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HomeMy WebLinkAbout0658DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23.09 -1 -16 kQ 1. ' 16 r LF Fr �14 -t No .: PUPNAM COUNTY .HEALTH DEPART ,:C DIVISION HEALTH SERVICES PROPOSAL FOR SrWAiE DISP06AL ICI ai lz . Au n p,h y.. PHONE r 9 i 41878 - 6084 �TION Beaa : #'U C.atate.d Road % atten.aon TO vp�.S 2 Box: 313C Bean .NLU 6atatea !Road . PatteAAon, N.Y.. /2563 �TERVIEiaED ALaR,::l�unple (ownea% PCHD Caaplaint# lie M yF :•Name & Relationships (i . e, owner, tenant; etc: ) r,�epf . /6, /!993 • TYPE FACILITY! T R L Late Dwil z i./tg F T on -Sep .Inc. r . ( -1. 4)628 -4526 ahp Sn tai - :INSTALLER,' : __ 3 1 11-include' sketch locating °all adjacent wells): ?a.it :; musb. in same, location and of same type as original sewage disposal system. E. ;,location ,.may: require sii m ttal of proposal from licensed professional engineer! or. Bd architec nataLl .new. . /000 gaL(on pnecaat aepti.c . tank i.n aaine Locat on a.& old tank, i Ledge much La �ound 4►na .Lej, Inspector's Signature & Title ! Date 1.':'• Proposal approved with the following conditions: : -1. Procurement of ;any Town permit, . if ap icable. 2 Sukniision of .as�.built repair sketch .in duplicate showing: a. Owner!S.name. b. Site.Street:Name, Town:and Tax': Map number. s c. Location of.. instailed components tied '. to two _ fixed points (e.0. ,house corners) . Systan description (e.g :- 1250:.gal. concrete septic tank, three precast'6''diam. x 6''deep .d 3 wa. surrounded by: one-:foot + gravel) . `-'+,";,!". Installer's;: name and number. ;;3;Systeii ;repair to be performed in_ accordance with the above proposal and conditions. I,.asr or reported agent of owner agree to the above conditions. SIGNA %Y� l.Lr�- �o,y -t 1 T Gt- �.Q2J2. GATE X / lq�'% YeUcw (T, i z;-." MAHOPAC SANITATION SEPTIC, INC. Septic Tank Service Kennicut Hill Road MAHopAc, NEW YORK 10541 .628-4526 Joseph A. Mantovi U F /0-LO y4dr PLAMC* VJ'*W# 9-3 PUTNAM COUN'T'Y HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEfn M DISPOSAL SYSTEM REPAIR PER'S NAME Al an l�7urtnhu 0 SITE LOCATION Beazt #L.11 Cafatea Road l atteRaon PHONE (9.14J878-6084 TM# MAILING ADDRESS-RD 2 Boz 3/ 3C Bean NL�l Catatea Road l atteaaon, N.Y. 12563 PERSON INTERVIEWED � an Aun hu (ownea) PCHD Caggaint # Name & Relationship (i.e, owner,tenant, etc.) DATE Se ,2t. 16, 1993 TYPE FACILITY ! &Lvate ywe.L Lng PROPOSED INSTALLER Aahopac SanLtatLon Septic, Inc. PHONE (914)628 -4526 Pro (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. Inatall -new /000 gallon naecaat aentLC tank Ln game . ocaiLon as o.(d tank, Lt ledge hock La �ound amaUeA tank wi.0 be uaed. Proposal app Proposal Disapproved Inspector's Signature & Title ate 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 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 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 own or reported agent of owner agree to the conditions. SIGMA ✓ TITLE u. L� DATE k 4f3 PBS: Wiibe (P ED)i Yellow (Ztkn BI); Pink QQ21snt) :po rvhV,4- -Taw 311 3 00n �A j ,. FRED ADAMS, JR. INC. f I' 0 691 Fanners Mills Rd. Carmel, New York 10512 (845- 225 -8123) J � i l v/ - ^17f vo PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES�� Q� PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR YES NO Internal Use Only ❑ "Repair Permit issued in last 5 years in Watershed ❑ Repair within Boyd's Corners, W. Branch or Croton Falls Res. Delegated 9 ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION 'IV Re -AI& f t', 11 0-c—J TM # OWNER'S NAME WA P$04 . / ,i,s 0,*Vy PHONE # MAILING ADDRESS APPLICANT FP_, ,J A i ,4'7 n-s Name & Relationship (i.e., owner, tenant ntrac r) f.Fws- DATE lP `� l''�� FACILITY TYPE PCHD COMPLAINT # PROPOSED INSTALLER` ^e° i �} iJ� j PHONE # ADDRESS 4TI- 1:;�ao+.— S'Atdgr` L"e'j— REGISTRATION /LICENSE # ) .G>Y Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed trenches) NOTE: Repair must be in same location and of same type as original sewage disposal system. Different location and proposed pump systems will require submittal of proposal from licensed professional engineer or registered architect. r G-- '• I, as owner, or reported agent of owner agree to the conditions stated on this form SIGNATURE ZW ~4­e4LAe_, TITLE f --e�e, DATE 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 d. System description (e.g., 1250 gal. Concrete septic tank, etc.) e. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and conditions. Proposal Approved Proposal Denied Inspector's Signature & Titl bat COPIES: White (PCHD); Yellow (Town BI); Pink (Installer), Orange (Applicant) PC -RP 99ML Rev. 8/05 LA SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health June 1, 2006 Donna Janson 44 Bear Hill Road Patterson, NY 12563 Dear Ms. Janson: DEPARTMENT. OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Repair Permit — Janson —. R- 098 -06 44 Bear Hill Road (T) Patterson, TM # 23.9 -1 -16 Per your permit for repair, the following comments are offered. Please contact this Department at the number below to set up an appointment for excavation and examination of the septic system components as noted on your repair. Once a determination has been made as to the repair, the permit will then be revised and signed for such repair(s). To make an appointment or if you have any further questions, please contact me at (845) 278- 6130 ext. 2261. GDR:kly Sincerely, Gene D. Reed Sr. Environmental Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health May 18, 2006 Donna Janson 44 Bear Hill Road Patterson, NY 12563 Dear Ms. Janson: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health Re: Repair Permit —.Janson — R- 098 -06 44 Bear Hill Road (T) Patterson, TM # 23.9 -1 716 As per our discussion during my site inspection; I had stated to you that only an installer that is certified with the PCHD can repair or replace a septic system. If the owner wishes to do the repair as noted on your permit application, than the owner must be the only person involved in the repair. At this time your permit can not be approved until all the information noted on the permit has been fully completed. A new permit has been provided for your use in the event you wish to make any necessary changes. The submission of a revised permit will not require any additional fee. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. GDR:kly Enc. Sincerely, 74 1 Gene D. Reed Sr. Environmental Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early lntervention/Preschool(845)278 -6014 Fax(845)278 -6648 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR ti\ n YES NO Internal Use Only ❑ Repair Permit issued in last 5 years ❑ of in Watershed 11 /Repair within Boyd's Corners, W. Branch or Croton Falls Res. L Delegated ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review 4:�1 l SITE LOCATION d 1 i3ea - A; l [ 2t, ad TM # 37a!J00 23, OWNER'S NAME Ddrilaa Layl., -5011 PHONE # S,'%3-3 / `- 506 MAILING ADDRESS y_� &ejar b�l Fq A,ey -Sc i N y APPLICANT 100 n\r)a �cAr_So OW n-R V— Name & Relationship (i.e., owner, tenant, contractor) DATE 40 D FACILITY TYPE 5oA; e- Su b fQnk PCHD COMPLAINT # PROPOSED INSTALLER S.O PHONE # ADDRESS qY A,,, t II 19,omd �',r REGISTRATION /LICENSE # Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and proposed trenches) NOTE: Repair must be in same location and of same type as original sewage disposal system. Different location and proposed pump systems will require submittal of proposal from licensed professional engineer or registered architect. 4e 1%r1"r) ✓Yt I, as owner, or reported agent of owner agree to the conditions stated on this form SIGNATURE TITLE C Y?CPV— DATE 0 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 d. System description (e.g., 1250 gal. Concrete septic tank, etc.) e. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and conditions. Proposal Approved Proposal Denied Inspector's Signature & Title Date COPIES: White (PCHD); Yellow (Town BI); Pink (Installer), Orange (Applicant) PC -RP 99ML Rev. 8/05 •,ate �,�� r .,1��. � err- 11vr1��F'� ,,�'' A •,� a k t �"rl�� F�.k�e• -pia *E /,� �.�i =•5M s�t�ye ? „ttT •,ate �,�� r .,1��. � err- 11vr1��F'� ,,�'' A •,� a k t PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES ZOPOSAL FOR SEWAGE DISPOSAL SYSTEM - REPAIR YES NO ZZ Internal Use Only U ❑ epair Permit issued in last 5 years ❑ t in Watershed ❑ Repair within Bo yd's Comers, W. Branch or Croton Falls Res. Delegated P Y ❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review SITE LOCATION 44 'P ,eG1,f..pH 1l � TM #- 2 /y/ OWNER'S NAME �QI'l�l�i �GtV15t1n PHONE# MAILING ADDRESS APPLICANT b 0 n nl l � amxkl Name & Relationship (i.e., owner, tenant, contractor) DATE _rj�i,� FACILITY TYPE PCHD COMPLAINT # PROPOSED INSTALLER PHONE # 6LrV,1JIe1, -3001 ADDRESS I-} 4?X4C W1 � d t { -i°_1r 3h, �l`� REGISTRATION /LICENSE # �3 Proposal (include a separate sketch locating the house, property lines; all adjacent wells within 200 feet of repair and the location of existing and proposed trenches) NOTE: Repair must be in same location and of same type as original sewage disposal system. Different location and proposed pump systems will require submittal of proposal from licensed professional engineer o,r registered architect. ^ I, as owner, or reported agent of owner agree to the conditions stated on this form SIGNATURE TITLE Ow-in e y- Proposal approved with the following conditions: 1. Pr nt of an Town Perm�ifa l2 . Srepair sk a. Owne 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, etc.) e. Installers' name and phone number 3. System repair to be performed in accordance with the above proposal and conditions. Proposal Approved Proposal Denied Inspector's Signature & Title Date COPIES: White (PCHD); Yellow (Town BI); Pink (Installer), Orange (Applicant) PC -RP 99ML Rev. 8/05 DATE �J 0 � aa Aa 9v v 4 A ^ � M •� , OQ' 8 i #a r , i a ' !® k I y 0 !o ' D � a sAli �� e oil k � Q W Q CO^ Q Q N w v IX a Q V o O R ati �Q Oy V -3 /4 1 qeevv pt-ge-� - FRED ADAMS, JR- INC. 691 Farmers Mills Rd. Carmel, New York 10512 (845-225-8123) ri Sheet _of_� PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEATLH SERVICES FIELD ACTIVITY REPORT fil,&'Ju l..�• -._ _ - • nTlnr.ro• 11q '9,647E &U e- %ZI, PALn L?- .'>o.,/ A),-)I. HI/1111f 11• Street Town State Zip PERSON IN CHARGE ���/7 ��1 i T TNT -RVTL^�STF - /L�� LL n/I� /'1 T�AtP.. Name and Title �7 TYPE OF FACE.ITY •,pQ, y^ FINDINGS: PtO Dos k5 46 a.a— cal �`le 4>acr''w v�rF('T(1 �• Ci�� F TFT Signature and Title RFP0RT'Rrn,rrTVET) Uy. I acknowledge receipt of this report: SIGNATURE; 02/96 Title;