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01279
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PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
YES NW Internal Use Only PERMIT # -�
❑ Repair Permit issued in last 5 years VDelegated
ot in Watershed
❑ Repair within Boyd's Comers, W. Branch or Croton Falls Res.
❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland El Joint Review y
SITE LOCATION je,(OIZ I?4 TOWN R TM # — 1_
OWNER'S NAME Pt+1 LLl A TP-rPP000 PHONE # _
MAILING ADDRESS L%tC`16a _e�✓ A) y ;15'63 _
APPLICANT 7-e-z.
Name & Relationship (i.e., owner, tenant, contractor) _
DATE 311010 FACILITY TYPE l PCHD COMPLAINT #
PROPOSED INSTALLER
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PHONE # 3y57 6 35-,;q o-
ADDRESS P66 l71(p
pl ser ,(%
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g 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 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 the conditions stated on this form
kSIGNATURE TITLE D6ViU�, DATE �d Q
/K (owner)
e -C ptir`.i st 1 ��
_..... _.. _...... ' I, -the-septic .n;..a. ;agree to cortp!y with the conditions of -this Fcrrnit -fcr thv JcFtics tem sepal► - .... .
SIGNATURE TITLE DATE 3 t (7 d _
(installer)
Proposal appro d 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.
INTERNAL USE ONLY
Pro osal Approve Proposal Denied ❑
Inspector's Sign ure Tit, of Date Expiration Date
Re air ro o I is in Icom liance with applic le odes Yes ❑ No ❑
COPIES: PCHD; Owner; Installer
PC -RP 99ML Rev. 2/07
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Philip Trippodo
8 Victory Road
Patterson NY 12563
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AS BUILTORAWING
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illon Poly Tank
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FEB -07 -2008 10:19AM FROM - ENVIRONMENTAL HEALTH 8452787921
_ PUTNAM COUNTY HEALTH DEPARTMENT—
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
THIS IS NOT A REPA M PERMT
T -583 P.001 /001 F 7664
PROPOSAL FOR EXPLORATION OF SEPTIC SYSTEM FAILURE
All information below must be full completed prior to any scheduling
SITE LOCATION U J - TOWN " i TM # 'Jo —/ 5,.,3
OWNER'S NAME -ryL,j PP 4D a �-a�,c a� PHONE #
MAILING ADDRESS tt- Vbe'rTv-fLq Rtj - .e, Al•11 1 16iC q
PROPOS51D CONTRACTOR /INSTALLER R geL- PHONE 0
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ADDRESS l I/ REGISTRATION /LICENSE #
Reason for exploration:
Q failure to surface 1:1 back -up In house Q find limits of system for repair ''other (explain below)
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F.OR.
COUNTYUSF ONLY-___ _
Inspector's Sign ure & ills > Date
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Appointment Date: Time:
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MAP A OF PUTN4M i
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TOWN OF PA TTERSON
PUf NAM COUNTY, NEW YORK
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SCALE I "=20' {sl s
So /d mop filed Norch 20,1931 as Mop N9 149H
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:'Domes. C. •Edgett,
the surveyor who made . Note: All cerNflcotlons, hereon ore'vol /d forlhis
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f? thf : property shown
20 2'O ,
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PREPARED FOR
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;York License
n:` Registrolica
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''Main Street. E
F5632
C. Edgett
vors `
caster, New ?brk
SURVEY OF PROPERTY'
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PREPARED FOR
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PHIL IP A. 8 ' ROSE A. TRIPPODO, '
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LOTS A 869 — A 872 INCL.
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MAP A OF PUTN4M i
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TOWN OF PA TTERSON
PUf NAM COUNTY, NEW YORK
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SCALE I "=20' {sl s
So /d mop filed Norch 20,1931 as Mop N9 149H
:'Domes. C. •Edgett,
the surveyor who made . Note: All cerNflcotlons, hereon ore'vol /d forlhis
y /,s,i mop, do herebyi certify that the survey mop and copiesIthereofonly /f so %d mop
f? thf : property shown
hereon was completed or coA*s bear the impressed. seal of the
ov..3,1971 and this
'1971
'map was completed surveyor whose signature appears
by 15,
hereon.
;York License
n:` Registrolica
,- Office of ✓an
Land Su
''Main Street. E
F5632
C. Edgett
vors `
caster, New ?brk
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SURVEY OF PROPERrY-.--
PREPARED FOR
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PHILIP A, 8 ROSE TRIPP
BEING
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SHO WN ON:
VA P A OF PU MA 114,
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TOWN OF P4 r7,
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SCALE It =2-0�-
Sold mop filed Alarch 20,1931 as
Op N! 4.9
James C.'Edgett, the Surveyor who mode Note.' A#.Cerflflcot/ans,.`h&r*Oft gre-
volld: fo r Ws -
'�'lhe. property do. hereby, certify. that the survey mop and coplestthereof ony'jf-'Sg1dmOp
ShOwfi hereon was completed 0
r COO*$ bear the - Impressedt WO/ of the
2 v.:'g 19 71 - and this MOP Was Completed Surveyor, whose Wgnoture vppeora
Mk'45, '1971
hereon.
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D4 Licefis
Own. Registratico N.?5632
!Offlcv of Jama C. Edgett
-and sirvpyors
131, Wain Street 84wstier Afew )bfk
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Job N °7//02
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SURVEY OF PROPERrY-.--
PREPARED FOR
iM .4
PHILIP A, 8 ROSE TRIPP
BEING
L 0 TS A 8 69 - A 872 INCL
SHO WN ON:
VA P A OF PU MA 114,
L4 KE
S/ruArE IN
'E. RSO V,
TOWN OF P4 r7,
N41111 PL r-MAM COWY - NEW YORK,
7�.
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SCALE It =2-0�-
Sold mop filed Alarch 20,1931 as
Op N! 4.9
James C.'Edgett, the Surveyor who mode Note.' A#.Cerflflcot/ans,.`h&r*Oft gre-
volld: fo r Ws -
'�'lhe. property do. hereby, certify. that the survey mop and coplestthereof ony'jf-'Sg1dmOp
ShOwfi hereon was completed 0
r COO*$ bear the - Impressedt WO/ of the
2 v.:'g 19 71 - and this MOP Was Completed Surveyor, whose Wgnoture vppeora
Mk'45, '1971
hereon.
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D4 Licefis
Own. Registratico N.?5632
!Offlcv of Jama C. Edgett
-and sirvpyors
131, Wain Street 84wstier Afew )bfk
'hUfCh'51F*6fj P/W17S' Ma.
Job N °7//02
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ELEVAT- fi� LEFT E LE VAT 10, N
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IV OF PA TTFR SO A/ A�/
PROPOSED LOTS A8,L-9--A270-A87/-,A87,Z
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( THE PROPERTY PHILIPf•ROSE - FkfPPoa -o � 3jJar._t Fr
ro WAY. of P-.4 T rER S o 111 f�!_Y. _.
i PHIL 1 P. TRt pP6:D4 tnlHO- -DREW TH 1 -5 PLR N
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DEPARTMENT OF HEALTH
Division Of Environmental Health Services
110 Old Route. Six Center, Carmel, New York 10512
(914) 225-0310
Bay 31, 1991
Philip and Rose Trippodo
Victory Road
Patterson, New York 12563
Re: Proposed SSDS: Trippodo
Victory Road
(T) Patterson
Dear Mr. & Mrs. Trippodo:
JOHN KARELL Jr., P.E., M.S.
Public Health Director
Review of plans and other supporting documents submitted at this time relative to
the above- captioned project has been completed. Comments are offered as follows:
1. Separation distance between well and septic is approximately 30 feet, 100
feet is required by today's standards.
-2:- Ex ansion area for the existing septic system. 100 feet from the existing
well, is not available.
In light of the foregoing, your application is hereby denied.
It is advised that the proposed addition.is revised to meet current standards. I
may be reached at ext. 320 to discuss tip s possibility.
Ver truly yours,
Robert Morris
Assistant Public Health Engineer
RM /jp
OWNER'S NAME.
SITE LOCATION
MAILING ADDRESS
PERSON INTERVIEWED
EST
•V XX.��
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
225 - 3838/225 - 3833%225 -3641
_PROPC?SAT,. -F P -SE RAGE -- Dic- POLSAL SYSTEM - REPAII;..
%�- �D
ec -- PC HD Complaint #
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 fran licensed professional engineer or
registered architect.
ge y--S : Ci .O �e.a,�
-- '-Proposal approved ^�, r .. �._ . ............._.-- Proposal Disapproved__......_._ ._.....- .._.... _._ .... �_..- _.........__...__.. .
Q /
Inspector's Si ure a Date
2.
3.
bsal approved with the following conditions:
Procurement of any Town permit, if applicable.
Submission of as built repair sketch in duplicate shaving:
a. Cleaner'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.
(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 6e `���` �� DATE F-141
U0
OPM: Fhitie MD); Yellaw dam HI); Pink (Applicant)/
-. - :. . . - ,. - - LNTVIUARP.1 V!!'MV , - 1, - .-T . m..
DIVISION.. OF ENVIRONMENTAL HEALTH SERVIC�S-
John M. Simmo'ps,, M.D.
bqputy FIELDACTIVIT.Y REPORT -
Sheet, Of
INSPECTION
NAME" Z_4
Orig. =Routine
;A>
Okigo Complain
Orig. Rec
ADDRESS 7 V
:Request
t
No., Street Town., IM Noi.
Compliance
Complaint Corp
MAILING, ADDRESS
Final,
"Zip P.0 BOX. Post Office ' Code
Gr OUP Illness
'Construct -ion
4 -
Reinspection
PERSON IN CHARGE
Field, Sampling Only
OR INTERVIEWED
Field Conference
�,
land Title
me
D ATE: FACILITY t�5, 40:
Other
TIME:
FINDINGS:
T, U,
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J
4=
1.0
INSPECTOR:
TELEPHONE:
Signature, and Title
'OR
-
PERSON IN CHARGE INTERVIEWED: "
I ac)mQwledgp this Field Activity'Report. SIGNATURE :'_
6/86 TITLE'