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01556
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
WELL- COMPLETION REPORT
WeILLocation -77
Street Address: -
Victorian Heights, Lot #4
Town/Village:
Brewster
Tax Grid# '--
Map Y Block Lot(s) W/o
Well Owner:
Name: Address:
HYH Associates, 12. Old Forge Road, Greenwich, CT 06830
Use of Well:
1- primary
2- secondary
X Residential Public Supply Air cond/heat pump Irrigation
Business Farm Test/monitoring Other(specify)
Industrial Institutional Standby
Drilling Equipment
X Rotary Cable percussion X Compressed air percussion Other (specify)
Well Type
Screened Open end casing X Open hole in bedrock _ Other
Casing Details
Total length 32 ft.
Length below grade 31 ft.
Diameter .. -... 6 in.
Weight per f6ot 19 lb /ft.
Materials: X Steel Plastic. Other
Joints: _ Welded X Threaded _ Other
Seal:. X Cement grout _ Bentonite_ Other -
Drive shoe: X Yes No
Liner: Yes X No
Screen Details
Diameter (in)
Slot Size
Length(ft)
Depth to Screen (ft)
Developed ?'
First
-.Yes-No
Hours
Second
Well Yield Test
_ Bailed __L Pumped X Compressed Air _
Hours 6"
Yield 20 gpm
Depth Data
Measure from land surface- static (specify ft)
60'
During yield test(ft)
265'
Depth of completed well in feet
305'
Well Log
If more detailed
information
descriptions or
sieve analyses
are available,
please attach.
Depth From
Surface
Water
Bearing
Well
Diameter(in)
Formation
Description
ft.
ft.
Land Surface
10
Drilling
in overburden
clay and boulders
Hit rock
at 10'
---
10
32
Drilling
in rock,
set casing,-grouted
32
305
Drilling
in rock
Fq
granite'
If yield was tested
at different depths,
durin g drilling,
�
list:
Feet
Gallons Per Minute
Pump /Storage Tank InformatIM .�
Pump Type Capacity _ cn
De th Model
p
Voltage HP
Tank Type Volume
Date Well Completed
5/10/04
Putnam County Certification No.
004
Date of Report
4/26/05
Well Driller (signature)
Matthew L. Beal
i ,qv i z. rxact iocatnon of weir wttn atstances to at Least two permanent lanamarxs to oe proviaea on a separate sneevplan.
Well Driller's Name P. F. Beal & Sqns, Inc. Address: 4 Putnam Ave.. Brewster,NY 10509
Signature: l✓ Date: 4/26/05
Matthew L. Bea .
White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WC -97
MrA
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