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P UT NAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
nnae w75- -�j
1UP
WELL COMPLETION REPORT
Well Location
Street Address:
7 Vega Road
Town/Village:
Patterson
Tax Map#
Map36•48 Block -1 Lots) -46
GPS
1' 27:25"N
073032.30W
Well Owner:
Name: Address:
Greg Wunner, 7 Vega Road, Brewster, NY 10509
Use of Well:
1- Primary
2-Secondary
X Residential Public Supply Air cond/heat pump _Irrigation
Business Farm Test/monitoring —Other(specify)
Industrial Institutional Standby
Drilling Equipment
X Rotary _Cable percussion X Compressed air percussion _Other(specify)
Well Type
—Screened Open end casing L Open hole in bedrock Other
Casing Details
Total Length 2�f t.
Length below grade Byt.
Diameter 6 in.
Weight per foot 19 lb/ft
materials: X Steel Plastic Other
Joints: Welded X Threaded Other
Seal: X Cement grout Bentonite Other
Drive shoe: X Yes No
Liner: _Yes JL_No
Screen Details
Diameter (in)
Slot Size
Length (ft)
Dept to Screen (ft)
IDeveloped?
First
I .. �_Yes
—No
Hours
Second
I
Well Yield Test
Bailed Pumped X Compressed Air
Hours 6
Yield 30 — gPm
Depth Date —
'25urL
' from land surface-static (specify ft)
me 20'
uunng yield test (11)
140'
Depth of completed well in ft.
180'
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 SUrfa�:
DrillinR in-ovdrburden
cley
a d uQ IdDxa—"
Hit rock at 60'
60
90
Drillimz in rock-
spt casircr-
orniii-PH
90
180
Drilling in ro�k
granite
r---
If yield was tested
at different depths
during drilling
list:
Feet
'gLMQbl jjj Per Minute
Pump/Storage Tank Information
Pump Type Capacity
Depth Model
Voltage HP
Tank Type Volume
Date `well co .
Date f Ren '
6tRD1(
-"NY.S 19 Wee, Y
.
Rump u' taI1.e,rPQ-, Q.,' rtificate
W61V:Duller J:Na
'AV
Ave B rew t
611
W 11 9
0,4
Pump Installer Name &Address:. n �� � 2
p - 0,
n
Pump I t r(slgn tare) ����
'n. V
"A
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
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORE TTA 'MOLINARI, RN, MSN
Associate Commissioner of Health
ROBERT J. BONDI
County Executive
ROBERT MORRIS. PE
Director of Environmental Health
.DEPARTMENT OF HEALTH
DRINKING AND RECREATIONAL WATER
Matthew L. Beal
P.F. Beal & Sons, Inc.
4 Putnam Avenue
Brewster, NY 10509
Re: Proposed Well Warner
7 Vega Road
(T) Patterson
August 26, 2009
Dear Mr. Beal:
A field inspection was conducted on the above referenced lot by Mitchell Lee, Public
Health Technician. The application to drill a new well is approved with the following
stipulations:
1. The well is to be constructed with a minimum-of 87 feet of casing.
_.:. :....:.._.:..:...:...:. ..2.__,� Well..Completion Report (WC -97) shall be'subrriitted no later than, 30 days after
the well completion by the permittee.
Please contact me at (845) 225 -5186 ext.2233 if you have any questions.
ccf le
Si cerely,
Mitchell D. Lee
Public Health Technician
110 OLD ROUTE 6, BUILDING 3 - CARMEL MY 10512
(845) 225 -5186 FAX (845) 225 -5418
man
T1- f -7 -7 G� b o 5—r3
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
APPLICATION TO CONSTRUCT A WATER WELL ,
please print or type P R P l
Well Location
Street Address: Town/Village: Tax Map #
7 Vega Road Brewster Block 1 -46
Map ock - Lot(s)
Well Owner:
Name:
Address:
Phone #:
Greg Warner
7 Vega Road, Brewster, NY 10509
279 -3756
Use of Well:
X Residential iPublic Supply Air /cond /heat pump _Irrigation
1- Primary
Business Farm Test/monitoring Other(specify)
2- Secondary
Industrial Institutional Standby
Amount of Use
Yield SoughL 5 gpm # People Served Est. of Daily usage gal.
X Replace Existing Supply Test/Observation Additional Supply
Reason for Drilling
New Supply (new dwelling) Deepen Existing Well
Detailed Reason
Shared well no loner exists - was destroyed
for Drilling
Well Type
Drilled Driven Gravel Other
Is well site subject to flooding? ....................................................... ............................... Yes _ No
Is well located in a realty subdivision? ........................................... ............................... Yes — No
Name of subdivision Lot No.
Water Well Contractor: P. F. Beal & Sons, Inc. Address: 4 Putnam Ave., Brewster, NY 10509
Is Public Water Supply available on site? ....................................... ............................... Yes _ No
Name of Public Water Supply: Town/Village
Distance to property from nearest water main:
Proposed well location & sources of contamination to be provided on separa sh plan.
Date:- -- 5/27/09 -- Applicant Signature: az
Matthew Beal ' -
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 Departmei
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 Commissioner of Health. 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. A
Date of Issue 2 f) 9 Permit
Date of Expiration I I Title:_
Permit is Non - Transferable
White copy - HD file; Yellow copy - Building Inspector; Pink copy -
Orange copy - Well driller
Gt
Form WP -97
VVe�� U�- 1 ,�I��,� Rev. 106
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39 36.40 36.41 P I MAP 36.48
RsE` {� M -NARY SCALE , - 5e,
36.49
}M._T-aWN.., OF PATTERSON 50'
DATE: AERIAL PHOTOGRAPHY..4 -10 -87 MAP..2 -17 -89
36 56 36 57 PUTNAM COUNTY NEW YORK NY STATE PLANE COORO. = NAD83 IN FEET
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