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HomeMy WebLinkAbout1823DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 35. -5 -47 BOX 16 .� - .. I L � T � 01823 R e t re a ti a i PUTNAM COUNTY DEPARTMENT OF HEALTH 3 ' i DIVISION OF ENVIRONMENTAL HEALTH SERVICES ZOP AP#� -2 Pik 2:59 we��'Permt #, M WELL COMPLETION REPORT Well Location Street Address: 2096 Route 22 TownNillage: Patterson Tax Map # Map 35. Block -5 Lot(s) -47 GPS 41027'13.7N 073034'35.3W Well Owner: Name: Address: Peter Cipriano, 1671 Front Street, East Meadow, NY 11554 Use of Well: 1- Primary 2- Secondary X Residential _Public Supply Air cond /heat pump _Irrigation Business Farm I Test/monitoring —Other(specify) Industrial Institutional Standby Drilling Equipment XRotary _Cable percussion X Compressed air percussion_Other(specify) Well Type _Screened _Open end casing X Open hole in bedrock _Other Casing Details Total Length 72 ft. Length below grade7l ft. Diameter 6 in. Weight per foot 19lb /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 57 Diameter (in) Slot Size Length (ft) Dept to Screen (ft) Developed? Screen Details First _Yes _No Second Hours Well Yield Test Bailed X Pumped X Compressed Air Hours _6 Yield 22+ gpm Depth Date Measure from land surface-static (specify 50' During yield test () 665' 77705' p eted wel in ft. 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.... Dr i I. . -. �,,.'. - Hit rock at 571 57 72 ri ling in ro k set casiLaR, grouted 72 705 Drillin2 in it ylew was testea at different depths during drilling list: Per Minute rum Pump Type _ Depth Voltage Tank Tvoe Tank Information Capacity Model HP Volume NOTE: Exact Location of well with distances to at least two permanent landmarks to be provided on a separate sheet/plan. White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 Rev. 3106