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MAILING ADDRESS
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PERSON INTERVIEWED PCHD Camplaint #
Name & Relationship (i.e, owner,tenant, etc.)
DATE TYPE FACILITY:
PROPOSED INSTALLER PHONE
REGISTRATION #
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.
Proposal approved Proposal Disapproved
Inspector's Signature &
tle
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
drywells surrounded by one foot + gravel).
e. Installer's name and number.
L System repair to be performed in accordance with the above proposal and conditions.
I, as owner, or rbported agent of owner agree to the above conditions.
SIGNATURE TITLE
7
CPM: *dte (PAD); Mow ('Ibwn BI); Pink (Applicant)
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PUTNAM COUNTY DEPARTMENT OF HEALTH Compla, J, N0.
x-98 -1 g
COMPLAINT OR SERVICE REQUEST RECORD
TOWN _ Patterson DATE 5 / 2 0 / 98 - REFERRED TO
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TAKEN BY ML TELEPHONE •CALL X IN PERSON LETTER
CONFIDENTIAL
REQUEST FROM Chandler Reich TELEPHONE 27g -4441
ADDRESS 10 Lakeport
ENVIRONMENTAL HEALTH: Sewage Nuisance X Public Health Nuisance
Chemical Emergency Individual Water Other
COMPLAINT OR REQUEST
Septic odor from 13 Lakeport, Clark residence.
ACTION TAKEN BY DATE s
FINDINGS
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PROBLEM ABATED
DATE /0 1 PERSON NOTIFIED C, , c�L.
ESTIMATED TOTAL MAN HOURS SPENT Z �%
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Shect of
PUTNAM COUNTY DEPARTMENT OF HEALTH
- DIVISION OF ENVIRONMENTAL, HEATLH SERVICES
FIELD ACTIVITY REPORT
NA Tel•
AT)nRFC4e
Street Town . State Zip
PERSON IN CHARGE ______
nR TNTFR VTFwFn: Tarp:
Name and Title
TYPE OF FACILITY:
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-� FINDINGS
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Signature and Title
RFPnRT REC F.TVFn_RY:
I acknowledge receipt of this report: SIGNATURE:
02/96
Rev.
BOTTGE SEPTIC, INC.
5 SODOM ROAD BREWSTER, NEW YORK 10509
Mail to P.O. Box 766 •
Tel: (914) 270-6069 • Fax: (914) 279-2872
SEPTEMBER 23,1998
MR. CHARLES CLARK
#13 LAKEPORT DRIVE
PATTERSON, NEW YORK 12563
ESTIMATE
REFERENCE: INSTALLATION OF NEW DRYWELL AT ABOVE RESIDENCE.
INSTALLATION OF (6) SIX HI CAPACITY INFILTRATORS
WITH STONE,- CONNECTEDiTO EXISTING 2 "-GALVANIZED
PIPE. NEW DRYWELL INSTALLED TO REDUCE AMOUNT
OF WATER CURRENTLY DISCHARGING TO EXISTING SEPTIC
SYSTEM. CUSTOMER RESPONSIBLE FOR CONNECTION OF
HOUSE PLUMBING TO DRYWELL. DISTURBED AREAS TO BE
MACHINE GRADED.
PRICE: $ 1,700.00
50% DEPOSIT REQUIRED PRIOR TO COMMENCEMENT OF
WORK, BALANCE DUE UPON COMPLETION.
NO PROVISIONS IN ABOVE PRICE FOR ROCK, WATER,
EXISTING DRAINS, OR UTILITIES.
Ej
WILLIAM BOTTGE
L PRESIDENT
7
- BOTTGE SEPTIC, INC.
- - - - -- - - _ . - -
5 SODOM ROAD BREWSTER, NEW YORK 10509
Mail to P.O. Box 766
Tel: (914) 279 -6069 • Fax: (914) 279 -2872
SEPTEMBER 23, 1998
MR. CHARLES CLARK
#13 LAKEPORT DRIVE
PATTERSON, NEW YORK 12563
ESTIMATE
REFERENCE: INSTALLATION OF NEW DRYWELL AT ABOVE RESIDENCE.
INSTALLATION OF (6) SIX HI CAPACITY INFILTRATORS
WITH STONE, CONNECTED TO EXISTING 2" GALVANIZED.
PIPE. NEW DRYWELL INSTALLED TO REDUCE AMOUNT
OF WATER CURRENTLY DISCHARGING TO EXISTING SEPTIC
SYSTEM. CUSTOMER RESPONSIBLE FOR CONNECTION OF
HOUSE PLUMBING TO DRYWELL. DISTURBED AREAS TO BE
MACHINE GRADED.
PRICE: $ 1,700.00
50% DEPOSIT REQUIRED PRIOR TO COMMENCEMENT OF
WORK, BALANCE DUE UPON COMPLETION.
NO PROVISIONS IN ABOVE PRICE FOR ROCK, WATER,
EXISTING DRAINS, OR UTILITIES.
WILLIAM BOTTGE
PRESIDENT
RECORD OF-TELEPHONE CONVERSATION
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmenal Health Services
Facility: f) o Town:
Time: / - DO Date: Telephone # F.-7q —4-
Caller's Name: , 14.7 lam. z -�-. /,Z, l / /-S,)
DISCUSSION: rs�-{�
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Signed: Date: Rev. 6/97
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road
Brewster, New York 10509
Tel. (914) 278-6130 Fax (914) 278-7921
Chandler Reich
Lakeport Road
Pa te_r nY 12563
Re: Water Quality
Dear Mr. Reich:
July 9, 1998
BRUCE R. FOLEY
Public Health Director -
Water samples were collected from your property at 10 Lakeport Road, Patterson, New York on June
22, 1998 and June 25, 1998.
The results of the bacterial analysis indicates that the water was not of satisfactory quality at the time
the sample was collected.
Al water for drinking and cooking purposes must be boiled for 5 minutes before use or bottled water
and packaged ice from an approved source may be used.
Enclosed please find a procedure for Disinfection of Well. Please notify me 10 days after the
procedure is completed and I will resample the water.
Should you have any questions relative to this matter, do not hesitate to contact me at this office.
Very truly yours,
Michael Luke
Public Health Technician
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RECORD OF TELEPHONE CONVERSATION
PUTNAM COUNTY - DEPARTMENT OF HEALTH
Division of Environmenal Health Services
Facility: La L,- , -� � r • Town •
Time: ° Date: 2 i Telephone #
Caller's Name: /r r. C ( 0.
DISCUSSION:
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Signed: `�� Date: ��Z� % �' Rev. 6/97
Sheet of 1
PUTNAM COUNTY DEPARTMENT OF HEALTH
- DIVISION OF ENVIRONMENTAL HEATLII SERVICES
FIELD ACTIVITY REPORT
NAME: C (& r k— TPI.
ADDRRgq: L- 0.IL� 1 r r. I�cx _ V" %
Street Town State Zip
PERSON IN CHARGE %
OR TNTFRVTF.WFT-): - -__ _ Tate_ yh I / 17
Name and Title
TYPE OF FACILITY:
FINDINGS: /7�o C r y r�� %,�S -e eW. c�un L 5'irn c- -e-
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Signature and Title •
R.RPQRT RFCF.TVRT RV:
I acknowledge receipt of this report: SIGNATURE:
02196 Title;
RECORD OF TELEPHONE CONVERSATION
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmenal Health Services
Facility: Le, 4 av rJ— Town: f ",-4
Time: '7� = `� Date: Y 9 F Telephone #
215- 3� ?c)/-`
Caller's Name: m'Z---,
DISCUSSION: C (- %
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Signed: ��� "` Date: �' 3 %� Rev. 6/97
Sheet Of_�
PUTNAM COUNTY DEPARTMENT OF HEALTH
_ ...._.._ ...• DIVISION OF ENVIRONMENTAL- HEATLkI SERVICES - - - -
FIELD ACTIVITY REPORT
NAME, C TPl•
ADDRESS: Lc poi ^T �ti fVY
Street Town State Zip
PERSON IN CHARGE
nD TTTT1rDXTMX1M1T%.
Name and Title
YPE OF FACILITY:
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Signature and Title
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I acknowledge receipt of this report: SIGNATURE:
02/96
Rev.
Title:
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
COUNTY OF PUTNAM- STATE OF NEW YORK
IN THE MATTER OF THE COMPLAINT AGAINST:
-- Charles Clark-,
RESPONDENT(s),
Arising out of the Alleged Violations of the Public
D1 Cdr.
No
L � �
Health Law of the,State of New York, the Sanitary NOTICE OF HEARING
Code of the State of New York, the Sanitary Code CASE #025 -9849
of the County of Putnam, and Administrative Rules,
Regulations and Standards Promulgated Pursuant Thereto:
TO: Charles Clark PREMISES: 13 Lakeport Drive
13 Lakeport Drive Patterson, NY 12563
Patterson, NY 12563 TM #25.55 -1 -45
PLEASE TAKE NOTICE THAT CHARGES have been preferred against you to the effect that you
have violated the health laws as more fully. set forth on the reverse side of this notice:
YOU ARE HEREBY SUMMONED TO APPEAR at a hearing to be held under the provisions of
the Putnam County Sanitary Code and Public Health Law of the State of New York before Earle
Warren Zaidins, Esq., an Administrative Law Judge of the Department of Health of the County of
Putnam on the 2nd day of September 1998 at 11:30 AM, 'in the Hearing Room, located at Route 312,
4 Geneva Road, Terravest Corporate Park, Brewster, New York, at which time the charges will be
informally discussed, and such adjourned dates as may be designated:
AT ALL TIMES YOU WILL HAVE THE RIGHT to be represented by counsel and the right to
deny the charges, in whole or in part, following which the m4tter will be rescheduled to a date certain
and a Formal Hearing will be conducted thereon, and a record of all the proceedings will be made,
witnesses will-be sworn-and examined and cross examined, and documentary evidence maybe offered
and received, and you may produce witnesses and evidence in your behalf;
IN THE EVENT YOU WISH TO ADMIT TO THE CHARGES, the Hearing may be terminated
by written stipulation of discontinuance provided the violations have been corrected;
UPON YOUR FAILURE TO APPEAR, a warrant compelling your appearance may be issued or
an Inquest Hearing conducted and a determination made;
CIVIL PENALTIES up to $1,000 for a single violation, per day, may be assessed against you, and
such further orders' may be made herein as the circumstances may warrant; THE BOARD OF
HEALTH may issue a warrant to any Peace Officer of the county, pursuant to Section 309 of the
Public Health Law, to bring to its aid the power of the County whenever it shall be necessary to do
so, with the same force and effect as if such warrant had been issued out of a court of record.
DATED: August 10,.1998
Brewster, NY 10509
PUTNAM CO 1TY BOARD OF HEALTH
BY: _
Bruce
Public
Foley, R.S.
:alth Director
STATEMENT OF CHARGE
IT IS HEREBY ALLEGED THAT THE PERSONS HEREIN BEFORE NAMED RESPONDENTS
- -- are charged with- violations of-the'Health-Laws of the -State ofNew York arid" the County of'Putriam as
follows:
PUBLIC HEALTH LAW OF THE STATE OF NEW YORK
Violations of any and all provisions of the Public Health Law of the State of New York and the State and
County Codes and Administrative Rules and Regulations promulgated pursuant thereto - which shall be found
to constitute a NUISANCE, particularly, and not limited to the provisions of Article 13 of the Public Health
Law.
SANITARY CODE OF THE STATE OF NEW YORK
PUTNAM COUNTY SANITARY CODE
Article III Section 4 - Evidence of sewage discharged onto the ground was found at 13 Lakeport Dr., (T)
Patterson, NY TM #25.55 -1 -45 on May 27,1 998, May 28, 1998, June 8, 1998, June 22, 1998, June 25,
1998, July 13,1998. y
ADJOURNMENTS: Public Health Law violations are serious. They affect or may affect the health, safety
and welfare of the community. They cannot-be permitted to go on indefinitely.' Casual adjournments or
hearings will be granted. Applications for adjournments must be made in person or by counsel to the Hearing
Officer at the time set for hearings, except for legal excuses. Persons operating an establishment, business
or facility, for which a permit is required - without such permit - will not be granted and adjournment. Health
matters are involved and the Public Safety is a paramount consideration.
BF:jp
cc: B. Foley
R. Carano
BH/ML
- RECORD- OF-TELEPHONE CONVERSATION - _ .......
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmenal Health Services
Facility: t-a /C�q- ro r Town•_ Pa
Time: 8 fir-. Date:. % Z Z Ife Telephone #
Caller's Name: C �� �� C lay L
DISCUSSION: fi,7e- s
5f2e
Signed: ' �� �c... Date: Rev. 6/97
RECORD OF TELEPHONE CONVERSATION
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmenal Health Services
Facility: C`� K-� p _ Town:
Time: 7 `r Date: 7 2 Telephone #
Caller's Name: C k6-r (CS C (o r
DISCUSSION: •�.Q rs -�� /;l,- C (0, L Iru
l-p- C'O'd al l l h"4- A-0/ k t,r s_e,, -4.t
Rev. 6/97
Signed: ��., -.�'� Date:
RECORD OF TELEPHONECONVERSATION
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmenal Health Services
Facility: L a_ �<- P o rT Town: /PI-
Time: Y - �. O A, Date: 7 I`% Telephone #
Caller's Name: Me s se
..� /y{,, G(, k
DISCUSSION: 121 -1 C (cr ✓� e�a,� r-�S- �L��(
e o ,-. 1 riiex
Signed: / ix Date: 7 /,/Y/ 7,Y Rev. 6/97
I
RECORD OF TELEPHONE CONVERSATION''
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmenal Health Services
Facility: L k e r+ R Town:
Time: Date: 71/0h?. Telephone # 7 9- 3 7 a Y
Caller's Name:
DISCUSSION: Aq,. C. lam �- 5- ko- e-1
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Signed:
� �� `"'�` Date: -I / v 5 J, Rev. 6/97
•
DEPARTMENT , OF HEALTH
Division of Environmental Health Services
4 Geneva Road.
Brewster, New York 10509
Tel. (914) 278-6130 Fax (914) 278-7921
CERTIFIED RETURN RECEIPT REQUESTED
BRUCE R. FOLEY
Public -Health Director
June 26, 1998
Mr. Charles Clark PLEASE REFER CORRESPONDENCE TO:
13 Lakeport Drive NAME: Mike Luke
Patterson NY 12563 TITLE: Public Health Technician
PHONE: (914) 278 -6130 ext. 127
*SECOND NOTICE*
YOU ARE HEREBY NOTIFIED that non- compliance with Article III section 4 of the Putnam County Sanitary
Code where evidence of sewage, discharged onto the surface of the ground was found at 13 Lakeport Drive,
Patterson NY, TM# 25.55 -1=45, by a representative of this Department on May 28, 1998.
It is believed that you are responsible for correction of this condition. If you are not responsible, you are
requested to immediately notify the inspector indicated above.
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 or rebuildirig of
existing disposal systems. An application is enclosed.
Failure to pump the septic tank by July 1, 1998 and further, to correct this condition by July 10, 1998 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.
ML:tn
enc:Permit Application
cc: BI (T)
William Hedges
For the Public Health Director
Very truly yours,
Bruce R. Foley, R. S.
Public Health Directo
Gam""
By: Mike Luke
Public Health Technician
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road
Brewster, New York 10509
Tel. (914) 278-6130 Fax (914) 278-7921
Chandler Reich
10 Lakeport Road
Patterson NY 12563
Re.- Water Quality
Dear Mr. Reich:
July 9, 1998
BRUCE R. FOLEY
- Public Health Director
Water samples were collected from your property at 10 Lakeport Road, Patterson, New York on June
22, 1998 and June 25, 1998.
The results of the bacterial analysis indicates that the water was not of satisfactory quality at the time
the sample was collected.
All water for drinking and cooking purposes must be boiled for 5 minutes before use or bottled water
and packaged ice from an approved source may be used.
Enclosed please find a procedure for Disinfection of Well. Please notify me 10 days after the
procedure is completed and I will resample the water.
Should you have any questions relative to this matter, do not hesitate to contact me at this office.
Very truly yours,
Michael Luke
Public Health Technician
ML:tn
RECORD OF TELEPHONE CONVERSATION
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmenal Health Services .
Facility: 1—,, L J � Town:—
'•
Time: -7 d y Date: f � Telephone #
Caller's Name: 40�
DISCUSSION: ke e,- fie- /,J
Xr-
rel SL., ce(vj
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Signed: X222 '� Date: /�'� Rev. 6/97
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Severn Trent Envirotest
315. Fullerton Avenue
-Newburgh - -
NY 12550
Tel. (914) 562-0890
Fax: (914) 562.0841
Date:
�
:
rnAp yak l�s
(including cover page)
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FROM:
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Company:
Company:
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Severn Treat Envirotest
Phone:
Phone:
(914) 562 -0890
Fax Phone:
Fax Phone:
562
(914) -0841
REMARKS:
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All analytical reports, interpretations, or information faxed by Severn Trent FAv)rotest to its customers arc
preliminary data only. Due to problems that can occur with the transmission of data via fax, Severn Trent
Envirotest cannot guarantee or assume any responsibility for the following transmission of data if any of
the following information is not legible or clear, we encourage our customers to verify We data by phoning
our office or by the examination of the final analytical report.
a part of
ern Trent P c
Other Laboratory Locations:
0Wesftd Executive Park, 53 Southampton Road
Westfield. MA 01085
Tel: (413) 5724000 Fax: (413) 5723707
if_/.j UU1
BRUCE R. FOLEY, R.S.
Actina Public Health Director
�/ DEPARTMENT OF HEALTH
Divi 2n Of Environmental Health Services
4 eneva Road, Brewster, New York 10509
e� (914) 278 -6`130
p3 gSY�
yo;s DISINFECTION OF WELL
THE FOLLOWING PROCEDURE SHOULD BE USED AFTER COMPLETION OF A NEW DRILLED
WELL, THE REPAIR OR RENOVATION OF ANY WELL OR WHEN ANY WELL TESTS
UNSATISFACTORY FOR BACTERIA.
1. FOR EACH 50 FOOT DEPTH, MIX ONE QUART, OF PLAIN LAUNDRY BLEACH
CONTAINING 5 1/4% CHLORINE IN 5 GALLONS OF WATER.
2. POUR THE' SOLUTION INTO THE WELL. RUN A HOSE FROM AN OUTSIDE FAUCET
IN TO %THE WELL, THEN START THE PUMP. (THIS PULLS THE DISINFECTING
SOLUTION INTO THE STORAGE TANK FASTER.)
3. ALLOW WATER TO FLOW FROM EACH TAP UNTIL A CHLORINE ODOR IS DETECTED.
WHERE POSSIBLE, REMOVE THE PLUG ON TOP OF THE PRESSURE TANK AND ALLOW
THE,SOLUTION TO FILL THE TANK COMPLETELY, THEN TURN OFF THE PUMP.
4. ALLOW THE SOLUTION TO REMAIN IN THE, SYSTEM FOR AT LEAST 8 HOURS OR
PREFERABLY OVERNIGHT.
5. DRAIN THE PRESSURE TANK AND REPLACE THE PLUG. START THE PUMP AND
ALLOW WATER TO FLOW TO WASTE FROM EACH TAP UNTIL THE CHLORINE ODOR
DISAPPEARS.
TO AVOID DISRUPTION TO THE SEPTIC TANK PROCESSES, DISCHARGE OF THE
CHLORINE SOLU'T'ION IN THE SYSTEM SHOULD BE DONE BY .TAKING A GARDEN
HOSE AND ATTACHING IT TO THE VALVE AT THE BOTTOM OF THE WATER STORAGE
TANK (USUALLY IN THE BASEMENT) . THE VALVE SHOULD THEN BE TURNED ON
AND THE WATER SHOULD BE DISCHARGED OUT ONTO THE GROUND IN THE YARD.
WHEN MOST OF THE STORAGE TANK WATER HAS BEEN FLUSHED, CHECK THE ODOR
OF THE.WATER COMING OUT OF THE HOSE. WHEN THE CHLORINE SMELL HAS
NEARLY DISAPPEARED, OPEN UP OTHER FAUCETS -IN THE HOUSE FOR 15 MINUTES
OR UNTIL THE SMELL OF CHLORINE IS NOT DETECTED.
6. USE THE WATER NORMALLY EXCEPT FOR DRINKING AND COOKING.- PURPOSES FOR
ONE WEEK. COLLECT A SAMPLE OF WATER IN A LABORATORY CONTAINER FOR
BACTERIA ANALYSIS. ANY NYS DOH CERTIFIED ELAP LABORATORY
(ENVIRONMENTAL LABORATORY APPROVAL PROGRAM) CAN BE USED FOR THE
ANALYSIS. IT IS ALSO OF EQUAL IMPORTANCE THAT YOU RETEST 7 -10 DAYS
AFTER DISINFECTION FOR COLIFORM BACTERIA. IF THERE IS NO PROBLEM
WITH CONTAMINATION, THE WATER TEST AFTER 10 DAYS WILL REMAIN GOOD IF
THE DISINFECTION .WAS. DONE PROPERLY,
7. SHOULD THE BACTERIA RE -TEST FAIL, THIS PROCEDURE MAY BE FOLLOWED
AGAIN OR .CONTACT THE WELL DRILLER OR THIS DEPARTMENT AT 278 -6130 FOR
FURTHER ASSISTANCE. ��
... . NYS CERTIFIED LABORATORIES FOR' _ _ .___ - ._
DRINKING WATER AND WASTE WATER ANALYSIS
NORTH AMERICAN LABORATORIES, INC.
618 Clocktower Commons
Route 22
Brewster, New York 10509
Att: Richard Emerich
278 -7600
THE TARLTON ENVIRONMENTAL LABORATORY
22 Kenosia Avenue
PO Box 2328
Danbury, Connecticut 06810
Att: Karin L. Helsel
(203) 748 -7903
CAMO LABORATORIES, INC.
367 Violet Avenue
Poughkeepsie, NY 12601
Att: John Eisenhardt
473 -9200
ENVIROT EST LABORATORIES, INC.
315 Fullerton Avenue
Newburgh, NY 12550
Att: Ron Bayer
562 -0890
WESTCHESTER COUNTY LABORATORIES AND RESEARCH
2 Dana Road
Valhalla, NY 10595
Att: Jerry Babski
593 -5590
YORKTOWN MEDICAL LABORATORY, INC.
321 Kear Street
Yorktown Heights, NY 10598
Att: Albert Padovani �
245 -3203
revised 3/22/95 amb
Drop -off location at the corner of
Stoneleigh Ave. & Drewville Rd.
Check drop -off times at 278 -9330.
Client Name:
[TL Sample Number:
Client I.D.:
Date Collected:
Dote Received:
Comments:
Federal Id: Collected by:
Inorgan ts Ana y�is Data Sheet
PUTNAN COUNTY HEALTH DEPT.
08693'07
ML-16 '
25-JUN-98
D5:JUN'00
0&'D BY luke
Project Name: lO LAKEPORT DR
Matrix: l DrinkH20
Anal ysis Resul t Units Method Analyzed
Total Coliform PRESENT /100 MB 9223 25 'JUN'98 l
Remarks:
uo
CO
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mo Fullerton Avenue
Newburgh, NY 12550
� M Tel: (914)o62*o90
��q�E-1-11 NYSDOH 10142 NJDEP 73015 CTDOHS PH-0664 EPA NY049 PA 68-378 m-Nv049 Fax: (914)o62-0841
PUTNAM COUNTY DEPARTMENT OF HEALTH Complaint NO. 9f3_iq
COMPLAINT OR SERVICE REQUEST RECORD
^WN P a t t e r s p m` DATE 5/20/98 REFERRED TO ML
TAKEN BY ML TELEPHONE -CALL X IN PERSON LETTER
CONFIDENTIAL
REQUEST FROM Chandler Reich TELEPHONE 279 -4441
ADDRESS 10 Lakeport (Zo CIO -7
ENVIRONMENTAL HEALTH: Sewage Nuisance X Public Health Nuisance
Chemical Emergency Individual Water Other
COMPLAINT OR REQUEST
Septic odor from 13 Lakeport, Clark residence,
ACTION TAKEN BY DATE
FINDINGS
.FOLLOW •UP .INSPECTION __(s)
DATE FINDINGS
DATE FINDINGS
PROBLEM ABATED
DATE PERSON NOTIFIED
ESTIMATED TOTAL MAN HOURS SPENT
PC- CR.
n,
RECORD OF TELEPHONE CONVERSATION
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmenal Health Services
Facility: (3r �ce �`"''` Town:. Pat-
Time: Date: S Z6 l a Telephone #
Caller's Name:' C,
DISCUSSION:
Signed: Date: 5 2 Rev. 6/97
Client Name:
ETL Sample Number:
Client I.D.:
Date Collected:
Date Received:
Comments:
Federal Id: Collected -b
�y
Inorganics Analysis Data Sheet
Form I - IN
PUTNAM COUNTY HEALTH DEPT.
188470.11
PHD-ML-13
22-JUN-98
22-JUN-98
COLL'D BY LUKE
Project Name: LAKEPORT DR
Matrix: 1 DrinkH20
Analysis Result Units Method Analyzed
i ............... EN.T.....:
..
.. ........
.......... . iiiii�.-2 J
.... ................... ...
..
16fal toliform PRESENT A00
MLS 9223 22-JUN-98 1
Remarks:
CS :01 [
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I f).J
Ujill
315 Fullerton Avenue
Newburgh, NY 12550
'5rL Tel: (914) 562-0890
NYSDOH 10142 NJDEP73016 CTDOHS PH-0664 EPA NY049 PA 6e-378 M-NY049 Fax: (914) 562-0841
DEPARTMENT OF HEALTH
Division of Environmental Health . Services
4 Geneva Road
Brewster, New York 10509
Tel. (914) 278-6130 Fax (914) 278-7921
CERTIFIED RETURN RECEIPT REQUESTED
E I
BRUCE R. FOLEY
Public Health Director
June 2, 1998
Mr. Charles :Clark PLEASE REFER CORRESPONDENCE TO:
13 Lakeport Drive NAME: Mike Luke
Patterson NY 12563 TITLE: Public Health Technician
PHONE: (914) 278 -6130 ext. 127
YOU ARE HEREBY NOTIFIED that non - compliance with Article III section 4 of the Putnam County Sanitary
Code where evidence of sewage, discharged onto the surface of the ground was found at 13 Lakeport Drive,
Patterson NY,.TM# 25.55 -1 -45, by a representative of this Department on May 28, 1998.
It is believed that you are responsible for correction of this condition. If you are not responsible, you are
requested to immediately notify the inspector indicated above.
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 or rebuilding of
existing disposal systems. An application is enclosed.
Failure to pump the septic tank by June 12, 1998 and further, to correct this condition by June 22, 1998 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.
ML:tn
enc:Permit Application
cc: BI (T)
For the Public Health Director
Very truly yours,
Bruce R. Foley, R. S.
Public Health Director
By: Mike Luke
Public Health Technician
PUTNAM COUNTY HEALTH DEPARDIM
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
• ia• i /i/ SIG. •
SITE =XTION /� 11� -.rr «��I,�i ,kl .4i] 5� �"� .� •, 5"- 5�1..�
MAILING ADDRESS
DATE
PCHD Complaint #
Name & Relationship (i.e, owner,tenant, etc.) �
TYPE FACILITY
PROPOSED INSTAILER� PHONE`7Cj
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 - ----- Proposal Disapproved
2.
3.
Inspector's Signature & Title
mal amroved with the following conditions:
Procurement of any Town permit, if applicable.
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.
a
(e.g.,house corners).
three precast 6' diam. x 6' deep
System repair to be performed in accordance with the above proposal and conditions.
I, as owner, or reported agent of owner agree to the above conditions.
SIGNATURE TITLE DATE'�.ti�
7
F134: V&te (PQD); Yellow Mitin HI); Pink (.Anplimnt)
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08`/18/2009 10:19 832381.0 PLM PAGE 01
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PLM
LANDSCAPE AND CONSTRUCTION
191 LADE ELLIS ROAD
WINGDALE NEW YORK 12594
PHONE' /FAN 845-832-38.1.0
CELL # 845 - 2221239
MR.CLARK
LAKE FORT DRW
PATTERSON NY 12563 -1619
PHONE 4 279 -3704
222 -4356
contract date 5/01/09
start date: 5/13/09
compledun date: 5/1.5/09
SCOPE OF WORK:
+
INSTALL A 300 GALLON HOLDING TANK FOR SINK WASTE WATER not
able to because of ledge.
+ FUMP OUT OLD TRI GALtIES
+ REMOVE OLD TRY GALLEY. SYSTEM AND HAUL OFF UNITS.
- ` INSTALL NEW SYSTEM.. OF SIX 24 INCH HIGH X 5 TT LONG WITH PROPER
GRAVEL AND FJLTER PAVER.
+ BACK FILL, RAKE OUT ,SEED ANT) HAY.
I
.05/18/20.09 10:19 8323810. 'PLM
PAGE 02
PUTNAM COUNTY REALTH. DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
PROPOSAL FOR SEWAGE TREATMENT SYSTEM REPAIR
SITE LOCATION
OWNER'S NAME
MAILING ADDRESS
APPLICANT
Internal Use Only PERMrr #
Repair Permit issued in last 5 years t in Watershed
Repair Within Boyd's Corners, W. Branch or Croton Falls Res. . Delegated
Repair within. 200 ft. of a watercourse or DISC- mapped "tlartcl ❑ Joint Review
t- TM
j(" TOWN
PHONE#
Name & Relationship (.e., owner, tenant. contractor)
DATE f FACILITY TYPE PCHD COMPLAINT #
7
PROPOSED INSTALLER
n PHONE #. "'if a'
ADDRESS R LS REGISTRATION /LICENSE #
Pr lu
p(%s I Qhc do a( separate sketch thd house, property linoo, all adjacent wells within 200
feet of repair and the location of existing and proposed system)
NOTE: The Department may require submittal of proposal from licensed professional depending, on the
nature and extent of the repair.
4�
as owner,agree to the conditions stqted,on this form
"X A* -
SIGNATURE
TITLE
DATE
1, the septic installer, aqree to comply with the conditions of this permit for the septic systemi repair
SIGNATURE fTIT LE DATE
(installer)
P=gn&I approved with the t ligwing conditions;
1. Procurement of any Town Permit, it applicable,
2, Submission of as built.repair sketch by the Septic System instanerAdthin So days of the repair, in duplicate, showing:
a. Owner's name, Site Street Name, Town and Tax Map number
b. Location of installed uumporients tied to two fixed points
c. System description'(e.g,, 1250 gal. Concrete septic tank, etc.)
d. Installers' name and phone number
.3, Systgrn'repair to be performed in accordance with the above proposal and conditions
4.. The proposed SSTS repair Is considered a best fit design and there is no guarantee to the duration at which the
completed 96TS repair will function,
6. No completed work is to be backfilled until authorization to do so has been obtained from. the Department.
INTERNAL USE ONLY
Propq*I Approved..'-. Proposal Denied ❑
4-
lnsoq6tor's Signature & Title Date
Expiration Date
.VR6pair. proposal is in com pli.ance with eipplibable codes Yes 13
COPIES: PCHD; Owner.; Instaftr
Dr•:.RD 44M1
Rev. 2/07
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
_. .........P
R,
YES N C1 Internal Use Only PERMIT # ' ' %_A / -
❑ Repair Permit issued in last 5 years ❑ I)lot in Watershed
Repair within Boyd's Comers, W. Branch or Croton Falls Res. Delegated
❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review
SITE LOCATION
OWNER'S NAME
MAILING ADDRESS
Q3 GakL Pjfl' ��,TOWN P4- 94rsuiv
M l�• G1qr%
APPLICANT 11�aa�i -ci
Name & Relationsh p (i.e., owner, tenant, contractor)
TM #'
PHONE #
DATE -' 0 FACILITY TYPE PCHD COMPLAINT #
PROPOSED INSTALLER / j., K G Al f ;_PHONE #
ADDRESS %/ &Ake - REGISTRATION /LICENSE # l 7
Proposal (include a separate sketch locating th house, property lines, all adjacent wells within 200
feet of repair and the location of existing and proposed system)
NOTE: The Department may require submittal of proposal from licensed professional depending on the
nature and extent of the repair.
I, as owner,agree to th condit' ns stated on this form
SIGNATURE TITLES DATEV L,7
(owner)
J,.the septic. installer, agree to comply with the conditions of this permit for the septic system repair
SIGNATURE TITLE DATE
(installer) r,
Proposal approved with the following conditions: .,
1. Procurement of any Town Permit, if applicable.
2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, in duplicate showing:
a. Owner's name, Site Street Name, Town and Tax Map number
b. Location of installed components tied to two fixed points
c. System description (e.g., 1250 gal. Concrete septic tank, etc.)
d. Installers' name and phone number
3. System repair to be performed in accordance with the above proposal and conditions
4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the
completed SSTS repair will function.
5. No completed work is to be backfilled until authorization to do so has been obtained from the Department.
iN 1 ERNAL USE ONLY
Propo I Approved Proposal Denied El
'PA I X2
V epair tors Signature &Title �j Date Expirat on Date
proposal is in compliance with applicable codes Yes O No a
COPIES: PCHD; Owner; Installer
PC -RP 99ML Rev. 2/07
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PUTNAM .COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM
Owner: ar�� LI/r�✓ Address:
Located at (street): TM # Section: _Block_ Lot
Municipality: !'h`�"' "� (� �`'� Watershed:�='�'� /`
SOIL PERCOLATION TEST DATA
JS � � �.� rr
/ Witnessed by: i
Date of Pre - soaking: ?J° `� I ° �� Date of Percolation Test: G/ /g V
Hole No.
Run No,
Time
Start —
Stop
Elapse
Time
(min.)
Depth to
Water from
ground
surface
(inches)
Start - Stop
water
level drop
in inches
Percolation
.Rate
min /inch
2
-wsl
9 0
-7
3
-1 &3
.10:3q-
1
2
3
4`
5'
1
2
3
4.
5
I..
2
3
4
5.
Notes:
1. Tests to be repeated at same depth until approximately equal percolation rates are
obtained at each percolation test hole. (i.e., < 1 min for 1 -30 min /inch, < 2 min for 31 -60 min /inch).
All data to be submitted for review.
2. Depth measurements to be made from top of hole.
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