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Home My WebLink About4175DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.75 -1 -22 BOX 32 I,yL y r' or U16 04175 I Stephen Buccierc PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well' Location = 'Street Ad ress:' - 15B Morrissey Drive TownNillage: Putnam Valley Tax Grid Map 83.75 Block •-1 Lot(s) –22 Well Owner: Name: Address: StepheA Bucciero, 15B Morrissey Drive, .Putnam 'Valley, d141y 10579 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 X Open hole in bedrock Other Casing Details Total length 32 ft. Length below grade 31 ft. Diameter 6 in. Weight per foot 19 lb /ft. Materials: X Steel Plastic Other Joints: _ Welded K Threaded _ Other Seal: X Cement grout — Bentonite Other Drive shoe: X Yes No Liner: Yes X No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes —No Hours Second Well Yield Test _ Bailed X Pumped X Compressed Air Hours 5 Yield 40 gpm Depth Data Measure from land surface - static (specify ft) 30' During yield test(ft) 145' Depth of completed well in feet 185' 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 Surface 17 Drillin• in over mrden clay and bouldors Hit rec" at 17' 17 32 Drilling . in rock set casing, , g routed 32 185 Drillin- in rock granite If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity Depth Model Voltage HP Tank Type Volume Date Well Completed 9/'1.0/()2 Putnam County Certification No. 002 Date of Report 1/9/03 Well Driller (signature) Perry L. Heal NOTE: txact location of well with oistances to at [east two permanent lanamarxs to oe proviaea on a separate sneetrpran. Well Driller's Name P. F. Beal & 'Sons, Inc:. Address: -kw,, Signature: Date: 1/9/03 White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATLON TO CONSTRUCT A WATER please print or type r PCHD Permit # j;O g 3 26a Well Location: Street Address: Town/Village Tax Grid # 83.75 -1 -22 15B Morrissey Drive Putnam Valley Map Block Lot(s) Well Owner: Name: Address: Stephen Bucciero 115B Morrissey",Drive, Putnam Valley, NY 10579 Use of Well: X Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought 5 gpm # People Served Est. of Daily Usage gal. Reason for X Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason Hand dug well is contaminated for Drilling Well Type X 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 PaUmm Ave. Brewster NY 10509 Is Public Water Supply available to 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 provid o se eetl 1 Perry-L. B PERMIT TO CONSTRUCT 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 Department. During all well drilling operations, the applicant and/or well driller shall 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 Public Health Director. 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. Date of Issue q—l& -dZ Permi Date of Expiration - d 4 Title: Permit is Non-Transferrable White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES ter- ,,,a,v•.- ,..,.,.P...,.�„., g .t_.:.. :. ....-...... :,�`.� .�:� .:;:�....... . -,,:. APPLICATION TO ABANDON A WATER WELL please print or type PCHD PERMIT # Well Location: reet Address: TownNillage Tax Grid # 3 7 5B Morrissey Drive . Putnam Valley Map Block Lot(s)2 [Name: Well Owner: Address: Stephen Bucciero 15B Morrissey Drive, Putnam Valley, NY 10579 Well Type: Drilled Driven x Dug Gravel Other Depth Data: Well Depth C7 ft Static Water Level ZZ ft Date Measured V IS fl Use of Well: x Residential Public Supply Air /Cond/Heat Pump Abandoned 1- primary Business Farm Test/Observation Other (specify) 2- secondary Industrial Institutional Standby Water Well Name: Address: Contractor: P. F. Beal & Sons, Inc., 4 Putnam Avenue, Brewster, NY 10509 Reason For Hand dug well is contaminated; need to drill a new well. Abandonment: Description of Work To Be Performed: -z rn c Fill well with concrete from bottom to top. . a.. -... .� f -r .r- .....�....ti -C ._�. +.yM ... . -r -.. •.-. .. u..w - . --... __-.. __w.+. ►-.- �. y -� ..�._- ....� -.p -v. ��yy .. ate. +'.'. �.-' - Date: 9/10/02 Applicant Signature: Perry Beal PERMIT This permit, to abandon one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code, Subpart 5 -2 of Part 5 of the New York State Sanitary Code and/or Part 75 of 10 NYCRR and provided that: Within 30 days of the completion of the abandonment of the water well, the applicant shall submit to the Department a certified statement that the information delineated on the application for this. permit has been completed. 5=-16 --ate Date of Issue White copy: HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WA -97 * PUTNAM COUNTY DEPARTMENT 'OFHEALTH O' OF kNVIRONMENTAI ; If�EA T7LI C SEl<ti ES-,- _ FIELD ACTIVITY - REPORT NAME: e1�CC, O 7I � _ Street Town State Zi PERSON IN" CHARGE, _ _ = •(1R�- TN`T'FR�LIE3�IF7�.. Name andTitle . nafiP TYPE OF FACILITY • P�ir:�;n ` -Ah C 4� FINQIf�1GS:. 1%'_ . . 3 ' 5 AA • r: e. " v J, ,L 7 .. f ^_ a . „; �. - ms '1P £ , Signature and Title. .. � .., . y- .,... RFR(1RT RRC`FTUF,n RY.- _ 'l..Y 'ti'. Wit_ • ,- I acknowledge:recelpt,of this report SIGNATURE: 02/96 Title. :�. P.F. BEAL.& SONS, INC. 4 PUTNAM AVENUE ARTESIAN WELLS BREWSTER, NEW YORK 10509 WATER TANKS ..WATER.SYSTEM •:'aitkimps COMM ERCIAL WATEQ�SY§TRt4r - SUBMERSIBLE PUMPS WATER CONDITIONING EOUIPMENT TEL. (845) 279-2460 - 2461 FAX (845) 279-6613 COMPLETE INSTALLATION, REPLACEMENT AND REPAIR SERIVICE Au r2- I I -loo ...,.: ." � ..: � .. v .-•.�• _. .'ti''•F•� a "� .rY �- r .. .. r.. Vii. rJ - c L . 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SEWALL COMPANY tam uK -- il+ll LlK —_— YILI+K L1K -- -- aax uwr - - - tans [mD ti ]IRAI YQIY Y+sYw +rarer F Yi11 >4 147 CENTER STREET, OLD TOWN, MAINE . + a • A ]gain uK WIOOL 194 e - - -PUTNAM DEPARTMENT OF HEALTH 1 Geneva Road -- Brewster,. New York 10509 9 Date 9/1 TO: 1� FROM: ------- _.___— r For your information�E' 1� ►f eG1✓� f C7W 1 t `t For signature For your files Referred for handling Attached as requested _ Returned as requested Please see me Read and return CObOdENTS: WV�6 VII 0 ' --�e(� o�,,,�ne✓� cow�Pl��ns ��" Fine �,lat� �nas a SCAl� �5��