HomeMy WebLinkAbout1377DOCUMENT CONVERSION SERVICES PROVIDED BY
IMAGING & MICROFILM ACCESS, INC.
www.scanyourdocs.com
631- 589 -8100
25.79 -1 -63 & 25.79 -1 -64
BOX 13
utrm
16
oil I
�jq
UL
MA
#j
:m'r,:yKt
i ioil,
01377
)O
*WELL COMPLETION REPORT
3/71
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of ,Environmental Health Services
COUNTY OFFICE BUILDING - CARMEL, NEW YORK
..- Thie;,report js _to bo; comple od,by.well.driller.alid subriiitted-•fa,C6unty He`Mtif DdiSaftmerit- together with `Iabor-ator'y ieport' of —
analysis of water sample indicating water is of satisfactory bacterial quality before certificate of construction compliance is issued.
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION
OWNER
NAME ADDRESS
Jean Daniels Haviland Drive Put. Lk. Patterson NY
LOCATION
(No. a Street) (Town) (Lot Number)
OF WELL
Haviland Drive Put. Lk. Patterson
PROPOSED
BUSINESS
DOMESTIC ❑ ESTABLISHMENT ❑
FARM TEST WELL
USE OF
WELL
❑ SUPPLY El INDUSTRIAL ❑ CONDITIONING ❑ (S(Specify)
DRILLING
EQUIPMENT
COMPRESSED CABLE
F] ROTARY L_� AIR ❑ O(Specify)
PERCUSSION PERCUSSION
UBLP:ASING
DETAILS
LENGTH (teat)
50' — 6tt
DIAMETER (inches)
WEiuHT PER FOOT
a ❑
D SHOE
G 7
OYES
SjJD
s „
6 tt & 411
17 THREADED WELDED
YES ❑ NO
L I NO
YIELD
TEST
HOURS G.P.M. YIELD (G.P.M.)
❑ BAILED ❑ ®
PUMPED COMPRESSED AIR L� 4 12 12
WATER
WATER
MEASURE FROM LAND SURF DURING YIELD TEST [feet)
LEVEL
Depth of Completed Well
20
265 in feet below Land surface: 265
MAKE LENGTH OPEN TO AQUIFER (feet)
SCREEN
DETAILS
SLOT SIZE
DIAMETER (Inches)
IF GRAVEL
Diameter of well including
GRAVEL SIZE (Inches) FROM (feet) TO (feet)
PACKED:
gravel pack (inches):
DEPTH FROM LAND SURFACE
FORMATION DESCRIPTION
Sketch exact location of well with distances, to at least
FEET to FEET
two permanent landmarks.
0
43
Soft sand & gravel.
R�S.a;:NTIA`
43
53
Hard granite.
_.... -53
- 56...
Soft..,,f ne. zand-� .. - - - - - - r
56
265
Medium -hard granite.
n `
_
/
YARN T
If yield was tested at different depths during drilling, list below
FEET
GALLONS PER MINUTE
��.1J It��ivlj ►bp".'fa
DATE WELL COMPLETED
DATE OF REPORT
WELL DRILLER (Signature)
11/10/77
12/15/7 7
MIL DRILL G,
t
WATER ANALYSIS REPORT
SAMPLE PTO. 3985
SOURCE: Jean Daniels well supply
Haviland Drive
Putnam Lake, Patterson, N.Y.
COLLECTED: November 10, 19.77
BY: Mill Drilling, Inc.
BACTERIOLOGICAL EaCAMWAnOK
CoHform Count, MF Method
0 per 100 ml.
This result
indicates the
source -of
the sample was
of satisfactory sanitary
quality when
the sample
was collected.
L
November 15, 1977
tu�fBickwit P. E.