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02063
ELLIS A.. TARLTON LABORATORY
DIVISION OF ELLIS A. TARLTON, ENGINEERS, INC.
CHEMICAL WATER - WASTEWATER
PHYSICAL 34 PLEASANT STREET . DANBURY, CONN': 06813 -2328 METHODOLOGY
BIOLOGICAL P.O. BOX 2328 203- 748 -7903 APHA - EPA - ASTM
.RSPORT aP--BACT[-RIOLOGIC-AL AND CHEMICA °L -EXAMINATIONS -0- -WATEff
NAME AND
ADDRESS OF
PERSON TO
RECEIVE
REPORT
F Mill Drilling,, Inc.
Putnam Ave
Brewster, NY 10509
DATA
SOURCE OF SAMPLE
Water Supply,
Bertrum Const. Co.
Fairfield Drive
Patterson,- NY
DATE OF COLLECTION Sept. 19', 19 9 2
COLLECTED BY Mill Drilling
Hydrogen Ion
COLOR
TURBIDITY
ODOR
CORROSION INDEX
DISSOLVED SOLIDS
Concentration
LAN G EL I ER
(PH)
RYZNAR
NTU
•
61g!1
Alkalinity as CaCO3
Fluoride (F)
Bicarbonate
Nitrite
Mg /L
Mg /L
Mg /L
NITROGEN
Alkalinity as CaCO3
Chlorine Residual
CONSTITUENTS
Carbonate
O 0
AS
Nitrate
Mg /L
Mg /L
•
Mg /L
Total Hardness
Conductivity
NITROGEN (N)
as CaCO3
Ammonia
Mg / L
Mg / L
Mlcromohos /cm
'
MO /L
Iron as Fe
Mg /L
Mg /L
Chlorides as CL
Mg /L
Manganese as Mn
Mg /L
Mg /L
Detergent as MBAS
Mg /L
Sulfate as SO4
Mg /L
Mg /L
The arithmetic mean of all standard samples examined per month using the membrane filter technique shall not exceed
one colony per 100ml. Collform colonies per standard sample shall not exceed 3/50m1, 4/100ml. 7/200m1, or 13/500m1
-in, (a) - Two-- consocutive - samples; - {b)- Moro- thane -one standard sample when leis than 20 are exarnined-per month-- or (c)
More than five per cent of the samples when 20 or more are examined per Tmonth. ~
AT THE TIME THE SAMPLE WAS SUBMITTED:
® 1. The results of the analysis of this sample were satisfactory and met requirements for a potable water.
MEMBRANE FILTER TEST
Coliform Colonies /1DOML
Lj 2. The results of the analysis of this sample were satisfactory for a potable water but certain of the chemical or physical constituents were high. These are as follows:
C3. This sample was not satisfactory since it did not meet the bacterial requirements for potable water. The presence of organisms of the coliform group In a sample of potable water Is
undersirable and, while not necessarily indicating the presence of any disease - producing organismsadoes indicate that such contamination might survive to the same extent. The
presence of organisms of the coliform group may also indicate that the treatment was not adequate at the time the sample was collected.
4. This sample was unsatisfactory as a potable water because certain chemical or physical constituents were above 'acceptable limits. These are as follows:
COMMENTS
The bacterial analysis showed no organisms of the coliform group at the
time the sample was collected which indicated the water potable.
Certified ...... .. ... ........ ............. ... ... ...
s'
WD.Ula %JVrLr.UD1J_VL'4 LXMrVALI
DEPARTMENT OF HEALTH
D s7fdW"Of Vfedtfih&hfAr
' IVr E5 —Hdalth-SdnTE—e6—
PUTNAM COUNTY DEPARTMENT OF HEALTH
office Use Only
WELL LOCATION
STREET ADO ESS: W GRID NUM8ER:
Fairfield Drive Patterson., New York
WELL OWNER
NAME. ADDRESS:
BertrLm Construction Co... 100 Fairfield Dr, . Patterson., NY
PRIVATE
ro PUBLIC
USE Or WELL
1 - primary
secondary
=(RESIDENTIAL 0 PUBLIC SUPPLY 0 AIR/COND * MEAT PUMP 0 ABANDONED
❑ BUSINESS 0 FARM 0 TEST/OBSERVATION 0 OTHER (specify)
❑ INDUSTRIAL 0 INSTITUTIONAL 0 STAND-BY 0
AMOUNT OF USE
YIELD SOUGHT —5— gpm.!NO. PEOPLE SERVED 2 to 4
EST. OF DAILY USAGE gal.
REASON FOR
DRILLING
[]REPLACE EXISTING .SUPPLY EITIEST/OBSERVATION []ADDITIONAL SUPPLY,
NEW SUPPLY (NEW DWELLING) DEEPEN EXISTING WELL
... .. )Ca_
DEPTH DATA
WELL DEPTH 225
3
STATIC WATER LEVEL J7 ft.
9/15/92
DATE MEASURED
DRILLING
EQUIPMENT
❑ ROTARY A*COMPRESSED AIR PERCUSSION 0 DUG
0 WELL POINT 0 CABLE PERCUSSION ❑ OTHER ('specify):
WELL TYPE
0 SCREENED 0 OPEN END CASING )(9)(OPEN HOLE IN BEDROCK 0 OTHER
TOTAL LENGTH exiatiog ft
MATERIALS: X)IR STEEL ❑ PLASTIC 0 OTHER
CASING
DETAILS
LENGTH BELOW GRADE ft.
JOINTS: ❑ WELDED 0 THREADED .O OTHER
DIAMETER 6 in.
SEAL: 0 CEMENT GROUT .0 BENTONITE .0 OTHER
WEIGHT
PER FOOT ig
Ib./ft.
tDRIVE SHOE OYES ONO ]
LINER: J-YES ONO
SCREEN
DETAILS
DIAMETER (in)
'SLOT SIZE
LENGTH (11)
DEPTH TO SCREEN (It)
DEVELOPED?
FIRST
_E
0- YES 0 NO
HOURS
GRAVEL PACK
❑ YES
0 NO
GRAVEL
SIZE:
DIAMETER
OF PACK in.
TOP
DEPTH ft.
BOTTOM*
DEPTH
WELL YIELD TEST It If detailed pumping
I
METHOD: 0 PUMPED 1 tests were done is in-
ftCOMPRESSED AIR formation attached?
❑ BAILED ❑ OTHER ❑ YES 0 NO
VELL LOG
more detailed formation descriptions or sieve analyses
ft are available, please attach.
DEPTH FROM
SURFACE
Water
8ear-
ing
Well
Oia-
mettr
In
FORMATION DESCRIPTION
COOE
ft.
ft,
WELL DEPTH
It.
DURATION
hr. min.
DRAWDOWN
It.
YIELD
9pm.
1.2nd , ce
Sur,
95 '
I
Existing
qq
995
1
H6rd grey' black granite.
6 .
-
180
30
WATER CLEAR
QUALITY ❑ CLOUDY
❑ COLORED
ANALYSIS ATTACHED?
TEMP.
HARDNESS
-ANALYZED? )(RYES ONO
XX YES 0 NO
STORAGE TANK: TYPE Diaphw
CAPACITY
WELL DRILLER NAME
MILL DRILLING; I
ADDRESS Putnam Ave, SIG RE
Brewster. W091
I: " n I "IP
W t M. Mill; 11,40 4
R1 rt it' t
PUMP INFORMATION
7YPEswWwsible CAPACITY 10
MAKER 130111 D,� DEPTH 150'.
IOEJ05412
maDEL VOLTAGE 230 HPb/_2
-2 Mn
` A Ali ENT OF HEALTH
Division of Environmental Health Services
106. ' COUNTY CENTER - .CARMEL, N. Y." 10512 (914)0225 -3641 -"
APPLICATION 'TOCONSTRUCT A�WATERwWELL
PCHD PERMIT.
now
.St t d r s
Ralf-
Town/Village/City Tax Grid Number;��`x
ON
eMrive
Pattersop, NY
.x .
Name.
'Add ssPr,ivatey`'
Eertrtn
Fairfield Dr., Patterson
OPubi,lic��,
LL
XWWSIDENTIAL OPUBLIC
SUPPLY. QAIR /COND /HEAT PUMP
[?ABANDONED
O BUSINESS O
FARM O TEST /OBSERVATION
O OTHER(specif
PUS ary
O INDUSTRIAL U
INSTITUTIONAL O STAND -BY
M1„ �
D '}
FUSE
�- YIELD SOUGHT
5 gpm /# PEOPLE SERVED /'EST. OF DAILY'USAGE / a5�1
ASCU 4
NEW SUPPLY
OPROVIDE ADDITIONAVSLTPPLY ❑TEST OBSERVAT�QN;
RILG
EPLACE"E'XI5TIN6
SUPPLY XXDEEPEN,EXISTING WELLt i"'
'°`A 0'pp+
OR
cw We'd
l
DRILLED DRIVEN
DUG a GRAVEL..
a OTHER
I E''SUBJECT TO FLOODING?
YES NO
E :LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDiV161UN: 1VU
V.: :;.LOCATED
.. Lot No.
ATE �iLL'CONT$ACTOR• Name MILL DRILLING, INC • Address:
TER SUPPLY AVAILABLE TO SITE:, r YES )(X NO
I,IC . WATER SUPPLY: n/d TOWN /VIL /CITY
OFPROPERTY FROM NEAREST'WATER-MAIN: n/6
....
S ETCH & SOURCES OF CONTAMINATION PROVIDED -
OON REAR OF THIS APPLICATION `; OBI.SEP V E SHEET
d
M. fall ;at
ert
PERMIT -
!'':.; TO CONSTRUCT A WATER WELL A:
'permit to construct one water.well as s.et' forth abpve is granted under the
cisiops'of.Subpart 5 -2 of Part 5 of the New York State Sanitary Code, andY z
Hded that within thirty (30) days of the compl eti oh of water well constructio
applicant shall:
1. Pump the well until the water is clear.
"ssr2. Disinfect the well in accordance with the requirements of the Putnam:.°::`
County Health Department attached to th.ys permit.
Submit a Well Completion Report on a fo r provided by 'the Putnam County
Health Department.
-of Issue : 19
</
.,'of Expiration: 19 _ Permit Issuing Official
oit is Non - Transferrable
�t
DEPARTMENT OF HEALTH
Division of Environmental Health Services
0
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
APPLICAtIONL TO CONST�tUT TER
C A �WP,- WE r�
LL =R
A
f PCHD PERMIT #�
WELL LOCATION
St
et d
airfield
re s ,
Drive
Town/Village/City Tax
Patterson, NY
Grid Number
WELL OWNER
Na a
John Bertrw
Address
Fairfield Dr,,., Patterson
XXPrivate
❑ Public
USE OF WELL
1 - primary
2 - secondary
XMCRESIDENTIAL ❑ PUBLIC SUPPLY Q AIR /COND /HEAT PUMP
® BUSINESS 0 FARM ❑ TEST /OBSERVATION
® INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY
❑ ABANDONED
❑ OTHER (specify,
0
AMOUNT OF USE
YIELD SOUGHT
5 gpm /1 PEOPLE SERVED /EST. OF DAILY USAGE gal
REASON. FOR
DRILLING
❑NEW SUPPLY
EPLACE EXISTING
OPROVIDE ADDITIONAL„ SUPPLY
SUPPLY PXEDEEPN EXISTING WELL
0 TEST/ OBSERVATION
DETAILED
REASON FOR
DRILLING
aw Weld
WELL TYPE
DRILLED
11
DRIVEN ®DUG
[]GRAVEL
® 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 MILL DRILLING, INC.' Address: Putn Ave,
_n, _
- - - — - - DI CWJ LCl , IV 1
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES XX NO
NAME OF PUBLIC WATER SUPPLY: n/a TOWN /VIL /CITY
DISTANCETO PROPERTY FROM NEAREST WATER MAIN: h1n
LOCATION SKETCH & SOURCES OF CONTAMINATION
®ON REAR OF THIS APPLICATION
9/4/92
(date)
PERMIT
ident
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. --
Date of Issue:] -�� 19--;
�'
Date of Expiration: 19. Permit Issuing Official
Permit is Non - Transferrable
' J
0 0.
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b
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