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631- 589 -8100
62.06 -1 -11
BOX 24
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252 West Shore Drive
Putnam Valley, NY 10579
April 5, 1989
Department of Health
110 Old Route Six Center
Carmel, NY 10512
Attention: John Kareii, Jr., P.E.
Director, Environmental Health Services
Re: Well Permit # W-25-87
Dear Sir:
As per your letter of March 30, 1987, we enclose the
following for approval of the well:
1. Well Completion Report for the new well
2. Result of Bacterioloqical Analysis
--wel
We had no well; our water supply was from
Lake Oscawana.
The well was drilled November 18, 1988; our permit was
good through March 23, 1989.
-C". . !, - : Y:
Very truly yours,
Anne Schrot
WLJLl LVr1rjz11.V1q L-,Lzrurtl
DEPARTMENT OF HEALTH
Environmental. Health- Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
Office Use Only
AT I _0N
_ E_ L_ L LOCATION
W
STREET ADORESS:, LA CI
[V IL ly TAX Numb
Y.
WELL OWNER
E AD E _
X
81 A TE
0 PUBLIC
USE OF WELL
1 - primary
2 - secondary
ja RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP 17, ANDO ED
❑ BUSINESS ❑ FARM ❑ TEST/ OBSERVATION ❑ OTHER (specify)
❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND-BY ❑
AMOUNT OF USE
YIELD SOUGHT g*pm.INO. PEOPLE SERVED EST. OF DAILY USAGE gal.
REASON FOR
DRILLING
9 NEW SUPPLY 0 PROVIDE ADDITIONAL SUPPLY ❑ TEST/OBSERVATION
❑ REPLACE EXISTING SUPPLY 0 DEEPEN EXISTING WELL
_
DEPTH DATA
WELL DEPTH zoo, ftT
T ST T 14.
IC WATER LEVEL. it
DATE MEASURED
DRILLING
EQUIPMENT
E"OTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG
❑ WELL 50INT ❑ CABLE PERCUSSION . 0 OTHER (specify):
WELL TYPE
❑ SCREENED ❑ OPEN END CASING. OPEN HOLE IN BEDROCK 0 OTHER
.CASING
TOTAL LENGTH ft
MATERIALS: IaSTEEL ❑ PLASTIC 0 ❑OTHER
LENGTH.BELOW GRADE fL
JOINTS: ❑ WELDED aTHREADED ❑ OTHER
DETAILS
DIAMETER in.
SEAL: ❑ CEMENT GROUT D BENTONITE 19,0THER
WEIGHT
PER FOOT 12- Ib./fL
DRIVE SHOF_�fES ❑ NO
LINER: OYES KNO
SCREEN
DIAMETER (in)
SLOT SIZE
LENGTH
(ft)
DEPTH TO SCREEN (ft)
DEVELOPED?
FIRST
w�-
OYES ONO
-.1ETA .,-:,
5EC�ONU"
GRAVEL PACK
11 YES
0 NO
GRAVEL
SIZE:
_1WELL
DIAMETER
OF PACK in.
TOP
DEPTH ft.
BOTTOM
OEM — It.
WELL YIELD TEST If detailed pumping
METHOD: 0 PUMPED i tests were done is in-
COMPRESSED RESSED JUR formation attached?
0 BAILED 0 OTHER 0 YES 0 No
It_ more detailed formation descriptions or sieve analyses
LOG are available, please attach.
DEPTH
F F8011
DEPTH FROM
SURFACE
, C,
water
pear-
ing
well
Dia
meter
In
FORMATION DESCRIPTION
COOE
It _
WELL DEPTH
iL
DURATION
hr. min.
DRAWDOWN
It
YIELD
gpm.
Land
Surface
Surface
LIZA,'
,
czqol
I.
I -
ay 0
a
-a
WATER 0 CLEAR TEMP.
QUALITY 0 CLOUDY HARDNESS
0 COLORS ANALYZED? O-Y ES ONO
ANALYSIS ATTACHED? 0 YES ONO
STORAGE TANK TYPE
CAPACITY
PUMP INFfIRMATION
TYPES APACITY
MAKER Adzt" — DEPTH
MODEL VOLTAGE2� _HP
WELL DRII.LER NAME-1tolr-4, DA
ADORE SlGiffMRE
n
COJUNTY OF WESTCMESTER.'
E Yt Rev 86 DEPARTMENT CF LABORATORIES AND RESEARCH
VALHALLA. NEW YORK 10595,_ r=
ACTE W?EO N i A N d RS s
.C..riln
,%- 'p,.:.. fi +�[�:: yy- -`'v^ "tvr Yn; •i« ? s 41st Eti� z S��art.^',;.'E r ,� ;
Lab No ANT Oate Cold¢ ^ _ ` Tams
Time Set x `` Time Submitted " ' s x
Tests (Circlet. SPC Coliform MPNoltforrn Membrane Fecal Other
A,
Coll'd by _ Agency Coll d for
._ Coll'd Name
ame , wad
If�ntl - -
Address' •7 YY E ,31�i'rst s ►� fl 'rAl A'An -VA ` f t S ' Tr�'77#,r A A4,
1st: as) ( n: Towif vmpo) - IYw cold) Ifounryl
Identification of Source - -
Sampling .Point within Premisee��" Refngeretetl?
Chlo
mg /
rinated Kes a No Free k r I =Total in pH
ER>
, r
Standard Plate;Count " ,L
RePOned by-1
Bactertaper mi (48 nr) `^�
a
Memhsanb Method /loo ml
t -;
RePOned by-1
i
t -;
s
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
� .� ..., - _ -CA _ TO CONSTRtJGT._.A .�nI.ATER;3nT.EL1L..._,:L:w
PCHD PERMIT
WELL LOCAT
Street Address Town/Village City Tax Grid Number
" At s JA ®�� raves ��i'+�
WELL OWNER
Name
Address �,
RM 13&yt 292. 1
0Private
Q Public
USE OF WELL
1 - primary
2 - secondary
91 RESIDENTIAL
O BUSINESS
❑ INDUSTRIAL
❑ PUBLIC SUPPLY ❑ AIR /COND /HEAT PUMP
O FARM - 0 TEST /OBSERVATION
b INSTITUTIONAL O STAND -BY
O ABANDONED
0 OTHER (specify
AMOUNT OF USE
YIELD SOUGHT
gpm /# PEOPLE SERVED /EST. OF DAILY USAGE gal
REASON FOR
DRILLING
❑NEW SUPPLY OPROVIDE ADDITIONAL SUPPLY OTEST /OBSERVATION
@REPLACE EXISTING SUPPLY ❑DEEPEN EXISTING WELL
DETAILED
REASON FOR
DRILLING
g&&4ar
ce,SS
'
'
WELL` TYPE
DRILLED
DRIVEN
®DUG
GRAVEL
®
OTHER
IS WELL SITE SUBJECT TO FLOODING? YES NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: IV A
Lot No.
WATER WELL CONTRACTOR: Name Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES .1-0 NO .
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
•- _ -•-• -� c�_oNrF _Trl �Rr;�r.`7t.. TT %._ FROM. __t�EARFS.��= ;�ATER�ML�IN:�-,_. � -.._. � __ _.:_.�_:.� _ �__�.. -- ____.�•__ -_�... ' �.,
LOCATION SKETCH & SOURCES OF CONTAMINATION
(DON REAR OF THIS APPLICATION
1-f
(d Ate)
PROVIDED
ON SEPARATE HEFT
(signature)
PERMIT
TO CONSTRUCT A WATER WELL
This permit to construct one water well as.s,et 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 6 7
Date of Expiration: a 19.� mit Issuing Official
Permit is Non - Transferrable
R.D.. 4 Box 282
Putnam Valley, NY 10579
March 18, 1987-
U3
rr,m
Department of Health '
110 Old Route Six Center
Carmel, NY 10512 _
-- rn
Sirs: C
Enclosed is our application for a new well- We,- ;,have contacted
Mr. Anderson and would like to get severa4,. estima'�tes. Mr.
Anderson would not give an estimate untilNe had - =zthe permit.
Therefore, we have left that question blank.
Presently, we are two people in the house which has 3 -4
bedrooms. We would want an excellent yield to replace the
unlimited supply we now have from the lake.
Please call 526 -2099 to speak with my husband regarding
any questions and /or appointment for inspection. I can be
reached at 528 -8143 from 8:30 to 3:30.
_R.. Thank you for .yo?ir. considpratior < <.. _. �,-
Sincerely,
Anne Schrot
Enclosures: Application
Location sketch
Oar
D
$4
0
4
En
4-J
M
Anne Schrot
West Shore Drive
Putnam Valley, New York
..........
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