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36.31 -1 -56
BOX 18
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01975
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PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
WELL COMPLETION REPORT .. W- 103 -97
Well Location
Street Address:
89 Hav it and Drive
Town/Village:
Patterson, NY
Tax Grid # 36.31-1-56
Map Block Lot(s)
Well Owner:
Name: Address:
Ralph Burdick Milltown Rd., Brewster, NY 36.31 -1 -56
Use of Well:
1- primary
2- secondary
XX Residential Public Supply Air cond/heat pump Irrigation
XX Business Farm Test/monitoring Other(specify)
Industrial Institutional Standby
Drilling Equipment
Rotary Cable percussion XX Compressed air percussion Other (specify)
Well Type
Screened Open end casing XX Open hole in bedrock _ Other
Casing Details
Total length -r— ft.
Length below grade ft.
Diameter �in.
Weight per foot lb /ft.
Materials: XX Steel _ Plastic _ Other
Joints: _ Welded xx Threaded — Other
Seal: _ Cement grout — Bentonite _ Other
Drive shoe: _ Yes _ No
Liner:_ Yes _ No
Screen Details
- Diameter (in)
Slot Size
Length(ft)
Depth to Screen (ft)
Developed?
First
_ Yes No
Hours
Second
Well Yield Test
_Bailed _ Pumped . xx Compressed Air
Hours 6
Yield .1 0_ gpm
Depth Data
Measure from land surface- static (specify ft)
40
During yield test(ft)
400
Depth of completed well in feet
550
Well Log
If more detailed
information
descriptions or
sieveanalyses
are available,
please attach.
Depth From
Surface
Water.
Bearing
Well
Diameter(in)
Formation
Description
ft.
ft.
Land Surface
185 to
500
Hard black granite
- -- ._ ..:
_. _ .._ . __
.... _. - . `. _ .
....- -.._
..._. i ._ _ _ __ .._. _..... _ ._.._..._ -7-
If yield was tested
at different depths
during drilling,
list:
Feet
Gallons Per Minute
Pump /Storage Tank Information
485
8
Pump Type submer- Capacity 10 GPM
Depth 42n, si bl a Model 10r, 15412
Voltage 230 HP 1 z
Tank Type di aphrag�Rolume 86
550
10
Date Well Completed
12/10/97
Putnam County Certification No.
3
Date of Report
12/1.1/97
Well Dril gnah II�
W&
NOTE: Exact location of well with aismances to at [east two perrriarioira rauuiiiaina L., VGrVI I"-- �•• ��r-•-•� �•• - - -r -
DRILLI , INC. Address:PUTNAM. AVE„ BREWST.ER, NY
Well Driller's N r
Signature: Date:
White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WC -97
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NORTHEAST LA Q P-,ATC)RY of� DANBURY
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PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES: REbg:LL''
- APPILIC.A.T)<QN TO CONSTRUCT A WATER -WELL
.,- ,.._......_.......,.._...,�.
please print or type --._. w_._._...... �......._.,.....,..._ �_......._.,..._�PCHDPermit _V �� .�:....x�.,___......
Well Location:
Street Address: Town/Village Tax Grid # 36.31 -1 -56
Haviland Drive Patterson, NY Map Block Lot(s)
Well Owner:
Name:
Address:
Ralph Burdick
Milltown Rd „ Brewster, NY
Us _ -
xx Residential Public Supply Air /Cond/Heat Pump Irrigation
I- primary
xx Business Farm Test/Monitoring Other (specify)
2- secondary
Industrial Institutional Standby
Amount of Use .
Yield Sought gpm # People Served 4 Est. of Daily Usage _____gal.
Reason for
Replace Existing Supply Test/Observation Additional Supply
Drilling
New Supply (new dwelling) xx Deepen Existing Well
Detailed Reason
Shallow drilled well has very.,1 ow. ,yi el do They run out
of water every da Y _ er' e Y ei:
for Drilling
Well Type
Drilled Driven Gravel Other
Is well site subject to flooding? ................................................. ............................... Yes No XX
Is well located in a realty subdivision? xx
.................:.................... ............................... Yes No
Name of subdivision n/a Lot No.
Water Well Contractor: MILT. DRILLING, INC, Address: PUTNAM AVE,, BREWSTER, NY
Is Public Water Supply available to site? . xx
................................. ............................... Yes No
Name of Public Water Supply: n. /a Town/Village
Distance to property from nearest water main: n/a
Proposed well location & sources of contamination to be ledon s parate sheet/plan.
-- _
Date: ? -� - ° -Applicant Signature: -
e t A. 911 r� 6esri dent
PERMIT TO CONSTRUCT A WATER WELL
This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the
Putnam County Sanitary Code and 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 or their designated
representative 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. 3) Submit a Well Completion Report on a form
provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or
well driller shall take appropriate action to assure that any and all water and 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.
APPROVED .FOR CONSTRUCTION: This approval expires two years from the date issued unless
construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be
amended or modified when considered necessary by the Public Health Director. Any revision or alteration
of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam
County.
Date of Issue Permit Iss ' g ffici :
Date of Expiration i Title:
Permit is Non - Transferrable
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WP -97
53rD° 27 30 "►✓ 74,47 "tP- =y3t)4'9
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Structure located from survey by surveyor noted below —_ — — - -- _
Well located by: Surveyors survey.— _— ❑_ __ - -- _ __
Well drillers report
Engineers mesurementsm`
Tank, boxes, pit &, galleries a laterals located by:Contioctor:
Engivnesr_ ❑
Health dept: ❑
Field inspection by: Health depth ❑a dote:
Enganeer n1 date's
This is to certify that the eerTage
disposal system was:construcIed as
NOTES: indicated on this plan and that the
system was inspected by me before it.I
was covered over. The syatesl was
constructed in accordance with afl' .
standard rules and regulations of
the P.C.H.D: S the N.-.y.S.D.H.
b I M E N SION S
A - B =_ 3Q1=12
A - C 1QT !PTj-B C
A - E •_ -�- B - E __ 325
A- F -�17h C.>4 B_ F
A - 6 s?GJ Q�B - �_ �u
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A_ H .Z r �yj B- H
A - K -,-.Z7 - 8 K °-
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5ANIT RY SYSTEM DES4GN I'ASiSUIL "
OWNER: -
LOCATION Street-
Town: - ���/I�J�1 P ���� r�
4'r��iIZG�Q1 County: LLT± State += - --
SUBD.�I ISvI N:��,��� -��fl
Mn p'Y%N
Block. _ LOT N2-Z131
Builder: (9 _
Surveyor: �I�LQ� 5�, — • _ - --
�rown:P �4, Date.Z„IC)_ Swle: I ( J b Ns z5i 44-
JOHN H, PR'ENTISS PE, wg' s
CONSULTING ENGINEER
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