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35. -5 -47
BOX 16
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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