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Home My WebLink About2181DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 30.18 -1 -29 BOX 19 02181 a NNIN S.-I -r 0 r T 6r �, , ■, NO , 'i 1_6 1%9 ,. JIL rL jo 02181 P C WELL COMPLETION REPORT Office Use Only o .t DEPARTMENT OF HEALTH r� q 4.r. Division Of Environmental Health Services Uj ......, Q - PUTNAM BOUNTY - DEPARTMENT.: OF- HEALTI?.; -- - :-::;,:_ STREET AOURESS: rOWNIVILUGAIC11Y TAZ GRID NUMBER: WELL LOCATION 391 Lake Shore Dr. Putnam Valley, NY WELL OWNER NAME: ADDRESS: ❑ PBIVATE 10PUBLIC Henry /Mary Wale it 1 Lake Shan Dr. PutnamValley NY USE OF WELL ® RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ ABANDONED 1- primary O BUSINESS O FARM Q TEST /OBSERVATION O OTHER (specify) 2 - secondary ❑ INDUSTRIAL O INSTITUTIONAL Q STAND -BY ❑ MOUNT OF USE YIELD SOUGHT gpm. /N0. PEOPLE SERVED / EST. OF DAILY USAGE gal. REASON FOR QREPLACE EXISTING SUPPLY []TEST /OBSERVATION ❑ADDITIONAL SUPPLY DRILLING ONEW SUPPLY (NEW DWELLING) [:]DEEPEN EXISTING WELL DEPTH DATA ' WELL DEPTH 325 ft. STATIC WATER LEVEL 50 ft. DATE MEASURED 6/18/92. DRILLING ® ROTARY ( COMPRESSED AIR PERCUSSION ❑ DUG EQUIPMENT ❑ WELL POINT O CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE 0 SCREENED ❑ OPEN END CASING 91 OPEN HOLE IN BEDROCK O OTHER TOTAL LENGTH ft. MATERIALS: Z5TEEL O PLASTIC ❑ OTHER CASING LENGTH BELOW GRADE 42 ft. JOINTS: ❑ WELDED IN THREADED ❑ OTHER DETAILS DIAMETER 6 in. SEAL:I$CEMENT GROUT O BENTONITE OOTHER WEIGHT PER FOOT ? ? lb./ft. DRIVE SHOE ® YES ONO I LINER: ❑ YES QNO SCREEN DIAMETER (in) 'SLOT SIZE LENGTH (ft) DEPTH TO SCREEN (ft) DEVELOPED? DETAILS FIRST O YES ONO SECOND HOURS •• GRAVEL PAC(.. O NOS GRAVEL _ _ _ ... DIAMETER '" "7UP _ `80TTUM - __ ..... , • _ SIZE: OF PACK in.. DEPTH ft. DEPTH It: WELL YIELD TEST If detailed pumping HELL LOG if more detailed formation descriptions or sieve analyses are available, please attach: METHOD: O PUMPED t tests were done is in- t DEPTH FROM Water well Q¢ COMPRESSED AIR ,formation attached? SURFACE Bear- Oia- FORMATION DESCRIPTION cool! O BAILED O OTHER ; ❑ 'YES O NO It. ft. ing meter WELL DEPTH DURATION DRANlOOWN YIELD Surface 1 D ll n in overburden clay & bould rs It. hr. min. It. 9Cm• Hit rock at 151 325 6 305. 40 1 43 Drill.ng 1 in rock set casing, grouted. WATER ❑ CLEAR TEMP. QUALITY ❑ CLOUDY HARDNESS O COLORED ANALYZED? ❑ YES ❑ NO ANALYSIS ATTACHED? O YES O NO STORAGE TANK: TYPE PUMP INFORMATION CAPACITY GAL. TYPE CAPACITY WELL DRILLER NAME P.F. Beal & Sons c . AT If 6/18/92 MAKEA DEPTH ADDRESS. 4 Putnam Ave. 90, MODEL VOLTAGE HP Brewster,NY 10509 �. YML Envir ®rim ental :x Services 3.21 Kear- :Street, Yorktown Heights, NY. 105.98 ELAP #10323 (914) 245 -2800 Mrs. Mary P. Walegir. 391 Lake Shore Dr. For Lab Use Only Putnam Valley, NY 10579 <4G Potable _ HNO3 PH LT 2 — _ Nonpotable NaOH ; pH OT 9 <20>4C, HCl _ Na2SO3 >20C COLD BY Mary P. Walegir - STAT! ^ H2SO4 Z c r-- -- -_- LNOTES >� r NUN P/A RESULTS OF WATER TESTING RESULTS OE WATER TESTING X ANALYTE ` RESULT UNITS X A' NALYTE RESULT' UNITS ALKALINITY mg/L PHOSPHOROUS mg/L AMMONIA mg/L SILVER mg/L AR'; SENIC mg/L SODIUM mg/L LAB NUMBER These results indicate that the water sample [WAS] [ S N T] [NA1 of a satisfactory sanitary quality according to the New York State.Sanitary Code, for the parameters to , at the time of sample collection. . These results in that the w ter ample [WAS] [WAS.NOT] NA] a satisfactory chemical quality according to the New York State Sani,ary de, r the'parameters tested, at t e ti of sample collection. NA = Not Applicable. N =Not Present (Negative) SUBMITTED BY: P = Present (Positive) SA = See Attachment(s) = Also done because Total Coliform was present Albert H. Pado ni, M.T. (ASCP) TNTC = Too Numerous To Count Director > = GT.= Greater Than <= LT= Less Than DATE /TIME TAKEN 6/1/92 11:30 AM mg/L .DATE; %TIME RC'T) _ 6/1/92 2 :00 .PM r .DATE REPORTED JUN. 031992 COLOR Units SAMPLING:: SITE Kitchen: Tap These results indicate that the water sample [WAS] [ S N T] [NA1 of a satisfactory sanitary quality according to the New York State.Sanitary Code, for the parameters to , at the time of sample collection. . These results in that the w ter ample [WAS] [WAS.NOT] NA] a satisfactory chemical quality according to the New York State Sani,ary de, r the'parameters tested, at t e ti of sample collection. NA = Not Applicable. N =Not Present (Negative) SUBMITTED BY: P = Present (Positive) SA = See Attachment(s) = Also done because Total Coliform was present Albert H. Pado ni, M.T. (ASCP) TNTC = Too Numerous To Count Director > = GT.= Greater Than <= LT= Less Than CHLORIDE mg/L SULFATE mg/L COLOR Units SULFIDE nzg/L . CONDUCTIVITY umhos /cm SULFITE. mg/L COPPER mg/L TURBIDITY NTU DETERGENTS. rr�/L ZINC nrtg/L. FLUORIDE HARDNESS mg/L IRON mg/L LEAD mg/L MANGANESE mg/L MERCURY mg/L SI'G per 1.0 ml, NITRATE ing/L TOTAL COLIFORM per 100 mL NITRITE mg/L FECAL COLIFORM per 100 ml, 10ODOR TON E. COLI per 100 mL : H S.U. FECAL STREP. per 100 ml, These results indicate that the water sample [WAS] [ S N T] [NA1 of a satisfactory sanitary quality according to the New York State.Sanitary Code, for the parameters to , at the time of sample collection. . These results in that the w ter ample [WAS] [WAS.NOT] NA] a satisfactory chemical quality according to the New York State Sani,ary de, r the'parameters tested, at t e ti of sample collection. NA = Not Applicable. N =Not Present (Negative) SUBMITTED BY: P = Present (Positive) SA = See Attachment(s) = Also done because Total Coliform was present Albert H. Pado ni, M.T. (ASCP) TNTC = Too Numerous To Count Director > = GT.= Greater Than <= LT= Less Than DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -03 __. APPLICATION TO CONSTRUCT A WATER WELL 1.o +# 21 WELL LOCATION Stre t. Address Town/v. 39f om, ort- llage Ci ax a.. o rim rid Nu WELL OWNER Name mr r a' jing Address A l� 2 Pr ate 0 Public USE OF WELL 1 - primary 2- secondary J3 RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL.'. OPUBLIC SUPPLY 0 FARM O INSTITUTIONAL OAIR /COND /HEAT PUMP 0 TEST /OBSERVATION 0 STAND -BY 0ABANDONED 0 OTHER (specify, O AMOUNT OF USE YIELD SOUGHT 5 gpm/ # PEOPLE SERVED o , /EST'. OF DAILY USAGEJ" Sal REPLACE EXISTING SUPPLY 0 TEST/ OBSERVATION Gl ADDIT:IONAL SUPPLY 0 NEW SUPPLY NEW DWELLING O DEEP N EXISTING, WELL s q A •ow UW,-ff I'm REASON FOR DRILLING DETAILED REASON FOR DRILLING AAlo C WELL TYPE OPRILLED DRIVEN ®DUG OGRAVEL 0 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: Nameq. _�. ''' �^� �N�- Address : 4 Rk u n Xe, IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _ C� NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINA/T�InON PROVIDED OON SEPARATE SHEET Olt 2 (d to ) (s natu e 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 }� (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 otherwi ntaminate surface or groundwater. Date of Issue: 19 / Z Kt�. Date of Expiration_ 19_�Fk/ Permit "-Issuing Officia Permit is Non - Transferr ble White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller DEPARTMENT OF HEALTH Division Of Environmental Health Services Geneva Road, Brewster, New York 10509 (914) 278 -6130 June 15, 1992 Hr. Perry Beal P. F. Beal & Sons, Inc. 4 Putnam Avenue Brewster, MY 10509 Res Well Permit Walegir 391 Lakeshore Drive (T) Putnam Valley Dear Hr. Beal r—__ JOHN KARELL Jr., P.E., M.S. Public Health Director This Department has received the application to construct a water well as submitted by your office. Comments are offered as follorss Laboratory testing results are requested. This is to provide the type and severity of contamination of the existing well for our files. Location of the existing .hand-- dug--well -has not been. shown on,_plan. -- -.._ ... Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Ver truly yours, AW, 0 Robert Morris Assistant Public }health Engineer RU /jp