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Home My WebLink About1938DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36.23 -1 -67 BOX 17 him IN i 'a malls I ,Ni y . ,I!1; ' T .4 . r-�4 NN ML v DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT # WELL LOCATION Street Address Town Village Citp Tax Grid Number 12 Veterans Road Patterson, NY WELL OWNER AName Y nthon &Linda 'Mailing Address OPrivate Marinaccio 129 Veterans Rd. ,Pattersorppublic USE OF WELL 1 - primary 2 - secondary 9 RESIDENTIAL 0 BUSINESS O INDUSTRIAL O PUBLIC SUPPLY Q AIR /COND /HEAT PUMP D ABANDONED ,O FARM p TEST /OBSERVATION O OTHER (specify UINSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE SERVED /EST. OF DAILY USAGE _�aal, M REPLACE EXISTING SUPPLY O TEST /OBSERVATION Q ADDITIONAL SUPPLY 0 NEW SUPPLY NEW DWELLING 13 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING No Water. Well went dry WELL TYPE QDRILLED ODRIVEN []DUG GRAVEL Q OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name P .:F . Beal & Sons .Inc . Address:-- ARutnamAve.. _,.Brewster, N 279-2460 ±e5aq IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST -WATER MAIN: - - - LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED O ON SEPARATE SHEET 8/25193 b&ck / (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 thirt -y (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 de rade or otherwis�e-.aon- taurisiate surface or groundwater. Date of Issue • 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 r rt -- �n - CIA L r RV x - X� s �, _ g t : - - _ ...� � ---- -- - - v RECEIVED wt" L;vrLrL✓-u-LuL4 "rur"PUTNAM COUN DEPARTMENT & HEALTH? V. 14 EE i i ALTH SR eff i "1 10 PUTNAM COUNTY DEPARTMENT OF HEAL-W yoffice Use Only : CS 7. 58 WELL LOCATION STREET ADDRESS: 76WN1ft[G11CIIY TAX GRID NUMBER: 129A Veterans Rd. Patt6rs6n NY , WELL OWNER NAME: ADDRESS: Anthony/Linda Marinac"Cio, Same ❑ PBIVATE 0 PUBLIC USE OF WELL 1 - primary_ 2 - secondary (3 RESIDENTIAL 0 PUBLIC SUPPLY ❑ AIRICONDJHEAT PUMP 0 ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST./OBSERVATION 0 OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND-BY ❑ AMOUNT OF USE YIELD SOUGHT gpm./NO. PEOPLE SERVED EST. OF DAILY USAGE gal. REASON FOR DRILLING E]REPLACE EXISTING SUPPLY []TEST /OBSERVATION ❑ADDITIONAL SUPPLY E]NEW SUPPLY (NEW DWELLING) ❑DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 365 ft. I STATIC WATER LEVEL 20 ft.1 DATE MEASURED q-/27.193- DRILLING EQUIPMENT jU ROTARY EkCOMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER. (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING � OPEN HOLE IN BEDROCK 0 OTHER CASING -DETAILS. TOTAL LENGTH - fit. MATERIALS: 40cSTEEL 0 PLASTIC 0 OTHER LENGTH BELOW GRADE 32 ft. JOINTS: 0 WELDED 0qHRWED 0 OTHER DIAMETER in.- 'SEAU (il tEMENT GROUT 0 BENTONITE 00THER WEIGHT PEA FOOT 9 lb./It. DRIVE SHO EWES - ONO j LINER: 0 YES Q:N0 SCREEN DETAILS DIAMETER (in) SLOT SIZE LENGTH (11) DEPTH TO SCREEN (It) DEVELOPED? FrRST -0 YES ONO, POURS SECOND.- - GRAVEL PACK 0 YES ONO GRAVEL SIZE. DIAMETER OF PACK -- - In. TOP OEM -tL BOTTOM I DEPTH - It. WELL YIELD TEST If detailed pumping METHOD: ❑ PUMPED 11 tests were done is in- QVMPRESSED AIR iormation attached? 0 BAILED 0 OTHER ❑ YES 0 NO WELL LOG. more detailed formation descriptions or sieve analyses la l are available, please attach. DEPTH FROM SURFACE water peak- log Well Dia- meter FORMATION DESCRIFMN COE ft. . ft WELL OEM ft. DURATION hr. min. DRAWOOWN ft. YIELD gpm• 1.2nd Surface 8 Drill Ang in overburden clay & boullfe.rs Hi Ack I at 81 365 6 300 11 8 33 Dr I Iling in rock, set casing, grou ed. - 'A'A 'I A Dr,.j-'ULjg--Ji3 rock g-rRnjtP.- WATER 0 CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS 0 COLORED ANALYZED? 0 YES ONO ANALYSIS ATTACHED? 0 YES 0 NO STORAGE TANK: TYPE CAPACITY. GAT,. A PUMP INFORMATION TYPE gilbmersiblecApACITy 7 g Gould 3201 MAKER ld DEPTH MODEL 7EHO7412-VOL-TAGE230HP WELLDRILLERNAME P.F. Beal & Sons,I c. 5. 0 20/93 ADDRESS 4 Putnam Ave. SIGNATM Brewster, NY 10509 D9 j/tsy