATE MEASURED 4/16/93 DRILLING EQUIPMENT ❑ ROTARY COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING $.(OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH 52 ft. MATERIALS: XWTEEL D PLASTIC ❑ OTHER LENGTH BELOW GRADE 51 ft. JOINTS: ❑ WELDED X0 THREADED ❑ OTHER DIAMETER SEAL:)q CEMENT GROUT O BENTONITE ❑ OTHER WEIGHT PER FOOT __12_ lb'/ft- DRIVE SHOFXW YES ❑ NO I LINER: O YES ❑ NO SCREEN _...__ . DETAILS. -_- DIAMETER (in) 'SLOT SIZE LENGTH (it) DEPTH TO SCREEN (ft) DEVELOPED? FIRST . _ _ _._...... _._..._ ..... _._...._. ❑YES. C14W...... . HOURS SECOND GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM OEM It. WELL YIELD TEST I( detailed pumping p p 9 METHOD: ❑ PUMPED i tests were done is in- >Q(COMPRESSED AIR , formation attached? ❑ BAILED ❑ OTHER ; ❑ YES ❑ NO WELL LOG )1 more detailed formation descriptions or sieve analyses are available. please attach. DEPTH FaDM SURFACE water Bear- ing Well Oia- mete! FORMATION DESCRIPTION CODE ft. tt. WELL DEPTH it. DURATION hr. min.. DRAWOOWN ft. YIELD gpm. Surface 40 Sandy grave w/boullders e & black granite 2 WATER OP)CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS ❑ COLORED ANALYZED? )t*ES ONO ANALYSIS ATTACHEDX0 YES O NO STORAGE TANK: TYPE CAPACITY A GA PUMP INFORMATION TYPE MAKER MODEL CAPACITY DEPTH VOLTAGE HP WELL DRILLER NAME MILL. . D R I LL A / 120/93 ADDRESS Putnam Ave. SIG? • Brewster, NY 1, . 1 1, resides ELLIS A. TARLT ®N LABORATORY DIVISION OF ELLIS A. TARLTON, ENGINEERS, INC. CHEMICAL 34 PLEASANT STREET DANBURY, CONN. 06813 -2328 WATER - AVER PHYSICAL METHODOLOGY BIOLOGICAL P.O. BOX 2328 203- 748 -7903 APHA - EPA - ASTM a' - ____ REPORT -OF--- RACTE-RIOLOGICAL AND CHEMICAL EXAMINATION -OF WATER' NAME AND ADDRESS OF PERSON TO RECEIVE REPORT F Mill Drilling Inc. Putnam Ave Brewster, NY 10509 DATA SOURCE OF SAMPLE Water Supply, Sanborn Road Patterson, NY DATE OF COLLECTION COLLECTED BY DeBetta Res. April 15, 1993 Mill Drilling Hydrogen ion COLOR TURBIDITY ODOR CORROSION INDEX DISSOLVED SOLIDS Concentration LANGELIER (PH) RYZNAR NTU Mg /L Alkalinity as CaCO3 Fluoride (F) Bicarbonate Nitrite Mg /L Mg /L Mg /L NITROGEN Alkalinity as CaCO3 Chlorine Residual CONSTITUENTS Carbonate O 0 AS Nitrate Mg /L Mg /L • Mg /L Total Hardness Conductivity NITROGEN (N) as CaCO 3 Ammonia Mg/ L Mg/ L M icromohos/cm Mg /l Iron as Fe Mg /L Mg /L Chlorides as CL Mg /L Manganese as Mn Mg /L Mg /L Detergent as MBAS Mg/l. Sulfate as SO4 Mg /L Mg /L The arithmetic mean of all standard samples examined per month using the membrane filter technique shall not exceed MEMBRANE FILTER TEST one colony per 100ml. Coliform colonies per standard sample shall not exceed 3/50ml. 4/100ml. 7/200ml. or 13/500ml Coliform Colonies /100ML - I _..._.._.- ._......_ -... - ._.... ,. in...de).. Two. . consecutive. - samples;_ (b) More then- one- standard- -semp!e whon-•ls s than •20 -are examined -per month; or (c) • More than five per cent of the samples when 20 or more are examined per month. 0 AT THE TIME THE SAMPLE WAS SUBMITTED: ® 1. The results of the analysis of this sample were satisfactory and met requirements for a potable water. El2. The results of the analysis of this sample were satisfactory for a potable water but certain of the chemical or physical constituents were high. These are as follows: 3. This sample was not satisfactory since it did not meet the bacterial requirements for potable water. The presence of organisms of the Coliform group in a sample of potable water is undersirable and, while not necessarily Indicating the presence of any disease - producing organisms, does indicate that such contamination might survive to the same extent. The presence of organisms of the coliform group may also indicate that the treatment was not adequate at the time the sample was collected. El4. This sample was unsatisfactory as a potable water because certain chemical or physical constituents were above acceptable limits. These are as follows: COMMENTS The bacterial analysis showed no organisms of the coliform group at the time the sample was collected which indicated the water potable. Certified..................................................... ............................... ...... ..................... Z DEPARTMENT OF HEALTH Division of Environmental Health Services .110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 - APPLICATION TO CONSTRUCT --A WA -TRR -WELL - t% PCHD PERMIT #. _11=> WELL LOCATION Street Address Sanborn Road Town/Village/City Tax Grid Number Putnam Lake, Patterson, NY WELL OWNER Name Frank & Viola Mailing Address DeBetta, Sr., Sanborn Rd., Patterson • 43Private O Public USE OF WELL I - primary 2 - secondary 2$ RESIDENTIAL O BUSINESS 'O INDUSTRIAL O PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION U INSTITUTIONAL O STAND -BY 0 ABANDONED O OTHER (specify, O AMOUNT OF USE YIELD SOUGHT 5 gpm /# PEOPLE SERVED 2 /EST. OF DAILY USAGE gal 2M REPLACE EXISTING SUPPLY O TEST /OBSERVATION GL ADDITIONAL SUPPLY O NEW SUPPLY NEW DWE LING ) O DEEPEN E ISTING WELL REASON FOR DRILLING DETAILED REASON FOR 'DRILLING WELL TYPE x ®DRILLED DRIVEN ODUG 1:1 GRAVEL ❑OTHER IS WELL SITE SUBJECT TO FLOODING? YES x xx NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Seventh map of Putnam Lake, filed Map 149 -F Lot No.4838- 4840 - 4793 -4795 WATER WELL CONTRACTOR: Name MILL DRILLING, INC. Address: Putnam Avenue Brewster, NY IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES xx NO NAME OF PUBLIC WATER SUPPLY:, n/a TOWN /VIL /CITY ........- DISTANCE .TO_.P- ROPERTY_FROM_.NEAFEST _WATER... MAIN..:_-..-- u/ ..a.:__..w.__::.- :......_..__.. LOCATION SKETCH & SOURCES OF CONTAMINATION PROVI _ XO ON SEPARATE SHEET 4/8/93 (date) obert M. �Iirl.at President 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 thirty (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. Date of Issue:� leI l l—a 19 Date of Expiration: 19 Permit Issuing Of icia-1 Permit is Non - Transferrable White Copy: H.D. File Yellow copy: Building Inspector Rev. 10/88 Pink Copy: Owner Orange copy: Well Driller PUTNAM COUNTY HEALTH DEPARI�PP DIVISION OF ENVIRONMENTAL HEALTH SERVICES John M. Simmons, M.D. Deputy Ccm ni.ssioner of Health - FIELD ACTIVITY REPORT - Sheet of 1N5Y�1 iON NAME /�i��,��jG� �'° � Orig. Routine T Orig. Canplain ADDRESS ��✓�_� Orig. Request No. Street Town TM No. Compliance Complaint Carp MAILING ADDRESS Final P.O. Box Post Office Zip Code Group Illness Construction TELEPHONE Reinspection PERSON IN CHARGE /% �� –+ /�— Field, Sampling Only OR INTERVIEWED d Conference andAitle Other DATE TYPE FACILITY TIME ARRIVED TIME LEFT Explain INSPECTOR: PERSON IN CHARGE OR INTERVIEWED: I acknowledge this Field Activity Report. SIGNATURE: 6/86 TITLE: TI ROAM CUN UNIMPf?OVt;'O� N00. -0 00 "W r 8 _ I IRON PIN TOT I O Z 0 44 N � O �1 G :y►G.f ri E v N p �Z O d t: m o 6� p° S 1 N j to I 1 � 2 i J CONC. I 7 7§4 C) L /�d�'_ "�� o ✓ER'�� oX� � � 'S+ o r�F� 47' __ -"� .mss i 1 _. IRe WIT�y �1Y WIRE G6 ieT - ¢i e t?j Op „E 14 (n 0. p p • f j�E �o SAN509 S j a[• I• �i iu l of Y Fe r uS�VWTH NOS- 48�_ 48 _ Y N1A� pp �'UTNAwt Lq AS��Ly N 040 • 13 ! ;I VIOL �a,� Np. Imo, 47q� A °� o ON Fl ANK D FO1e i7�w N �� P A� neoP� �I N C �1--Ta S SON '�� w VCIQ, j, G4l..E : � = 2O” pUTN MA IeGH co., QY, iq 3