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HomeMy WebLinkAbout0313DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 13. -2 -9 BOX 4 7 ' ' � 'IN �v I I Is I Ij : �If �} = � 00122 b 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 Z of ' * PUTNAM COUNTY DEPARTMENT OF HEALTH 'DIVIS ION ° "OF EN VIRONIVIENTAL'HEATLH SERVICES= { FIELD ACTIVITY REPORT ♦) 2) b ,Ae I've o�-r' Street Town State, Zip PERSON IN- CHARGE. : Date. l %b NN e and Tit . TYPE OF FACILITY :. K FINDINGS :' ... (. e 4 : ulATO -_ _f s Signature and Title RFPCIRT RFC:FTVFT) RV: - I `acknowledge receipt of this report:. SIGNATURE; 02%96 Title. �..