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HomeMy WebLinkAbout2042DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36.41 -1 -9 BOX 18 ." :: ''y�, I ., �, '. �. �i !�'� . � . Ilmi: Amom r NJ ti JSrr Is III ll- Is 0 DEPARTMENT OF HEALTH UWW', WELL GUMYLETIULV ,KbrUmi Division —Of ' Environmental H6alt PUTNAM COUNTY DEPARTMENT. OF HEALTH Office Use Only WELL LOCATION STREET ADDRESS: TOWN/ I TAX GRID NUMBER: 79. Cameron Road Brewster, Nl�j.. WELL OWNER NAME: ADDRESS: Robert Villani 79 Cameron Rd., Brewster, Nth 160 PRIVATE PUBLIC USE OF WELL 1 - .primary 2 - secondary RESIDENTIAL ❑ PUBLIC SUPPLY 0 AIR /COND. /HEAT PUMP ❑ ABANDONED O BUSINESS ❑ FARM O TEST /OBSERVATION O OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STANQ -BY ❑ MOUNT OF USE YIELD SOUGHT 5 gpm. /NO.,PEOPLE SERVED 3 / EST. OF DAILY USAGE gal. REASON FOR DRILLING 4DREPLACE EXISTING SUPPLY []TEST /OBSERVATION ❑ADDITIONAL SUPPLY. []NEW SUPPLY (NEW DWELLING) ❑ DEEPEN EXISTING WELL DEPTH DATA 285. WELL DEPTH ft. 10 STATIC WATER LEVEL ft. 10118196 DATE MEASURED DRILLING EQUIPMENT ❑ ROTARY 4�COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED ❑ OPEN END CASING xQcOPEN HOLE IN BEDROCK O OTHER CASING DETAILS TOTAL LENGTH 60 _ ft MATERIALS: x kSTEEL . ❑ PLASTIC . ❑ OTHER LENGTH BELOW GRADE 59 n- JOINTS: O WELDED ,daTHREADED O OTHER DIAMETER 6 in. SEAL:>&EEMENT GROUT O BENTONITE 0OTHER WEIGHT PER FOOT 19 lb./ft. I DRIVE SHOE O YES D NO I LINER: O YES O NO SCREEN _DETAILS.._ DIAMETER (in) SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (it) _ DEVELOPED? FIRST OYES ONO BOUR4 SECOND ... _ _......._. , ._.._ . _ .... _ .. ... �_._ GRAVEL PACK O YES O NO GRAVEL SIZE. DIAMETER OF PACK in. TOP DEPTH IL BOTTOM DEPTH ft. WELL YIELD TEST If detailed pumping METHOD: O PUMPED t tests were done is in- xBCOMPRESSED AIR ; `. ormation attached? O BAILED ❑ OTHER ; 0 YES 7 NO If mare detailed formation descriptions or sieve analyses WELL LOG are available, please attach. DEPTH FaaM SURFACE g air wen Dia- meter FORMATION DESCRIPTION cool ft. tt ling WELL DEPTH ft, DURATION hr. min. ORAWOOWN ft. YIELD gpm. Land 50 Si 1t, sand & gravel . 5C 2&5 Medium to hard black & grey granit . 285 6 - 200 45 4D T'Ti rn:; CO�' WATER x�aCLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? >42LYES ONO ANALYSIS ATTACHED?.13cYES ONO "p J «' STORAGE TANK: TYPE biaphragm co rs—; CAPACITY 62 GAI,. l PUMP INFORMATION TYPE ,submersible CAPACITY 7 MAKER . s DEPTH 100. MODEL 7GS0541 l VOLTAGE 115 HP 112 WELLDAILLERNAME &1A /96 ADDRESS Putnam Ave. SI Brewster, L' y 1 3/89 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 79 Cameron Road, Town/Village/City Tax Grid Number Patterson, WELL OWNER Name Mailing Address Robert Villani 79 Cameron Road,. xWrivate O Public USE OF WELL 1 - primary 2- secondary =Q RESIDENTIAL O BUSINESS O INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION U INSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT 5. gpm /# PEOPLE SERVED 2 /EST. OF DAILY USAGE_ al REPLACE EXISTING SUPPLY 13 TEST/ OBSERVATION GI ADDITIONAL SUPPLY O NEW SUPPLY NEW DWELLINGI kDEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING L5 and rlvg n-11 yoru shallpw acrd low nie_ld. WELL TYPE 149DRILLED DRIVEN ODUG GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES roc NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name )Pl. a Address:PUTNM AW•, MMMp NJ IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES sac NO NAME OF PUBLIC WATER SUPPLY: m/a TOWN /VIL /CITY DISTANCE TO PROPERTY -FROM - NEAREST -WATER MAIN: Nor LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED / , O ON SEPARATE SHEET 10/15/96 ° Aff (date) Bober Qke stiderit 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 thirty* (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 degrade or otherwise contaminate 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 11 -05 -�n6 11:40PM FROM NORTHEAST LABS TO i ENVIR0NMENTAL -LAR0 A Division 4AT6,- theast Laboratories Inc. M[n L PLAIN ROAD - ; �DA1+[SiTRY, CT 06811 Z,,.. BERLIN: I2� MML STREET - BERLN CT' 06037 � T.A1i0RAT0Ri REPORT -- WA MILL DRILL G,1NC. Pi MARMA AV NUB BREWSTE&' , ,Y, 10509 ,i ml = miliilitei > ° Mimi ND - none dE 1055519142795075 P.01 SUPPL CT Ceit PH -0404 and PH -0606 N7l Cert: 11471 G DATE SAMPLE COLLECTE7: ''10/30/96 TIME COLLECTED: 1:30 P.M. COLLECTED BY: R MILL SR- DATE RECEIVED Q LAB: 10/30/96 DATE(S) TESTED: 10/3.,0/96 TESTED BY: LAB #11471 REPORT DATE: I1/4196 I i • VILLANI 79 CAMERON RD. , PATTERSON N.Y. HOSE H.YBH WELL R D RESULT: RECQMMENDED.LPIT . toliform (Baal a) 0 per 100 ml 0 per 100 ml - Chlo>'ine Re ' ual ND nag/): - - - -- s W.Liter d itESULTS: LASED ON SAIi'I�'I-LES SUMMED: 10/30/96 � i • SAMPLE, - i TESTED ABC JJA: �X OTAELE or Fo POTABLE (PEP STATE OF NEW YORK DEPT. OFe 1-MALTH SERVICES STANDARDS FOR POTABLE WATER) 1n Laboratory Director i•