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Home My WebLink About0836DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 24.18 -1 -15 BOX 9 =` r 1 ..'DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A. WATER WELL PCHD, PERMIT WELL LOCATION 'St.r - et Address . .Town V llage' City.. Tax Grid • Number ai' /l Gyl r7 Q WELL OWNER . N e cT8 K 0 Mailing Address GND Sk 2cQ� P �l,e AA_ OtPrivate O Public': USE OF WELL primary .2 - secondary `.RESIDENTIAL :0 BUSINESS P.INDUSTRIAL- ❑ PUBLIC SUPPLY 0 AIR /COND /HEAT PUMP O FARM 0 TEST /OBSERVATION CIINSTITUTIONAL O.STAND -BY O ABANDONED . O OTHER' (§Oecify O AMOUNT OF USE YIELD SOUGHT 15 gpm /# PEOPLE SERVED s /EST. OF DAILY USAGE S'OcD gal REASON FOR DRILLING ONEW SUPPLY. ❑PROVIDE :.ADDITIONAL SUPPLY ' OTEST OBSERVATION OREPLACE EXISTING SUPPLY '-`_ d3EPENEXSTIN�LL .DETAILED' ,.REASON FOR DRILLING WELL. -TYPE MpRILLED aDRIVEN QDUG aGRAVEL OTHER IS WELL SITE SUBJECT -TO FLOODING? YES NO IF WELL IS LOCATEV IN A REALTY SUBDIVISION, NAME. OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name .Avtz4 ux.,n WwCt L� Address: w yva l.cuk /as-o,, IS PUBLIC WATER SUPPLY AVAILABLE TO SITE:-. YES NO NAME OF PUBLIC�WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED Q ON,REAR OF THIS APPLICATION []ON SEPARATE SHEET (date) (si nature) 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 thirty (30) days of the completion of water well construction, the applicant s.hall: 1. 2. 3. Date of Date of Permit 2/87 Pump the well until the water is clear. Disinfect the well. in accordance with the requirements of the Putnam County Health Department attached to this permit. Submit- ,a Well Completion Report on a form pro ided y tQP n m C un y Health Departme t. Issue: 19J�. Expiration: 1g it ss g Official is Non - Transferrable Waite copy: H.D. File Yellow copy: Building Inspector Pink Copy: Owner (ramp- mt)v: Well Dri1.1Pr. a �y DIVISION OF ENVIRONMENTAL HEALTH SERVICES 225 -0310 PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR pp OWNER' S rum J C� ti1 `flCG -�. ►� D PHONE SITE LOCATION S V-1-1 ( MAILING ADDRESS PERSON INTERVIEWED Pao complaint # 610-01 -1,q ' Narro � Rcal at i nnch i n ! i; a OWller tenant etC ) TYPE FACILITY PHONE Proposal (include sketch locating all adjacent wells): NOTE: Repair must be in same location and of same.type'as original sewage disposal system. Different. location may require submittal.of� proposal frc*n'licensed professional engineer or registered architect. ._ iD(_NUJ rzL-L Lot IT9 4 x4 4 tai or/,/- DR..gtAJ�t -L= . I Fani hQ�VG� S�Qorir��nn�nti, Tv fit% F t F-L D 1/4,8 PELT-E D RF ev e_t~ Pr pproved _ Proposal Disapproved Inspector's Signature & Title Datd Proposal approved with the following conditions: 1. Procurement of any Town permit, if applicable. 2. Submission of as built repair sketch in duplicate showing: a. Owner's name. b. Site Street Name, Town and Tax Map number. c. Location of installed components tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diem. x 6' deep dkywells surrounded by one foot + gravel). e.;,Installer's name and number. Sy ``'6. , ' , Pa P proposal and conditions. 3. stegn�re it to be formed in accordance with the above ro I, as owner, or reported gent of owner agree to the above conditions. p SIGNATURE I TITLE �'/ DATE �D •? 3 `0 7n1ES: WAte (PLED); YeUcw (T.,vn HI); Pink Lbg2ia int) I AJ NAMDCOUNTY DEPARTMENT OF HEALTH NO. 61` -89 19 .. 30 w COMPLAINT OR.SERVICE REQUEST RECORD.. TOWN¢'' DATE September 22 1989'.- — gERRED TO - - - -TAKEN BY Bruce Foley' TELEPHONE CALL X IN PERSON LETTER CONFIDENTIAL REQUEST FROM Randy Laurant TELEPHONE 278- 6108,, ADDRESS Engineer- Laurent Eng. ENVIRONMENTAL HEALTH: Home Sewage Rodents Refuse Public Water Food Service Migrant Camp Other COMPLAINT OR REQUEST Lot South of Robin Corporate Park- Old 22 South from 164 to Robin Hill (Sky Lane) Roadon left after subdivision. 3 houses -one is leaking - .bottom of embankment - :level acre - septic leak =- 70 =1 -1.2 3.0 Trembalay .1.1 Foppina.g 2.0 Boelsen: ACTION TAKEN BY % DATE FINDINGS ` FOLLOW UP INSPECTION (s) I 'O) f-e d ;A _W _ DATE _ ....._ _, - - FINDINGS" - 6�ee4 -t -y.x,. wL a idd z AI &*a1c �h0' i/.; . Ones: n �/�I / /.J.d DATE FINDINGS PROBLEM A TE DATE 10 131 911 PERSON NOTIFIED__ It, LA✓ 90 r ESTIMATED TOTAL MAN HOURS SPENT 77 d_ �q l� �b PET KCLEXANDERSON County Executive . L' Public Health Director JOHN KARELL Jr. P.E. DEPARTMENT OF HEALTH Director CERTIFIED Division Of Environmental Health Services RETURN RECEIPT 110 Old Route Six Center, Carmel, New York 10512 REQUESTED (914) 225 -0310 October 5, 1989 John & Helen Roccomo PLEASE REFER CORRESPONDENCE TO: Rd 6 Sky Lane NAME: Thomas J. Carroll Br *a N. Y. 10509 TITLE: Environmental Health Technician PHONE.: (914) 225 -0310 ext. 362 'Pot-, OFFICIAL NOTICE OF NON - COMPLIANCE YOU ARE HEREBY NOTIFIED that non - compliance with Article III Section 3 of the Putnam County Sanitary Code consisting of a discharge of sewage onto the surface of the ground was found at Skylane, Patterson, N. Y., tax map 70 -1 -1.1 by a representative of this Department on October 4th, 1989. It is believed that you are responsible for correction of this condition. If you are not responsible, you are requested to notify immediately the inspector above indicated. Please be advised that appropriate steps must be taken immediately in order that the sewage overflow cease by arranging for the dry well to be pumped out and maintained pumped until the proper repairs are made to the system. Approval of proposed repairs_ must be-obtained from this Department prior to any alteration or rebuilding of existing disposal systems. An application is enclosed. Failure to pump the dry well by October 9th, 1989 and further, to correct this condition by October 17th, 1989, will make you liable for additional penalties provided by law, including prosecution on a charge of committing a violation punishable by a fine or imprisonment, or both such fine and imprisonment, as prescribed by law, in addition to such other action as.may be prescribed. A reinspection will be made.' It is sincerely hoped that the above - mentioned further action will not be necessary and that you will cooperate by securing the correction of this condition. cq) JK /Tcc enc. P A .For the Public Health Director ery, ruly yours, J ` � John Karell, Jr., P.E., Director Environme al Hea h Services � Environmantal Health Technician I b n PETER C. ALEXANDERSON County Executive DEPARTMENT OF HEALTH CERTIFIED Division Of Environmental Health Services RETURN RECEIPT 110 Old Route Six Center, Carmel, New York 10512 REQUESTED (914) 225-0310 October 5, 1989 John & Helen Roc Como PLEASE REFER CORRESPONDENCE TO: Rd 6 Sky Lane NAME: Thomas J. Carroll Brewster, N. Y. 10509 TITLE: Environmental Health Technician PHONE: (914) 225 -0310 ext. 362 OFFICIAL NOTICE OF NON— COMPLIANCE % L Public Health Director JOHN KARELL Jr. P.E. Director YOU ARE HEREBY NOTIFIED that non — compliance with Article III Section 3 of the Putnam County Sanitary Code consisting of a discharge of sewage onto the surface of the ground was found at Skylane, Patterson, N. Y., tax map 70 -1 -1.1 by a representative of this Department on October 4th, 1989. It is believed that you are responsible for correction of this condition. If you are not responsible, you are requested to notify immediately the inspector above indicated. Please be advised that appropriate steps, must be taken immediately in order that the sewage overflow cease by arranging for,the dry well to be pumped out and maintained pumped until the proper repairs are made to the system. Approval of proposed, repairs must be obtained_. from this Department - . prior to. any _. -. aTtera -t ion or - rebuilding--of ex-i-sring dispos•al••--s-y•st- em -s'. - -'An - app-1'ication• -is- -•- •- ••••• enclosed. Failure to pump the dry well by October 9th, 1989 and further, to correct this condition by October 17th; 1989, will make you liable for additional penalties provided by law, including prosecution on a charge of committing a violation punishable by a fine or imprisonment, or both such fine and imprisonment, as prescribed by law, in addition to such other action as may be prescribed. A reinspection will be made. It is sincerely hoped that the above — mentioned further action will not be necessary and that you will cooperate by securing the correction of this condition. For the Public Health Director ,PeryAruly yours, i John Karell,.Jr., P.E., Director JK /TC /jh Environme al Hea h Services cc - John,Calbb ---' enc. Permit Application BY !r- Environm, ntal Health Technician 9: Rdte WO);, Ydkw (TiAn 31); Pli* Uwudut) ;� �, ��., � (i 1 e 1 U- �� .� .��