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Home My WebLink About1295DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.71 -1-40 BOX 12 J i,?I � J6 T L , 1 19 01295 /��` "✓G�' WELL UUrirLtllun A-zrvAi DEPARTMENT OF HEALTH Division 'Uf'-Eriviroriinental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only o Q STREET ADORESS: TOWN IVIE TAi GRIO NUMBER' 8 Weston Rd., Patterson,NY WELL LOCATION WELL OWNER NAME: ADDRESS: Arthur Annechino 8 Weston Rd. Patterson,NY 12563 ❑ PRIVATE 0 PUBLIC USE OF WELL 1 - primary 2 - secondary ® RESIDENTIAL O PUBLIC SUPPLY O AIR /CONDAEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION O OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING 0 NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION 12 REPLACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 685 ft. STATIC WATER LEVEL 80 ft. DATE MEASURED 11/18/88 DRILLING EQUIPMENT (3 ROTARY 13 COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED O OPEN END CASING. -1 OPEN HOLE IN BEDROCK ❑ OTHER TOTAL LENGTH — fL MATERIALS:. CISTEEL O PLASTIC 0 OTHER CASING DETAILS LENGTH.BELOW GRADE 40 ft. JOINTS: O WELDED THREADED 0 OTHER DIAMETER 6.— in. SEAL: IR CEMENT GROUT ❑ BENTONITE 0 OTHER WEIGHT PER FOOT -1 Ib. /ft. DRIVE SHOE 13 YES 0 NO LINER: 0 YES [MO SCREEN DETAIL'S DIAMETER (in) SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST. ❑ YES O NO HOURS SECOND GRAVEL PACK ❑ YES O NO GRAVEL SIZE: DIAMETER OF PACK in. TOP DEPTH ft- BOTTOM DEPTH It. WELL YIELD TEST 'I'll detailed pumping METH00: O PUMPED i tests were done is in- COMPRESSED AIR , formation attached? BAILED ❑ OTHER : 0 YES 0 NO LOG 1f more detailed formation descriptions or sieve analyses are available, please attach. NWELL ROM CE Waer Bear- in9 N1e! Dia- neter FORMATION DESCRIPTION cooE❑ ft WELL DEPTH It. DURATION hr. min. DRAWOOWN It. YIELD gpm. Sur 4 Drilling in overburden clay & bld s . Hi rock at 4 feet 685 6 665 f 2 !,, _`rr 4 41 Drilling in rock,set casing,grou ed 41 685 riling in rock granite. WATER ❑ CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS O COLORED ANALYZED? OYES ❑ NO ANALYSIS ATTACHED? ❑ YES O NO STORAGE TANK: TYPE CAPACITY GAL. PUMP INFORMATION TYPE giibm,-rs i b1 P CAPACITY 5 9 MAKER Gould p H 620' MODEL 5ES10412 yOLTAGE230 HP 1 WELL DRILLER NAME p ; F . $eal & Sons ,Inc . DATE 1/13/89 AOORESS PO Box B SIGRATURE Brewster,NY 10509 A{ Ak DEPARTMENT OF HEALTH 1� Division of Environmental Health Services TWO CO U CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT WELL ,LOCATION Street Address 8 Weston Rd., Town/Village/City Tax Grid Num er Patterson, NY J WELL OWNER Name Mailing Address Arthur Annechino, 8 Weston Rd.,Patterson,NY CPrivate 13 Public USE OF WELL 1 - primary 2 - secondary JU RESIDENTIAL ® BUSINESS ® INDUSTRIAL 0PUBLIC SUPPLY ❑AIR /COND /HEAT PUMP. O FARM O TEST /OBSERVATION O INSTITUTIONAL O STAND -BY ❑ABANDONED O OTHER (specify AMOUNT OF USE YIELD SOUGHT 5 gpm /# PEOPLE SERVED /EST. OF DAILY USAGE gal REASON FOR DRILLING 0 NEW SUPPLY OPROVIDE ADDITIONAL SUPPLY. (REPLACE EXISTING SUPPLY -0 DEEPEN EXISTING WELL OTEST OBSERVATION' DETAILED REASON FOR DRILLING WELL TYPE ®DRILLED ODRIVEN ODUG OGRAVEL OOTHER IS WELL SITE SUBJECT TO FLOODING? YES X NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name P.F. Beal & Sons,Inc. Address: PO Box B.,Brewster,NY IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES X NO -NAHE OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED ONE E OF THIS APPLICATION TE HE ` (date) (signature) 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 s.hall: 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 19 fi Date of Expiration: 19 ermit G��rg cia Permit is Non - Transferrable SPY: H. D. File Yellow copy: Building Inspec�r Pink Copy: Owner 2/87 Orange copy: Well Driller PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES John M. Simmons, M.D. Deputy Commissioner of Health - FIELD ACTIVITY REPORT - Sheet of INSPECTION NAME • -�,� �� i �, Orig. Routine Orig. Complain ADDRESS 0� 5G �1 �O� _ Orig. Request No. Street Town `K No. _ Compliance Canplaint Comp MAILING ADDRESS �p 2 Final P.O. Box Post Office Zip Code _ Group Illness Construction i VD-1 d§71 10 • i5 PERSON IN CHARGE OR INTERVIEWED Name and Title DATE G 5 TYPE FACILITY TIME TIME LEFT Reinspection Field, Sampling Only Field Conference Other Explain INSPECTOR: TELEPHOR: Signature and Title PERSON IN CHARGE OR INTERVIEWED: I acknowledge this Field Activity Report. SIGNATURE: 6/86 TITLE: