The URL can be used to link to this page

Home My WebLink About1453DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 34. -2 -41 BOX 13 Is r ` ��' oil- . 1 ■,� I me ir t ` 'Z 1 � Z I I ar:' 4� �,� ' �- 01453 f' PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES zkl.. J L) YL SITE LOCATION OWNER'S NAME MAILING ADDRESS OFFICIAL USE ONLY TO TM# lf L- -� 3 % : _ a �T Z ,vo C- a. ID PHONE ; S_S 10 PERSON INTERVIEWED PCHD Complaint # ame & Relationsaip i.e., owner, tenant, etc. DATE 01 TYPE FACILITY PROPOSED INSTALLER 11- cA, PHONE ADDRESS REGISTRATION# 1 Proposal (include 7sketch locating all adjacent wells): NOTE: Repair must be in same location and of same type as original sewage disposal system .Different location I, as owner,- Or, report 1d agent of owner agree to the conditions stated on this form: SIGNATURE ZL TITLE erfroi(L' %A DATE I L0-1 ProTaQproved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name b. Site Street.=Name, Town and Tax Map number. C. Location of installed components tied to two fixed points (e.g.,house cornea d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6'd e. Installers' name and number. 3. System repair to be performed in accordance with the above proposal and conditioi Proposal approved Inspector's Signature & Title COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99ML l DATE �'X 6' deep j ti Gc qz"D -1-0-7 /v i,Fe 'r LOW F r LADAMS, INC. C, A), -� 610 Route. 292 Holmes, N.Y. 12531 SS i (845- 855 -3733) el jRgJ/ La, 3k- � � /05) t' i 3 � j i ' S ` . , ag Tax Block L't Date Pernift �/` PL lipply ply Number of Bedrdo a as listed serving the Abov'e pre�i werp,coristr6ctid isdaritiall -as shown 6n-tfi' hs of-tlie coiipleted work copies ate bate -Title AA- I.—Q a- WELL UUr1rLr."11U1v mr:runi ,E DEPARTMENT OF HEALTH - Division Of Environmental' - Hg- &lt$"SaYv'tC�es' PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL LOCATION STREET ADDRESS: WNW I // -- TAX GRID NUMBER: CO Jennifer Lane Patterson, NY T WELL OWNER NAME: ADDRESS: Carl /Nancy Gallo c/o Metro Modular,l8CA.lpine Dr.,Wapp.F ❑ PRIVATE PUBLIC USE OF WELL 1 - primary 2 - secondary -n RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /CONC. /HEAT PUMP ❑ ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR DRILLING []REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION ❑ADDITIONAL SUPPLY .0NEW SUPPLY (NEW DWELLING) [:]DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 2501 ft. STATIC WATER LEVEL --20—' ft. DATE MEASURED 10/29/93 DRILLING EQUIPMENT t ROTARY .0 COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING M OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS TOTAL LENGTH 51 it MATERIALS: 0 STEEL ❑ PLASTIC ❑ OTHER LENGTH BELOW GRADE 50 ft. JOINTS. ❑ WELDED C2[THREADED ❑ OTHER DIAMETER 6 in. SEAL::0 CEMENT GROUT O BENTONITE ❑OTHER WEIGHT PER FOOT 19 Ib. /ft. I DRIVE SHOE M YES ❑ NO I LINER: G YES .M NO SCREEN DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? DETAILS �.._.... _... ... , . FIRST 0 YES ❑ NO HOUflS ��_ _SECON D ,.. .... _ .. ... .._... _... .._ .. GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE; DIAMETER I OF PACK in. TOP DEPTH ft. BOTTOM DEPTH ft. WELL YIELD TEST If detailed pumping METHOD: ❑ PUMPED i tests were done is in- � JM COMPRESSED AIR , ! ormation attached? ❑ BAILED ❑ OTHER i ❑ YES ❑ NO WELL LOG It more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE Witef Bear- ing Well Ora- meter FORMATION DESCRIPTION p0e ft ft WELL DEPTH ft. DURATION hr. min. DRAWOOWN ft. YIELD gym. Lom e li in overburden clay & bould rs it ro k at 35' 250 6 200 8 35 51 Drilliag in rock, set casing, grout d. 51 250 Drilliag in rock granite. WATER ❑ CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS ❑ COLORED ANALYZED? ❑ YES ❑ NO ANALYSIS ATTACHED? ❑ YES 0 N STORAGE TANK: TYPE Well Xtrol 302 CAPACITY 86 GATT -1 PUMP INFORMATION TYPE submersible CAPACITY 79• MAKER Gould DEPTH 220 MODEL 7EHO5 412 VOLTAGL2� HP _2__ WELL DRILLER NAME Mr. Beal on n T'1/2 4 ADDRESS 4 Putnam Ave. SIGNATU Brewster, NY 10509 ' j 1 pUTNAm COUNTY DEPARTMENT OF HEALTH DIVISION .OF ENVIR.ONMENTAL..HEALTH SERVICES - :- 4uor Purchaser o-."-- Building Section Block Lot Building Constructed by Location - Street -J Municipality Buil i.ng Type IZ' Subdivision Name Subdivision Lot # GCARANTEE OF SUBSURFACE SEWAGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, materiEL1, construction and drainage of the sewage disposal system serving the above described property, and that it has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns,. to place in good operating condition any part of said system constructed by me which fails to operate for a periai of two years immediately following the date of approval of the ate .of ompliance for -- the -- sewage disposal systen-,- -or-a y ia repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environinental Health Services of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the buiXdi� itilizing the system. • Dated this day of 191- 1 s General-,"Contractor (Owner) - Signature Corporation Name (if Corp.) Address rev. 9/85 mk Signature Title C>-o'i 4-1 Corporation Name (if Corp.) Address PUTNAM COUNTS DEPARTMENT --F EALTH 1 NO. 584 -93 -19 COMPLAINT GR SERVICE REQUEST cECOR �-,' :owrr'r'� 1TTE#tS(J� �T kKEN By BH TELEPHONE CALL X IN PERSON LETTER CONFIDENTIAL REQUEST FROM Mrs. Pompa TELEPHONE 225 -7440 or 7446 ADDRESS Jennifer Lane, Patterson ENVIRONMENTAL HEALTH: Home Sewage Rodents Refuse Public Water Food Service Migrant Camp Other COMPLAINT OR REQUEST New house next to Pampa has been graded X so that water drains onto Pompa's lot. Fair St. to Highview to Jennifer, Windsor Oaks RS. ACTION TAKEN BY FINDINGS c FOLLOW UP INSPE( I- EUN l S) FINDINGS f >Z�'G >y DATE FINDINGS (\`7 ir PROBLEM �ABATED DATE /�/ C1 _ PERSON NOTIFIED 77 cy v DATE ny ✓ L r� ESTIMATED TOTAL MAN HOURS SPENT zmiww � ' ' Zb Do o DEPARTMENT OF HEALTH ° Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT #'3Z WELL LOCATION Street Address Town/Village/City Tax Grid Number WELL OWNER Name Mailing Address rivate O Public USE OF WELL primary - secondary RESIDENTIAL O BUSINESS ® INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED O FARM O TEST /OBSERVATION O OTHER (specify b INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT SERVED_ 45 EST. OF DAILY USAGE 4$� Sal O REPLACE EXISTING SUPPLY O TEST/ OBSERVATION 13. ADDITIONAL SUPPLY WATEW SUPP Y (NEW PWkLLING) 0 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DRILLED ❑DRIVEN ®DUG ®GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES t/ NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name "'[":V Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES t.�NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO - PROPERTY FROM NEAREST WATER- MAhN,: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED N SEPARATE SHEET (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 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. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: 6 19� ---�' Date of Expiration 19 %- Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller P I� s r PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date %/7 Re: Property of_ r Located at_zn j d 1 ' (T _:f) A Section S 4a- Block 2 Lot 4-' Subdivision of Subdv. Lot A`- S -5 Filed Map # LL94- Date Gentlemen • T. MICHAEL DALY, P.E. CONSULTING ENGINEER This letter is to authorize P. O. BOX 243 EpT/A aaeDn , jogs? a duly licensed professional engineer or registered architect (Indicate to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by.the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, Signed,%` ! �� Countersigne 011,41- Own r of roperty of P.E., R.A. , # "Y �'zy�d Address T. MICHAEL DALY, P.E. Address CONSULTING ENGINEER P. (). BOX 243 SHEENOROCK, N. Y. 1058877% Telephone Town '7/ Y �-? !a V --y 3 3 6 Telephone 4. -f. 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+ T 67 Village City Tax -rz-��, A_j Grid Numb r (� -) - t 4�L3 WELL OWNER Name Log I Mai ing Address mm CWrivate AJ %j 0 Public USE OF. WELL 1 - primary 2 - secondary ® SILENTIAL ® BUSINESS ® INDUf,TRIAL O PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION b INSTITUTIONAL O STAND -BY ❑ ABANDONED O OTHER (specify AMOUNT OF USE YIELU SOUGHT �j� gpm /# PEOPLE SERVED 4 /EST. OF DAILY USAGE 45-6 gal REASON FOR DRILLING UREW SUPPLY ❑REPLIXE EX STING S PPLY O PROVIDE ADDITIONAL SUPPLY ®DEEPEN EXISTING WELL O TEST /OBSERVATION DETAILED REASON FOR DRILLING v WELL TYPE RIL:LED . 1:1 DRIVEN DDUG ®GRAVEL ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES /N0 IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: T-4, (e— T Uw, >,d Lot No. oL3 WATER WELL CONTRACTOR:. Name (_i3,� Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY ADISTANCE TOPROPERTY FROM-NEAREST'WATER- MAINi'- LOCATION SKETCH & SOURCE:; OF CONTAMINATION PROVIDED ON REAR OF THIS APPLICATION S 2v mil. (date) (si nature 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 z, Well Completion Report on a form provided by the Putnam County .Health Department. Date of Issue :. _-2G 19 - Date of Ex ation; 19 f ermit ssui f icia White copy: H.D. File Permit is Non- Transferrable Yellow copy: Building Inspector Pink Copy : 2/87 Orange copy APPEIDDI B PUI -MMM CC'TJ -N 'Y DEP_ cRIV= OF HEALTH DIVISIO OF EN=O 'AL HEA.LTfi S�VICFS / INDI4T�tm r, WATER SUPPLY & S'JBSLItF?� Ste' gA.CE DISFCEdL SYSTEMS _ REVr- �Try - .CGNSTP=ION P�iMST DATL RE' V —, vim �� (curie of CwreT) (Street Lecaticn) C- S YES NO DCCiR,= I I Permit Amplicaticn I Corporate Resolution Plans - Three s`ts s/s Engineers Authorization Design rat-- Sheet (D -) SurDNrSiCN --i- I Dec Hole Log p_rc Crnsiste -ht Perc Res,,:!, tS (3) Fill I fi- I Ps--c Hole Dept_n c� LF tench provided 7 60 ft. to ccntour� 100; eye. SYSTE4S cl vcarrier 10 fill of= -s new sa _. 100 yr. flood eley.A(l- s 200 ft. rose- -voi=, etc. 150 ft. tricall /call. -I—' House Plans - 'rvo set; -1-- pe_':ni _; Prv~� letter_ daieRe ques t IC --- —4AL Leal Surdivi sicn Si ccivnsicn Approval C.ec�f I Es-= ncrcval SSDS Adj. Lots C':ec:cei Wfet-E :d (TCW -n /DEC Psrmi t R & D) "r �f Dot Cn DCS P? erns & P: Ii = SaE I RE4L� D=--, I c CN PT � VS II sewaage SJSt`n Flan - (nor-,-z a=ra ) T I S..vace S s `en r_rcraulic P_otiL- - G_av F' •'of i le & D u mens_cns - Voles -� - i� J ;Trench /Gallery -; arrp pi= de---: is 4-1 I - e—mtic Tank - Size, Ceta l l Well Detail, Service Line if over C:nst_- action Notes (cringer rats) 1 y Design. Data: per- and: deep..reGl`U- Two-Foot Contours 1:ci sting & P_;;ccsed Driveway & Slopes Cut I.._ Footing�Gatter,Curtain Drains (discharge OK) Perc & Deep Holes Lccated Representative of primary and e cansicn Expansion Asea; shown; gravity f1as, s,if_ . size Fumed Pit & D Box & Detailed House - No. of Bedr Wells & SSOS's Win 20 . of r oposed Slst: Property Metes & Bounds House Setback Necessary (Tight lot) House Sater - 1 /4 " /ft. 4"0; Tyce pipe r No Bend; Max. Bends 450 w /clez —rout SEP R- A -'ION DISUUNCES Sp'-PCT-P=D CN PL »i Fields 10' to P.L., Driveway, Large Treesjoo of f 20' to Foundation Walls 100' to Well; 200' in D.L.O.D, 150' pig 100' to Stream, Water course, Laka..(inc. err 15' to Drains- -Curta i z, La--der, Footing If 35'to match ) sin,stor_Tdrain,Diced watercat 10' to Seater Line (pits -20' ) 50' inte— rmittent drainage course Sentic tanks 10' fran Foundation; 50' to well 15' Well to PL 9 '. PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmental Health Services _.., .._ _.. AFr.LDAVIT;,. COP .�ORATE, dWNER APPLICATION ...... - _ -. FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT TO: Commissioner of Health In the matter of application for. /v Z represent that II am an officer or employee of the corporation and am authorized to act for N,i { L Svc -i�E (Name of //Corporation) having offices at �% A 04 Whose officers are: President : Vii' (Name and Address) Vice— President. j¢�jnGyie.2 (Name and Address Secretarv: _ .. (.N,am.e -and .Ad.dress -) Treasurer: (Name and Address) and that I am and wi11 :)e individually responsible for any and-all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Sworn to before me this day Signed: of 19 Title: Notary Public Corporate Seal 8/34 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY', OFFICE BUILDING; - -CARMEL; N. -'Y.' .-- 10512 - DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL*SYSTEM FILE NO. Owner �LOaj jAt� Address 4 S_ m4�✓ S! ov_- Located at (Street Si ez 76 Block ( Lot ( 2 indicate neares cross street) Municipality L `f Watershed ly l I DDL , 1jci SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole 06 19 Number CLOCK TIME-j/= PERCOLATION - PERCOLATION Run apse Depth to water water Level No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches i 1 O— _30 '30 31Q 34( ►? 2 ° — _T e) 13 c7 - -- - -- -- 1-9 zit `/, f f /a 20 1 3 G - ,qa 06 19 4 u _ C,y C1 19 5 y 1 2 3 4 5 �TO�w,4T�1.1 Notes: 1) Tests to be repeated at same depth until approximately equal soil rates are obtained at each percolation test hole. All data to be submitted for review. 2) Depth measurements to be made from top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES _ . _... DEPTH HOLE NO . F HOLE ' NO . HOLE NO. G.L. 611 r 1211 18" 24" 3011 f 3611 42" 48" 1� 54 of l l 6011 : 661. 70' q 84" _ 'INDICATE LEVEL° A7' WHICH GROUND WATER IS ENCOUNTERED d t/t Z INDICATE-LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED TESTS-MADE-BY- _ _.... _ ... :. - -._... Date_. �... - DESIGN Soil Rate Used ;• irVj "Drop: S.D. Usable Area Provided (Saavc%y No. of Bedrooms Septic Tank Capacity Gals. Type Absorption Area l'rov de By,_&� 'Z L. F. x24" -36- th rent . -� ��n�e er Tame - Address ure ar THIS SPACE FOR Ut3E BY HEALTH DEPARTMENT ONLY: °o Soil Rate Approved Sq. Ft /Cal. Checked Date_ PUTNAM COUNTY DEPARTMENT OF HEALTH - D. IVISION- .- OF__ ENVIRONMENTAL. .HEALTH.. SI;RVIGES.. <.,- Date %lio G-7 1 9� Re: Property of ►L-COnll&�' G Located at p (T) ��-;� Sa man '% �o Block 1 Lo , Subdivision of �� T. c:3'�J QA.) Subdv. Lot Filed Map # ?, 4'- Date Gentlemen: This letter is to authorize i�11/I.Lj,�re'a a duly licensed professional engineer -.---Or registered architect (Indicate .to apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to, supervisethe construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Very truly yours, Signed ,�yO-+wn of Property C Countersign d: v c,A.// P. E. , R. A. , # Address r/;k L Addres Telephone Aj L, y Town f f V - Z7 zz..P Telephone once `of the approval_of the Certdicate -,of Constructiod Com . will be loeated`Gs shodvn'on the approved plan and that said iii County Depart ent of laaalt%h' Date. `� D 5 Address �� '� -T APPROVED FOR,CONSTRl1CT.10N This approval. sxpves two revoceble for cbuse:or may be amendetl ordmotl�Uetl' when cor su required a' new permit.. Approved for disposal of'domeslkf sa 1/87 Date v ��•��i BY of the original system orilny repeira th to 2) that,the drilled wets aespitied above a be installed;.in acco[danee: with the n r s ' rul and;,regulations _Of ' the :'Putnam v`QA.- i: ; License. No s'from the',date issued unless construction `oOhe tiuitding has.,been .undertaken, antl is d necessary,by the, Commissioner of ",Health ' Any. change or alteration ,oi, construction ry'sewage ';anal or . "water supply only.' r�b- Loretta Molinari, P-N., BSN John KareU Jr., P.E-, M.S. Director of Patient Services Public Heaith Director DEPARTMENT OF HEAL Division of Nursing Servicts Geneva Road Brewster, New York 10509 914-278-6558 FAX COVER _SHEET DATE: TO: FROM: Putnam County Health Department Nursing Services & Home -Care Agency Geneva Road, Terravest Corp. Park Brewster, New York 10509 Attention: Number of pages to be transmit-ted (including cover sheet) ES NOTES 1MESSAGI ___ _' - -_ OUR FAI*I'\' NUMBER IS 9-14-9-78--6085 I n h e ev e n o t ra n S m s iJi 41 Ce contact our OT T_ - 91a-2 _78 _� 5::: 8 WELL COMPLETION REFUK'-C HEALTH,. 2F i� Y oar Division Of Environmental Healrh Services PUTNAM COUNTY 'DEPARTMENT OF HEALTH office Use Only WELL LOCATION STREET AOURESS: Jennifer Lane TAX GRID NU►AHER: Patterson, -NY WELL OWNER NAME. Carl/Nancy Gallo ADDRESS: c/o Metro Modular,18CAjpine Dr. ,Wapp.F PijIVATE PUBLIC USE OF WELL 1 - primary 2 - secondary �n RESIDENTIAL ❑ PUBLIC SUPPLY 0 AIR /COND. /HEAT PUMP 0 ABANDONED ❑ BUSINESS - ❑ FARM 0 TEST /OBSERVATION 0 OTHER (specify) C1 INDUSTRIAL 0 INSTITUTIONAL ❑ STAND-BY ❑ AMOUNT OF USE YIELD SOUGHT — gpm./NO. PEOPLE SERVED / EST. OF DAILY. USAGE — gal. REASON FOR DRILLING ❑REPLACE EXISTING SUPPLY ❑TEST/OBSERVATION ❑ADDITIONAL SUPPLY nNEW SUPPLY (NEW DWELLING) [:]DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 250 f ft. STATIC WATER LEVEL ---20—' ft. DATE MEASURED 10/29/93 DRILLING EQUIPMENT ROTARY 0 COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING 91 OPEN HOLE IN BEDROCK 0 OTHER TOTAL LENGTH 51 ft MATERIALS: IN STEEL ❑ PLASTIC 0 OTHER CASING DETAILS LENGTH. BELOW GRADE ___--50 ft. JOINTS: OWELDED [THREADED OffHER DIAMETER 6 in. SEAL: ZI CEMENT GROUT 08ENTONITE OOTHER WEIGHT PER FOOT 19 Ib./ft- I DRIVE SHOE- 99 YES 0 NO LINER: Q YES t NO SCREEN DETAILS - DIAMETER (in) SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? FIRST l 0 YES ONO HOURS'- SECOND GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE: DIAMETER OF PACK — in. TOP DEPTH —ft. BOTTOM OEM — e' pumping WELL YIELD TEST If detailed pumping test e were done in- METHOD: ❑ PUMPED i tests were done is in- ormation attached? )a COMPRESSED AIR s f 0 BAILED ❑ OTHER 0 YES ❑ NO p It more detailed formation descriptions or sieve analyses WELL LOG are available, please attach. W DEPTH FROM 02�T� SURFACE. F ""'r Bear- inq Wtil oia- meter In FORMATION DESCRIPTION CODE ft. ft. WELL DEPTH ft. DURATION hr. min. WOO,,V DRAWOOWN It. YIELD 9prn• Land surl2ce 35 Drilli-ig in overburden clay & bould rs �itjrofk at 35' 250 6 200 8 35 51 )rilliag in rock, set casing, grout d. 51 250 Drilliag in rock granite. WATER 0 CLEAR TEMP. �_ � �L�� QUALITY ❑ CLOUDY HARDNESS ❑ COLORED ANALYZED? ❑ YES ONO ANALYSIS ATTACHED? 0 YES ❑ NO STORAGE TANK: TYPE Well Xtr ol 302 CAPACITY 86 GAL/ PUMP INFORMATION TYPE submersible CAPACITY 79. MAKER ----f1Q1LLLt— DEPTH MODEL YEH05Al2 VOLTAGen-2—Ohl' —,A WELL DRILLER NAME ea TE1/2 94 4 Putnam Ave. Z AODRESS SIGUATURE , -` / ' Brewster, NY 10509 -.;I C a NORTH AMERICAN LABORATORIES, INC. ANALYSIS DATA SHEET J TYPE: PW LOCATION: 23 Jennifer Lane, Carmel, NY REPORT TO: Patrick McDonagh .ADDRESS: 18C Alpine Dr. CITY, STATE, ZIP: Wappingers Falls, NY 12590 DATE COLLECTED: 02 -07 -94 TIME COLLECTED: 11:30 COLLECTED BY: Patrick McDonagh REPORT DATE: 02 -10 -94 LAB # ; 94 -0588 SAMPLE •SOURCE : Kitchen tap DATE ANALYSIS RESULT UNITS METHOD ANALYZED Total Coliform Absent COLILERT 02 -07 -94 THIS SAMPLE AS ECEIIl- ED AT THIS LABORATORY ME't THE REQUIRE)tifE TS UF,�IVEW YO1�I�STATE DRINKINGWATER STANDARDS. Laboratory Director NEW YORK STATE ELAP CERTIFICATION NUMBER: 11218 0 18 CLOCK 'I OVVL:I: COMMONS, R IT 22, 6RE�%'STER, NY 10,509 / 914-278-7600 / FAX 914 -276 -7754 2g5b! oQ _� 1n Z Z �' N7, 77 { *, MW Afi s s� c, yRt r* j , +� trY s �.,y ,„ a " PAZ 7. fast . s a �5.xg 5 Y � ^• -�' " a � d '15 rsi sF � ^,, ah ,� y � .moo - �.`"',^4. ;? � ra ,�,�x;�ys s 's *s� a � � ✓:�s„� 's� � .,, Y 1r - Ry teal W 1W-XAW- V i+ 's F Ajuv. tt E- >PAY s W a r gam; Ft� t :.' et: 4; NOW air rs A MAN 4&A r 4;;y '� b Ea s'"' '°j v e ?icc �. ';� e ' x • -'47ro f k 4 �.#., ti ' ,,3,*r .t,*Et` &" 4,r tQ ; ,�:.. r f wr ? { ,,., rt .,,�x. :,,w`� 'PFn r�r,. <�; a ..M n #.?`Fm - ,� .�rrtr.S x Y 5 is gE3S;a ,,s Ah ^iF^.^, zk- We 0 z f M �•-,� ...t.., .ir` S Tz "-, yc ..k v xa u. WI k�n SOV. Zoe J, x v" ,,r r r r- Ya''.6r `` '^ '• ,5c`uw" ' �a < 5�t° - r;` ' '' '• kY x o-,,�Gtrt a�3 �r� 6+ t ?, ': ,! r , .ro-.c,�' n s.., ,'y- r..."ad ,1.e x'e ^tc r,r Wma r Z +K'sy, s k. 3.• -� } -i b . - -8 s d i r u G� a, w x ;:.'^G �, .r : .w w. K. J "F�.� y .t f t E -t �y 1 e�e Fi k.."xs. '''� 'S L,iAG i"� i gk } �,� 4�,P. F t 1 r i,i'.' c nos. �' r. r- ". '. v ' " x $ ��..r ^" rx:, - . �- s i' r b} d r` r i 1 r f „% r h In .r ' amS PIK F :r �.•m�,� t �a JTM .,r '` €Z bra � .FYI r,`'Y -sue .� ,y� '�. l�f °` �'� '.��.� �� V . ? Jr WK tv= SUM low remit °as kS t a r�` D' .♦` rC. ^� +' _k, two -.. 00"— f #.r r •�i ,� �._ J t r+.G -" N�*� r -,�,s. nT � �� 'Y 'e�s� ��,.A... =..„: 'r s'- +ac -ten- 4�' 3`�'rr�y.� " `�.w�.:it+�^r�'+�E�,�r''a°''?�, 'yy�� .7z�,n'r �,�• Y €'€`.�