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Home My WebLink About0932DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 25.40 -1 -40 BOX 10 . IlmT ! ILT-- i ` I a ill 1 r 00932 MFJu*;L,6,Zi •• � 1,D1• •41 loo el OWNER'S NAME �� / /Jim. ` E' ✓/ PHONE 2 7 E� / 2�L SITE LOCATION /t' �h o��A��l o� _ sTl�sd� 'III PEMM PM Ca(plaint �jL-- & Palationship (i.e, owner,tenant, etc.) DATE TYPE FACILITY PROPOSED � PHONE REGISTRATION # Pr pposal (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 from licensed professional engineer or �� registered architect. / Proposal approved Inspector's Signature & Tit] L000sal aoaroved with the following conditions: �►"' 1 M10 -0 MWO r- .777. z � ;77 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 camponents 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 drywalls surrounded by one foot + gravel). e. Installer's name and number. 3. System repair to be perfonmed in accordance with the above proposal and conditions. I, as owner, or a rted ag owner agree to the above conditions. SIGNUME TIME DATE CPI 6: Mite (POD); Yellow Mun ED; Pink Lk l cmit) P('_RP 07 P U T N A M COUNTY DEPARTMENT O F HEALTH NO 41 1 - 9 8 -1 9 -� COMPLAINT OR .SERVICE REQUEST RECD � TOWN Patterson DATE 6/12/98 . REFERRED TO TAKEN BY PM TELEPHONE CALL ___L_ IN PERSON LETTER CONFIDENTIAL REQUEST FROM Unknown TELEPHONE P Z A - , ? 1 ADDRESS ENVIRONMENTAL HEALTH: Home Sewage X Rodents Refuse Public Water Food Service Migrant Camp Other COMPLAINT OR REQUEST Septic leaking into road - O'Brien 36 Kendall Drive..'PUtnam Lake_. Second house on right brown - leaking behind mailbox-41. FINDINGS ....... .. - S FOLLOW UP INSPECT (s) ION r _ G: - -_ - DA - -- �)� F1NLl11VhS "- PROBLEM ABATED r DATE 7- e PERSON NOTIFIED b O ✓Z_ ESTIMATED TOTAL MAN HOURS SPENT 77 .A OWNER'S NAME SITE LOCATION PUTNAM COUNTY HEALTH DEPARTMENT L/ DIVISION OF ENVIRONMENEAL HEALTH SERVICES PROPOSAL FOR SBOM DISPOSAL SYSTEM REPAIR PHONE z -79 %z�L MAILING ADDRESS PERSON PCHD Complaint .# f4.G_ Nam & ationship U.e, owner,tenant, etc.) DATE 3 TYPE FACILITY 0 REGISTRATION # 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 from licensed professional engineer or registered architect. Proposal approved_ Insvector's Sianature & Tit] Proposal Disapproved All 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' diam. x 6' deep drywells surrounded by one foot + gravel). e. Installer's name and number. 3. System repair to be performed in accordance with the above proposal and conditions. I, as owner, or a rted age owner agree to the above. conditions. SIGNATURE TITLE DATE: OPTS: Whine (POD); YeUcw Mun 8I); Pink (1g irmnt) PC -RP 97 A b RECORD OF TELEPHONE CONVERSATION PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmenal Health Services Facility: /� b- Town: Time: // :i) 0 Date: Z2,� I�X Telephone #, Caller's Name: 6A DISCUSSION: j-. 0'6r,�, c---,HA�,O 71'-D l a,4- s -�V i"e-k k 41-- s z ?q- yzCZ-- �� ,t �G -s T r C S � 1 �-z c✓ e��. ��-c w r L- Signed: Date: b 9 Rev. 6/97 %M C � WELL LUV1rLL 1U1v rcLrUAI DEPARTMENT OF HEALTH Division Of Environmental Health--Services PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only STREET ADDRESS. TAX GRIO NUMBER: 4' 3 G a NZ,4 R1 V9 WELL LOCATION WELL OWNER USE OF WELL 1 - primary 2 - secondary NAME: ADDRESS: 1-/'t�,b jg-L,FJ pBIVATE �� /)p C, 0 990 w141nOTRO• `0,5 -f, ❑ PUBLIC gRESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP O ABANDONED ❑ BUSINESS ❑ FARM ❑ TEST! OBSERVATION ❑ OTHER (specify) ❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT _ gpm. /N0. PEOPLE SERVED Jr / EST. OF DAILY USAGE aXWQ gal. REASON FOR DRILLING NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 706 - ft. I STATIC WATER LEVEL ft. DATE MEASURED / DRILLING EQUIPMENT O ROTARY tR COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT O CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE O SCREENED ❑ OPEN END CASING. (�rOPEN HOLE IN BEDROCK O OTHER CASING TOTAL LENGTH ft. MATERIALS: WSTEEL ❑ PLASTIC ❑ OTHER LENGTH.BELOW GRADE ft. JOINTS: O WELDED l8'7HREADED ❑ OTHER DETAILS DIAMETER in. SEAL: XCEMENT GROUT ❑ BENTONITE POTHER WEIGHT PER FOOT lb./ft. DRIVE SHOE YES ONO UNEA: ❑YESNO SCREEN _n GT A I IS LYLrn,�u DIAMETER (in) 'SLOT SIZE LENGTH (it) DEPTH TO SCREEN (it) DEVELOPED? FIRST HOURS SECOND _. GRAVEL PACK ❑ YES ❑ NO GRAVEL SIZE DIAMETER OF PACK in. TOP DEPTH ft. BOTTOM DEPTH It. WELL YIELD TEST It detailed pumping t METHOD: O PUMPED 1 tests were done is in- COMPRESSED AIR , formation attached? O BAILED ❑ OTHER ; ❑ YES ❑ NO WELL LUG If more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM, SURFACE l water Bear- 1n9 wen Dia- m eter FORMATION DESCRIPTION coOE. ft. it WELL DEPTH It, DURATION hr. min. DRAWOOWN ft. YIELD gFm. Surface eo 1� ,t� .41 a5A� kOR j 1/ 6W D� 7o- 4, -P 7c �l•U l ��S X20,3 � �• 3`►0 3 7S' 1t/ G e, -IW4S 37Y D WATER O CLEAR TEMP. QUALITY O CLOUDY HARDNESS O COLORED ANALYZED? OYES ❑ NO ANALYSIS ATTACHED? O YES O NO 10 O'D 70S STORAGE TANK: TYPE CAPACITY GAL._ PUMP INFORMATION TYPE MAKER MOOEI CAPACITY DEPTH VOLTAGE HPiP�IFL� WELL DRILLER NAME 0 �D C2•+��5 /A E�CDj c ADO ESS�� st E Ny /per/ Z./ ,i %7 UEYAKTMEN I UI- HEALI H Division Of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y.. 10512 (914) 225-3641 APPLICATION TO CONSTRUCT A WATER"WELL WELL LOCATION. STREEI NiV1LLA / I Y IAX GRiO NUMBER. 3C ' �rpin�Qrd.i( t�� (Pv71`oLake) 317 � &33r�g -1-1 , af"ek'San WELL OWNER NAME. ADDRESS: ) Wilmot* 1 d yWVSae. 0/16s" (3 P$IVATL I ❑ PUBLIC . USE OF WELL 50 RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP ❑ A ANDONED e 1 - primary ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify) 2 - secondary ❑ INDUSTRIAL ❑ INSTITUTIONAL 0 STAND -BY ❑ MOUNT OF USE YIELD SOUGHT S gpm. /N0. PEOPLE SERVED S� / EST. OF DAILY USAGE .S �D gal. REASON FOR ❑ NEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY ❑ TEST /OBSERVATION DRILLING ® $EPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL WELL TYPE 10 DRILLED E] DRIVEN DUG GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: LOT NO.: WATER WELL CONTRACTOR: Name __60LA 4rfeA&A WCOGAddres s: (�f, �� C'r✓lu�.a,Q `1/L� IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ,IC NO NAME OF PUBLIC -WATER SUPPLY: TOW11 /V /C DISTANCE TO PROPERTY FROM NEAREST WATER.MAIN LOCATION SKETCH & SOURCES OF CONTAMINATION (date) (signature) 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 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: C19 Urn C`'�� r Permit Issuing off ici�l-- -"""�� - - -- Permit is Non— Transferrable i a d i 2n 12,,c 1 + Ok 1,04 r) CL eD Z.LT-1 vi eD I 15 v� P3 Nit 4. 0 r) 3 z o Z Ln vi- vi - r) " Vq a 4. DAVID D. 'BRUEN County Executive DEPARTMENT OF HEALTH Division Of Environmental Health Services December 18, 1986 Aldo Ge-1 so 990 Wilmot Road Scarsdale, New York 10583 JOHN SIMMONS. M.D. Deputy Commissioner Re:- Well Permit # W -66 -86 - 36 Kendall Drive Property Town of Patterson Dear Mr. Gelso: Forwarded herewith is a permit to drill a well on the above captioned pro - perty for potable purposes. You will note that the permit is.to drill the well only and is issued for-one year. .Approval -to place the well in service will be granted upon receipt of the following: , 1.. Well Completion Report for.the new.well. 2. Result•of.Bacteriological Analysis. 3. Information as to the depth of the old well. If you have any questions, please contact me at ext. 241. ry rul yours, J hn Karel I, Jr., P. E. JK:cj Director Environmental Health Services. cc: File TWO COUNTY CENTER - CARMEL,* N.Y. .10512 (914) 225 -3641