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04013
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OWNER'S NAME
SITE LOCATION
PUTNAM HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
f PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR''`
tG N ¢i 1 R -' PHONE
6 �;Z 1 C-.4-5-A/JT TM#
MAILING ADDRESS �AMF
PERSON INTERVIEWED PCHD Complaint #
31j Name & Relationship (i.e, owner,tenant, etc.)
DATE AA / 9 % TYPE FACILITY
PROPOSED INSTALLER ::�A TUCC" �' 60A) -5-7 PHONE Sao 3700
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. - - -- _
leg
Proposal approved Proposal Disapproved
Inspector's Signature & Title
roDosal amroved with the followinq 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 canponents tied to two fixed points
d. System description (e.g., 1250 gal. concrete septic tank,
drywells surrounded by one foot + gravel).
e. Installer's name and number.
_Z
Date
(e.g. house corners).
three precast 6' diam. x 6' deep
3. System repair to be performed in accordance with the above proposal and conditions.
I, as owner, or reported t fawner gree to the above conditions.
SIGNATURE TITLE DATE y y
EM: V&te (FAD); YeUc w (Tam HE); Pink 04licent)
PER FOC
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nlIPUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
v 225- 3838/225 - 3833/225 -3641
PROPOSAL FOR SEWAGE DISPOSAL SYSTEM_ WAIR
OWNER'S NAME
SITE .LOCATIO
(I 141 6zi3 -5020
85-2 -zz- 6,1 .
MAILING ADDRESSyj. -
PERSON INTERVIEWED PCHD Complaint #
Name & Relationship (i.e, owner,tenant, etc.)
DATE TYPE FACILT L7 '
. D 49 0 M f I DI'
(0
ff
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 fran licensed professional engineer or
registered architect.
Proposal approved
Inspector's
Proposal Disapproved
& Title
with the following conditions:
Date
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 canponents 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 reported agent of er agree to the above Aconditions.
SIGNATUREQ TITLE dVV DATE
FW: Vbite (FM); Yellow (Tatin HI); Pink (.A OICEint)
PLf` NAM Cy-)T HEALTji DEPARTMENT .
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
John M• Simmons, M.D.
Deputy Commissioner of Health
- FIELD ACTIVITY REPORT -
110. Street Town TH No.
MAILING ADDRESS
P.O. Box 4Post,Office Zip Code
TELEPHONE
%0'' No, I I �' IRA,! W 14 5
"Name and Title
DATE TYPE FACILITY
TIME ARRIVED® TIME LEFT ®�
Sheet of
INSPECTION
Orig. Routine
0 g. Complain
ig. Request
Compliance
Complaint Comp
Final
_ Group Illness
Construction
Reinspection
Field, Sampling Only
Field Conference
Other
Explain
INSPECTOR:
PERSON IN CHARGE OR INTERVIEWED:
I acknowledge this Field Activity Report. SIGNATURE:
TITLE:
PETER C. ALEXANDERSON
County Executive
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(914) 225-0310
April 20, 1990
CERTIFIED RETURN RECEIPT REQUESTED
PLEASE REFER CORRESPONDENCE TO:
Debra Salch NAME: William Hedges
RD #1 315 Pleasant Rd. TITLE: Public Health Sanitarian
Lake Peekskill, NY 10537 PHONE: (914) 225 -0310 ext. 319
DATE: April 20, 1990
OFFICIAL NOTICE OF NON COMPLIANCE
- - -- -- - - - - -- -- - -- -- - - - - --
JOHN KARELL Jr., P.E., M.S.
Public Health Director
YOU ARE HEREBY NOTIFIED that non - compliance with Article III Section 3 of the Putnam County
Sanitary Code where evidence of sewage, discharged from the amalt pipe onto the surface of the
ground was found at your residence, Pleasant Drive, by a representative of this Department on
April 18, 1990. The four inch PVC line between your residence and the septic tank is
disconnected in several places. This line must be repaired and buried or adequately protected.
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 septic tank 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 of
rebuilding of existing disposal systems. An application is enclosed.
Failure to correct this condition by April 27, 1990 will make you liable for additional.penaltie:
provided by law, including prosecution on a charge of committing a violation punishable by a fink
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 vill not be necessary and that you
will cooperate by securing the correction of this condition.
For The Public Health Director
Very truly yours,
John Karell, Jr., P.E. .
Director, Environmental Health Services
rK /WH /jp By: William Hedges
?nc: Permit Application Public Health Sanitarian
BI (T) Putnam Valley
. .
NOV I an 0 0 F;aaoc 1 9�-raa
CONSULT2NQ E/QSINFERK n. o
ELVIN'S LANE
GARRISON, NY 10524
(914) 245-6320
|
/ (914) 424-3560
October 14, 1986
PUTNAM COUNTY BOARD OF HEALTH '
2 County Center '
Carmel, NY 10512 `
Attn: Mr. John Karrell, P.E.
Re: SALCH Property, Putnam Valley, NY
Dear Mr. Karrell:
I am writing this letter to you to request permission to
effect a repair on the septic system servicing the Salch
` residence locatated on Pleasant Road, in the Town of Putnam
Valley. Presently the septic tank is overflowing and sewage
effluent is coming to the surface of the ground. We have reason
to believe that the fields have become clogged with the passage
of time and are therefore requesting permission to repair and or
replace th e sysbem system as needed.
Attached is a copy of a survey of the property showing the
surrounding wells and the septic location. We would like one of
your'inspectorsto meet us at the site to review the situation so
that we can correct this unhealthy situation as soon as possible.
' All repair work performed will be supervised by this office.
`
. . -_Sincerlyyours,'
-'------ ~~^ - ----'-- '---� - ' ' ''-----lMdt*t-he�i-A.-NbVi61Ib,-T;ET-
| cc: Ms. Debra Salch
| /
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,
I PUTNAM COUNTY HEALTH DEPART
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
225- 3.8;A/2257,383?53;H�'r'=
PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR
SITE LOCATION f1
MAILING ADDRESS
I 9+_ ,
owner,tenant, etc.)
TYPE FACILITY
Complaint #
PHONE
_mss
p3 °07 - 40 9 9
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. _
%� ee�',pd,yG�' �X�s7"i.✓� S� P�"�e 5���-Ei�1 �`�i�G
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M
24,01-
*0-0 Proposal Disapproved
T I-
tle Datet
Promsal 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
d. System description (e.g., 1250 gal. concrete septic tank,
drywells surrounded by one foot + gravel).
e. Installer's name and number.
(e.g.,house corners)•
three precast 6' diam• x 6' deep
3. System repair to be performed in accordance with the above proposal and conditions.
E as owner, or reported agent of owner agree to the above conditions.
;IGNATURE Ju TITLE �J %�QJL • DATE l0
IES: W-fte (KID); YeUcw (Tam HI); Pink (Applicant)
PAOAE,ery of
y6BRN S.vL�H
Box &I-r
PLEASAnrT ,PoAy
P/JTn/Anl 1�ALLEr� . ✓.�. ;•v.T %9
e I-PC j
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Wore : i9Ny NEW +/ELL yR / <LE,� oor
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94R�otLV��nf6- .gEO7 ":C. sy.rTE�7 i9.✓.�
F�Coary THE .�EpA f+fs� sy9TE Try ,i✓ctc
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CERTIFIED TO: -M AND 4,0rf .0.4ae4- Xr, AS Ch.'A.W ON
_A6rAL_y0&A jf '�y AfA.01 XVr1rzX'0 ".1.4" �VAAM&z f4r4710NX'
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cy &A., 4410 AMP BEING AIL449 1A1 C041A-rY CXje,&.r,
I?r,C;F 1Af.V&&A&CX Pwwwhi eouwry, _-.44,wzz N.Y. AS Am,-olpno
Certifications hereon are valid for Bank, SURVEY OF PROPERTY
SURVEYED:- Z-9" Title Co. & Owners for this transaction
BROUGHT TO DATE only. Certifications are not transferable to FOR
subsequent Bank, Title Co. or Own,,,
'13 ROUG t.i T-- Tq - D
2' — _'. .. r .1. . , '6 'q. ;';' Z.,
All certifications hereon are valid for this
map and copies thereof only if said map or
JOHN SALVATORE ROMEO copies bear the impressed seat of the sur. SITUATE IN THE
Ellgincel- & Land Sioveyar veyor whose signature appears hereon. 7'0,WW OF RurNwN V.4&Z)
1 NORTHRIDGE ROAD "if is hereby certified that this survey was ParN.4,0 COUNTY
PEEKSK
,�ILL. N. Y. prepared in accordance with the existing NEW YORK
Code of Practice for Land Surveys adopted
by the New York State Association of Pro-
ry
a
a
Bill Catucci
27 Wood Street
Mahopac, NY 10541
Dear Mr. Catucci:
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
4 Geneva Road, Brewster, New York 10509
(914) 278 -6130
December 15, 1995
pRUCE. R. F01_EY, R.S..
Acting Public Health Director
W/
Re: Addition -
No increase in number of
bedrooms
I have received and reviewed the plans for the proposed addition to the above
mentioned residence.
The proposal for the addition has been approved as per plans bearing the latest
revision date of December 12, 1995 and this Department's approval stamp.
Based on the information submitted, the above mentioned addition is approved with
the following conditions:
1. The total number of bedrooms must remain at one without prior approval by
this Department.
2. The area of the existing sewage disposal system, and its expansion..area, must..
be maintained-. .
�AT —plumbing fixtures must be updated with water saving devices, i.e., new
low flush toilets, restrictors for shower heads and faucets, etc.
Any other permits or variances required are the responsibility of the applicant
and the jurisdiction of the Town of Carmel.
If you have any questions, please contact me at your convenience.
Very truly yours,
9b evv Ao�
Robert Morris, P. E.
Public Health Engineer
RM/jp
cc: BI (T) Carmel
PUTNAM VAUT
MARVIN O'DELL PUTNAM VALLEY, N.Y.
Bldg, inspector (914) 526 2377
BETTE STOCKINGER
JOHN MAHONEY Bldg. Dept. Clerk
Deputy Zoning Inspector TOWN OF PUTNAM VALLEY
BUILDING, ZONING, AND SANITARY DEPARTMENT
Putnam County
4 Geneva Road
Brewster, N.Y.
Gentlemen:
November 17, 1995
Dept. of Health
10509
RE: Room Status
62.Pleasant Rd.
TM#83.65-1-38
A review of records within this Town regarding the
above noted property reveals the existing home
destroyed by fire consisted...of:.'one.bedroom and laundry
on lower level with a living room and kitchen on
upper level.
Please-.1 ind, attached. a- c.opy- .o.f _floor ..plans-.j.or
'
each_
-16vel whic h - we re taker frau our -ffotwtd-s-
_
Very truly yours,
MARVIN O'DELL
Building & Zoning Inspector
MO'D: es
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5URVLY OF PROPERTY
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JOHN SALYATORE ROMEO
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: Division Of Environmental Hq..*h Services
TWO COUNTY CENTER - CARMEL, N.Y.. 10512 (914) 225 -3641
_. _...
,... EiTs 1� _ T C_
CC45I. T CT ; �� .A•P•
WELL LOCATION
STRUI AOURESS. 1UWNiv1LLA JC1 Y W-URW NUn16ER.
,3 .S V-, M-AVI 1clC8g -2 -22 - (o.
WELL OWNER
NAME
ADDRESS:
3(S s
PUBL(
IC
US LL
JRIESIDENTIAL ❑ PUBLIC SUPPLY
❑ AIR /CONO. /HEAT PUMP
❑ ABAN06NED
- primar
❑ BUSINESS ❑ FARM
❑ TEST /OBSERVATION
❑ OTHER (specify)
= secondary
❑ INDUSTRIAL ❑ INSTITUTIONAL ❑ STAND -BY
❑
MOUNT OF,USE
YIELD SOUGHT gpm. /N0.
PEOPLE SERVED EST'
DAILY USAGE �`�� gal.
REASON FOR
Q'YEW SUPPLY
❑. PROVIDE ADDITIONAL SUPPLY
❑ TEST /OBSERVATION
ORILLING
❑ REPLACE EXISTING SUPPLY
❑ DEEPEN EXISTING WELL
WELL TYPE I 2_q--DRILLED DRIVEN M DUG GRAVEL F� 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 O)l*�) AKIV-4004V Address : P -rk (A mA
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _ NO
NAME OF PUBLIC -WATER SUPPLY: Z4ik fkkW TOWN /V /C
'DISTANCE TO PROPERTY FROM NEAREST WATER..MAIN
LOCATION SKETCH & SOURCES OF CONTAMINATION
(date) I ( sign ature)
PERMIT .
TO CONSTRUCT A WATER WELL
This permit to construct one water well asset 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: 19�v
Permit Issuing Offi ial
Permit .-is .Non- Transferrable
A C�
a" PUTNAM COUNTY. :HEALTH DEPARTMENT
DIVISION OF- ENVFRONMENTAL HEALTH SERVICES
John M. Simmons, M.D.
Deputy Commissioner of Health FIELD ACTIVITY REPORT'- Sheet of
INSPECTION
NAME; Orig. Routine
Orig. Complain
ADDRESS It U� cft� -f Orig. Request
No. Street Municipality (T .)(V)-(C) Compliance
Complaint Comp
MAILING ADDRESS Final
P.O. B'ox 'Po.st,Office` n' Zip Code Group Illness
Construction
TELEPHONE }
_ Reinspection
PERSON 'IN CHARGE Field, Sampling Only
ORfiITERVIEWED Field Conference
Name and, Title
Other
DATE_ = TYPE FACILITY
TIME ARRIVED TIME LEFT Explain
FINDINGS:
✓� ? 2_A__ t d r i. rb'� , I fi r. _ep
INSPECTOR. �J`�L�Cy -�
.,.Signature and Title
PERSON IN CHARGE OR INTERVIEWED:`
I acknowledge receipt of a copy o €- this
Field Activity- Report.., ....
SIGNATURE:
'TITLE :,'
TELEMUNL:.
PETER C. ALEXANDERSON
County Executive
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
x....;..;� := :, , :.-• > :;;;�: - „ -»:
110 Old Route Six Center, Carmel, New York 10512
(914) 225-0310
September 14, 1987
Debra Salch
RR #1 #315
Pleasant Road
Lake Peekskill, New York 10537
Dear Ms. Salch:
JOHN SIMMONS. M.D,
Deputy Commissioner
JOHN KARELL, Jr., P.E.
Director
As you know this Department issued you a permit to drill a water well on your
property located on Pleasant Drive, Lake Peekskill.
The permit was issued based on your proposal to construct a new sewage disposal
system on your adjoining eleven lots located on Tanglewylde Road, Lots 100 thru
111 inclusive.
A review of our records and a field inspection on September 9, 1987, revealed
there has..been no .permit ,issued .and the.. sewage_ disposal ._sys-tem.has•--not:.beer�:
..� .. d _ o
As you know, this Department requires that all new wells meet minimum
restrictive distances. Your permit was issued based on your assurance that the
sewage disposal system would be replaced greater than 100 feet fran your new
well. Therefore, plans for the new sewage disposal system must be submitted to
this Department and the system constructed- as - soon -as possible. The system
must be constructed and approved prior to using the well. Please contact this
office so that approval and construction can begin.
If you have any questions, please feel free to contact me at your convenience.
Very truly yours,
William Hedges, Jr.
Sr. Environmental Health Technician
WH:mk
cc: M. O'Dell, BI
PETER C. ALEXANDERSON
County Executive
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(914) 225 -0310
Mary Fichtl
Box 244
Lake Peekskill,
New York 10537
RE: Water Supply
Pleasant Road
Lake Peekskill
Putnam Valley (T)
Dear Mrs. Fichtl:
JOHN SIMMONS, M.D.
Deputy Commissioner
JOHN KARELL, Jr., P.E.
Director
Pursuant to our telephone conversation, please find a copy of
the file materials on the " Salch Well" for your information.
It is noted that this permit was issued conditional upon Mrs.
Salch relocating her sewage disposal system to the rear of
the house.
Recently, it has.been brought to our attention that the well
has been drilled, but the sewage system has not been
relocated. You should be aware that we will be actively
pursuing this matter with Mrs. Salch.
Relative to your problem with your water supply,as we
discussed, the problem could be caused by failure of a
component of your internal plumbing system as opposed to the
drilling and use of the well on the adjacent property. When
a date and time is finalized for inspection of your water
system by a well servicing contractor, please contact the
writer at Ext. 304, in order that I may arrange to have a
member of my staff present.
JK : pt
cc: Thomas Gaffney
Marvin O'Dell
JK
File
Ve t /ul yours,
Jb'hn Karel,, Jr. , P. E.
Director,
Environmental Health Services
(T) Building Inspector
i
DEPARTMENT OF HEALTH
Division Of Environmental HojAh Services
TWO COUNTY CENTER - CARMEL, N.Y..10512 (914) 225 -3641 �
,,I-
APPLICATION TO CONSTRUCT A WATER WELL
WELL LOCATION
SIREEI AUUHLSS. WWRIVILLAGEIUiT IAZ GAW NUMAR.
9PI p7ox�
WELL OWNER
NAME
P;e
AOORESS.
-
`
r
®'PgIV TE
o Pusuc
US LL
JRIESIOENTIAL O PUBLIC SUPPLY O AIR /COND. /HEAT PUMP
O ABANDONED
- rimar
O BUSINESS ❑ FARM
❑ TEST /OBSERVATION
O OTHER (specify)
- secondary
❑ INDUSTRIAL ❑ INSTITUTIONAL O STAND -BY
0
MOUNT OF USE
YIELD SOUGHT ,6 -- gpm. /NO.
PEOPLE SERVED 2. • / EST.
OF DAILY USAGED• gal.
REASON FOR
.15r�EW SUPPLY
❑ PROVIDE ADDITIONAL SUPPLY
❑ TEST /OBSERVATION.
DRILLING
O REPLACE EXISTING SUPPLY
❑ DEEPEN EXISTING WELL
WELL TYPE
DRILLED . - F-1 DRIVEN
- [__� DUG [:] GRAVEL OTHER
IS WELL-SITE SUBJECT TO FLOODING? _ YES Jel NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: -
LOT NO.. n
WATER WELL CONTRACTOR: Name /11JV'r, ,Address: T NAM
IS PUBLIC MATER SUPPLY AVAILABLE TO SITE:.''. o_ Y$S NO
4 NAME OF PUBLIC -WATER SUPPLY: ,� XAi1LF�t��•1' TOWNZ /V %C n
DISTANCF.-,•TO•-•PROFERTY-FROM NEAREST .WATER•:MAiN-- . -...:3
-
CONTAMINATION
..LOCATION SKETCH & SOURCES OF .
. � -
^g�o �v/►'_\
(date) (sigl ature)
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: (:' �3D 19<'
• Permit -Issuing Offer i.al
Permit.•is.Non- Transferrable
3
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'407.
APPLICATION
TO: RECORDS ACCESS OFFI
FOR PUBLIC ACCESS TO RECORDS
CER DATE:
Name of Agency
Address
l tq/ � /2
,
I HEREBY, APPLY TO INSPECT THE FOLLO:•7ING
a
EPH k. PELOSO, JR. , PUBXIYC'
INFORMATION OF FICVEER : ill
Signature
xepresenz_nu
?PROVED —
DENIED
Filch
Record of which this. agency is Legal Custodian cannot be found.
Rtll is m i a Tied by this Agency
S a ur 1_tIe Dat�
NOTICE: YOU HAVE A RIG'.-:-T TO APPEAL A DENIAL OF THIS APPLICATION TO THE
PUTN.A 4 COUNTY:•EXECUT =V7 .
Nam_
Business Address
WHO MUST FULLY EXPLAIN HIS REASONS FOR SUCH DENIAL IN WRITING SEVEN DAYS
OF R,CEIPT• OF P.N APPEcL.
I HEREBY APPEAL:
Sicnature
Date
Name --and Title
TYPE FACILITY
INSPECTION
Orig. Routine
Orig. Complain
Orig. Request
Compliaince
Complaint Comp
Final -
p Code Group
Illness
Consr-ruction
Reinspection
'Fiel
JLV amp ing'*Only
Field Conference
Other
A
INSPECTOR:
TELE' PHONE,:.
Signature and Title
OR INTERVIEWED:
PERSON IN
. -,CHARGE
'receipt of a c---
I acknowl this
"copy 0
SIGNATURE:
.,Field Activity Report...... .. .......
TITLE:
PUTNAM COUNTY DEPARTMENT OF HEALTH /j NO. 38`88
COMPLAINT OR SERVICE REQUEST RECD
DL,/
-�.:, en'...._. .� �.. .'.i:-:.i'+F "i ::.�.-' c +v �•F'w�' K':=: a .'..::::.:o�`�^w.vai�•i.= 1::r,. ,,. o- �+� °•:.� "_'.i _..... F•. =:7 :- .�n.:� i:: .... .moo+
~TOWN Putnam Val1 w DATE 1/20/g8 REFERRED TO
TAKEN BY LW TELEPHONE CALL_ IN PERSON LETTER
CONFIDENTIAL
REQUEST FROM Anonymous TELEPHONE
ADDRESS
ENVIRONMENTAL HEALTH: Home Sewage XX Rodents Refuse Public Water Food Service
Migrant Camp Other 38
COMPLAINT OR REQUEST Salch on Pleasant Rd in Lake Peekskill was issued a well hermit
isoa
but does not have a "nroDer" sewage fs a a -system,
ACTION TAKEN BY DATE
S SGa /G ' 2 I&/:,�c
.FOLLOW-UP-
I NSP9CTION (s)- .. -'— •.—
DATE FINDINGS _~S "J�:S ✓,_,...� :Q.� -�yf �L�,'�, __ - --
�/� �� ��.- � � � � sus �� U,` -o �--- - •�
DATE
FINDINGS
PROBLEM ABATED
DATE fWPERSON NOTIFIED
ESTIMATED TOTAL MAN HOURS SPENT
77
sve,
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