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Home My WebLink About1352DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.78 -1 -56 BOX 13 9 1 W.. i i- rill, . ri 01352 DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO 'CONSTAUCT A WATER WELL PCHD PERMIT # WELL LOCATION Street Address 26 Newport Rd, Town/Village/City Tax Pa tterson,NY Putnam Lake Grid. Number. WELL OWNER Name Jerry Maloney, Mailing Address 26 Newport Rd;, Patterson,NY OPrivate E3 Public USE OF WELL 1 - primary 2- secondary ® RESIDENTIAL O BUSINESS O INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM ❑ TEST /OBSERVATION O INSTITUTIONAL O STAND -BY Q ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT 5 gpm /# PEOPLE SERVED /EST. OF DAILY USAGE gal REASON FOR DRILLING NEW SUPPLY O PROVIDE ADDITIONAL SUPPLY EIREPLACE EXISTING SUPPLY 0DEEPEN EXISTING WELL O TEST /OBSERVATION DETAILED REASON FOR DRILLING r s o» WELL TYPE Ox DRILLED DDRIVEN ODUG OGRAVEL E] OTHER 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 NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST`VATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED O ON REAR OF THIS APPLICATION O ON SEPARATE SHEET ate) (signature) ✓der kdaUvwN 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 :/QUO ell Z 19 gr Date of Expiration: 19 Permit Issuing ficia Permit is Non - Transferrable White copy: H.D. File Yellow copy: Building Inspector Pink Copy: Owner 287 Orange copy: Well Driller DEPARTMENT OF HEALTH Division of.Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # �--� WELL LOCATION Street Address Town/Village/City Tax Grid Number WELL OWNER Name Mailing Address• r rivate b D Public USE F WELL 1 rimar 2 - 'secondary ARESIDENTIAL CI BUSINESS 13•INDUSTRIAL ®PUBLIC SUPPLY OAIR /COND /HEAT PUMP O FARM . O TEST /OBSERVATION CIINSTITUTIONAL O STAND -BY 13ABANDONED D OTHER (specify AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED /EST. OF DAILY USAGE gal REASON FOR DRILLING 0 NEW SUPPLY []PROVIDE ADDITIONAL SUPPLY O REPLACE EXISTING SUPPLY MEEPEN EXISTING WELL O TEST /OBSERVATION DETAILED REASON FOR DRILLING WELL TYPE ®DRILLED DRIVEN ®DUG []GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO 4 IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER.-WELL CONTRACTOR: NameM,'j_L Address: iV#M Aiia IS PUBLIC WATER SUPPLY AVAILABLE'TO SITE: YES X NO NAME OF PUBLIC WATER SUPPLY: '� TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:, LOCATION SKETCYON SOURCES OF CONTAMINATION PROVIDED REAR OF THIS APPLICATION (date) `Cs'. re) _a -... k _... PERMIT TO CONSTRUCT A WATER WELL'? 'tit This permit to construct one water well as set forth above i''s granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided"thi within thirfi "'(30) days of the completion of water well construction, the applicant shall: 4 y 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam w -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 Date of Expiration: 19 01 ermit Issuing Official White co • H D File Permit is Non - Transferrable 2/87 py. Yellow copy: Building Inspector Pink Copy: Owner Orange copy: Well Driller J4N- _a WELL COMYLETIUN KC;YUXr DEPARTMENT OF HEALTH "-Division Of Environmental `Health -Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only �- WELL LOCATION STREET ADDRESS: ?OWNIVIELAWLIC11Y TAX GRID NUMBER: 26 Newport Road, Patterson, NY WELL OWNER NAME Gerald Maloney, 26 Newport Rd... Patterson, NY o PUBLIC USE OF WELL 1 - primary 2 - secondary D\RESIDENTIAL ❑ PUBLIC SUPPLY O AIR /COND. /HEAT PUMP ❑ ABANDONED W USINESS ❑ FARM O TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY O MOUNT OF USE YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED 4 / EST. OF DAILY USAGE gal. REASON FOR DRILLING )E�WEPLACE EXISTING SUPPLY ❑TEST /OBSERVATION []ADDITIONAL SUPPLY nNEW SUPPLY (NEW DWELLING) []DEEPEN EXISTING WELL DEPTH DATA 305 WELL DEPTH ft. 125 STATIC WATER LEVEL ft. 10/7/93 I DATE MEASURED DRILLING EQUIPMENT ❑ ROTARY XQ COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED O OPEN END CASING )GU OPEN HOLE IN BEDROCK O OTHER CASING DETAILS TOTAL LENGTH _ fit. MATERIALS: STEEL O PLASTIC O OTHER LENGTH BELOW GRADE 4 ft. JOINTS: ❑ WELDED XjaTHREADED O OTHER DIAMETER 6 in. SEAL: EMENT GROUT ❑ BENT ONITE 0OTHER WEIGHT PER FOOT 19 — 1b./ft. DRIVE SHO YES .ONO I LINER: DYES ONO SCREEN DETAILS ..SECOND DIAMETER (in) SLOT SIZE LENGTH (It) DEPTH TO SCREEN (ft) DEVELOPED? FIRST O YES ONO HOURS _ _:.. __ .._ .... GRAVEL PACK OYES ❑ NO GRAVEL SIZE: DIAMETER OF PACK in. 70P DEPTH tL BOTTOM OEM It. WELL YIELD TEST If detailed pumping P P g METHOD: ❑ PUMPED tests were done is in- COMPRESSED AIR ; `formation attached? O BAILED O OTHER O YES ❑ NO If more detailed formation descriptions or sieve analyses VY CLL LOG are available, please attach. DEPTH FROM SURFACE 8 at�r ing well Dia- meter FORMATION DESCRIPTION coos It. It. WELL DEPTH It. DURATION hr. min. DRAWOOWN It. YIELD gpm. Surface TO SOl I & clay 5 305 ar aC & w i e granite 305 6 - 225 WATER XX CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? )((YES ONO ANALYSIS ATTACHED? )Q(YES O NO STORAGE TANK: TYPE D rom CAPACITY 62 GAI,. PUMP INFORMATION TYPE S�ixilE�sb 1 e CAPACITY Imo_ MAKER GOU DEPTH i n>= Imn i VOLTAGE .2� HP � WELL DRILLER NAME MiI L-L - DRILLING, ' /3 ADDRESS Putncm:Avenue SIGN Brewster, NY Ro I, I'I silent 9".* ` A� Co WrLL GU11rLL'11U1V ici_.rUAl Office Use Only DEPARTMENT OF HEALTH Division 'Of Environmental Health Services PUTNAM COUNTY DEPARTMENT OF HEALTH SiREEi ADDRESS: TOWNIVIL 1CIrT TAX GRID NUMBER: WELL LOCATION .26 Newport Patterson, NY WELL OWNER NAME: ADDRESS: Gerald Maw.. 26 Newport Rdaa Patterson.. NY PRIVATE o PueLlc USE OF WELL 1 - primary 2 - secondary )6RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP. ❑ ABANDONED' ❑-BUSINESS ❑ FARM ❑ TEST /OBSERVATION O OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY ❑ MOUNT OF USE YIELD�SOUGHT 5 gpm. /N0. PEOPLE SERVED / EST. OF DAILY. USAGE gal. REASON FOR DRILLING )REPLACE EXISTING SUPPLY ®TEST /OBSERVATION []ADDITIONAL SUPPLY []NEW SUPPLY (NEW DWELLING) ODEEPEN EXISTING,.WELL DEPTH DATA 305 WELL DEPTH ft. 125 STATIC WATER LEVEL ft. 10/7/93 DATE MEASURED 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 TOTAL LENGTH ^ ft. MATERIALS: STEEL ❑•PLASTIC O OTHER LENGTH BELOW GRADE ft. JOINTS: ❑ WELDED THREADED _ ❑ OTHER DETAILS DIAMETER 6 in. SEAL:)§WEMENT GROUT ❑ BENTONITE ❑OTHER WEIGHT PER FOOT 19 Ib. /ft. DRIVE.SHO YES O NO LINER :OYES ONO SCREE N._ DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST O YES ONO. . HOURS SECOND GRAVEL PACK 0 NO GRAVEL SIZE: DIAMETER OF PACK In: TOP DEPTH ft. BOTTOM DEPTH ft. WELL YIELD TEST It detailed pumping METHOD: ❑ PUMPED t tests were done is in- t COMPRESSED AIR , ! ormation attached? ❑ SAILED ❑ OTHER ' ❑ YES O NO ELL LOG it more detailed formation descriptions or sieve analyses are available; please attach. DEPTH FROM SURFACE Water Bear- ing wee We11 In FORMATION DESCRIPTION p0E ft. ft. WELL DEPTH It. DURATION hr. min. DRAWOOWN It. YIELD . 9Cm Land Surface 5 T of l clay 5 - ar MOCK e granite 305 305 6 m K$ CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS O COLORED ANALYZED? )=ES ONO ANALYSIS ATTACHED? XXYES ONO' 1 ,: ` STORAGE TANK: TYPE DI(lhr am- CAPACITY 62 GAS. l % "' =N PUMP I kHMATIOH TYPE sLtmrsible CAPACITY 1 MAKER DEPTH MODEL 1 ]' VOLTAGE HP .. WELL DRILLER NAME e D MILL DRILLINGo-INC� f IT l 9 ADDRESS PUtI1CtII AVenUe SIGNATURE ' f} ,. D�'ewster NY Robert Mod Mill, President 3/ ov PW ANALYSIS DATA SHEET LOCATION: Maloney REPORT TO: Mill Drilling ADDRESS: Putnam Ave. CITY, STATE, ZIP: Brewster, NY DATE COLLECTED: 10- -13 -93 TIME COLLECTED': 5:00 PM. COLLECTED BY: B. Mill. 10509 Total Coliform MF Ahscn( SM 17 (9215D)10 -14 -93 THIS SAMPLE AS RECEIVED AT THIS LABORATOPY MET THE REQUIREMENTS OF NEW YORK'iTATE DRIN KING WATER STANDARDS. ratory Director NEW YORK STATE ELAP CERTIFICATION NUMBER: 11218 618 CLOCK - rOWI.R ('( )MMONS I,' I I ', I I.I V,'' I I IN). NY I O ;OO /9 14 -:'18 -7000 / [-AX 91 4 -27fl 7 54