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PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
APPLICATION TO CONSTRUCT A WATER WELL ) �%
please print or type PCHD Permit #/J
Well Location:
Street Address: Town/Village Tax Grid #
2 Caroline Drive Patterson Map 13 Block 2 Lot(s) 9
Well Owner:
Name:
Address:
Michael Carafas
2 Caroline Drive, Patterson, NY 12563
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 -10 gpm # People Served Est. of Daily Usage gal.
Reason for
Replace Existing Supply Test/Observation Additional Supply
Drilling
New Supply (new dwelling) X Deepen Existing Well
Detailed Reason
Existinq well is inade -uate
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 Rtran 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 provided on separ sheet/plan.
Date: 6/10/02 Applicant Signature:
P it - 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 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 Directo . y revision or alteration
of the approved plan requires a new permit. Well to be constructed by a water wel driller c ified by Putnam
County.
Date of Issue /Z�b Permit Iss icial:
Date of Expiration D Title:
Permit is Non- Transferra le
White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WP -97
Michael Carafas
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
WELL COMPLETION REPORT
Well Location
4;
Street Address:
2 Caroline Drive
Town/Village:
Patterson
Tax Grid #
Map 23 Block 2 Lot(s) 9
Well Owner:
Name: Address:
Michael Carafas, 2 Caroline Drive, Patterson, NY 12563
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 ft.
Length below grade ft.
Diameter in.
Weight per foot lb /ft.
Materials: Steel Plastic Other
_
Joints: Welded Threaded Other
Seal: _ Cement grout Bentonite Other
Drive shoe: Yes No
Liner: . Yes 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 6
Yield 5 gpm
Depth Data
su e-static (specify ft)
Measure from land ac
30'
During yield test(ft)
589,
Depth of completed well in feet
740'
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
Did'nt
drill deeper
-• dr
lied out blockage and 'wens: to
bottom
of well (401)
with
drill bit.
If yield was tested
at different depths
during drilling,
list:
Feet
Gallons Per Minute
Pump /Storage Tank Information
Pump Type sub Capacity 599111
609 5a
Depth Model S13412
p
Voltage 230 Hp 1�
.... .
Tank Type— — Volume
;. °..
Date Well Completed
7/8/02
Putnam County Certification No. ]Date
002
ofReport
1/9/03
Well Driller (signatyre) ,.
Phili�i`,T.•' dB al
NU I : Exact location or well with distances to at least two permanent ianamarKS to De provtaea on a separate sneeupian.
Well Driller's Name. P• F. meal & Sane, Inc. Address: 4 Ft ice., ''�'r' NY ', N
Date: 1/9/03
Signature: :•f _ '`M ,y
Ph p ..i Heal
White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller
Form WC -97
M co
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of
' * PUTNAM COUNTY DEPARTMENT OF HEALTH
'DIVIS ION ° "OF EN VIRONIVIENTAL'HEATLH SERVICES=
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FIELD ACTIVITY REPORT
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Street
Town
State, Zip
PERSON IN- CHARGE. :
Date. l %b
NN e and Tit .
TYPE OF FACILITY :. K
FINDINGS :'
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Signature and Title
RFPCIRT RFC:FTVFT) RV:
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I `acknowledge receipt of this report:.
SIGNATURE;
02%96
Title.
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