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Home My WebLink About2081DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36.49 -1 -25 BOX 18 IN Ll J ' i_ 46{ , IN IN '. IN 02081 WM' S NAME PUTNAM COUNTY HEALTH D .11' •DICN DIVISIOWOF,R�q�� HEALTH SERVICES PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR .ITE LOCATION F f 1 TO IAUSNG ADDRFZS q' 5 /� e).-Y-6 / A m )ERSON INTERVIEWED PCHD Caq"int # Name & Relationship (i.e, owner,tenant, etc.) )ATE TYPE FACILITY POSED INSTALLER {Jr�_ c ,y G A R o- I'� PxxoNEaZ4 �'5�,� ,EGISTRATION # jo (include sketch locating all adjacent wells): 1O'I'E: Repair must be in same location and of same type as. original sewage disposal system. Afferent location may require submittal of proposal from licensed professional engineer or cegistered architect. ��` w e 1 i '- Jo Proposal approved 's Sianature & Title Proposal Disapproved Ate 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 ccmponents 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 owner agree to the above conditions. SIGNATEIRE TITLE DATE PI5: Wiite (PM).; Yelli w (Tam BI); Pink (AFpliamt) -10 -0 --�. -0 LAR rn U\ 0 � ? CA < � p f 9 'o > O"n. UN C M C) fJ LN 0 D V z CA 07 m P. LOG-. 6- � L4L 4 4.5 5; 1 Ti L� DI Q--r CQIV -fn c. LN o J vo 6'. ism LA 0 l4 'o > O"n. UN C M LN LN fn -n 0 �m� �b� tA SHERLITA AMLER, MD, MS, FAAP Commissioner of Health �..._ ._.� LORETTA MOLINARI, RN, MSN Associate Commissioner of Health William Beltran 40 Shoreham Dr. Brewster, NY 10509 Dear Mr. Beltran: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive June 15, 2005 Re: Repair — Incomplete; R- 146 -05 Beltran, Shoreham Dr. - (T)Patterson, TM #36.49 -1 -25 Review of plans and other supporting documents submitted at this time relative to the above - regarded repair has been completed. The following was not submitted with your application: 1. The permit and sketch submitted to this Department has been returned. Please - - - . -fully complete the permit under the Proposal- Section,- The information required on a Repair Permit is any new components that are going to be installed. The information on the sketch must include the location of all adjoining wells, location of existing pits and/or trenches and septic tank. The sketch must also include the location and type of new components and labeled as proposed. If you have any questions, please contact me at (845) 278 -6130 ext. 2261. Upon receipt of a submission, revised to reflect the above comments, this repair application will be considered further. Sincerely, GR: hm Enc. Gene D. Reed Senior Engineering Aide Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 PUTNAM COUNTY DEPARTMENT OF HEALTH 1 Geneva Road --- Brewster, New York 10509 Date FROM: For your information For signature For your files Referred for handling Attached as requested Returned as requested Please see me Read and return CON1MMS: o 1° r LORETTA MOLINARI Public Health Director DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 6 . Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 CERTIFIED RETURN RECEIPT REQUESTED PLEASE RETURN CORRESPONDENCE TO: William Beltran NAME: Michael Luke 40 Shoreham Road TITLE: Public Health Sanitarian Brewster, NY 10509 PHONE: (845) 278 -6130 Ext. 2127 * SECOND NOTICE DATE: January 5, 2005 OFFICIAL NOTICE OF NON - COMPLIANCE YOU ARE HEREBY NOTIFIED that non - compliance with Article III Section 4 of the Putnam County Sanitary Code consisting of a discharge of sewage on the surface of the ground was found at 40 Shoreham Road. (T) Patterson, TM # 36.49 -1 -25 by a representative of this Department on December 14, 2004 & January 5, 2005. 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 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. - -� Appr- opal =of propose(lrepairs must.be obtained,from this.Department prior to any.: alteration n or rebuilding of existing disposal systems. An application is enclosed. . Failure to pump the septic tank immediately and further, to correct this condition by January 31, 2005 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 actions as may be prescribed. A re- inspection 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. For the Public Health Director Very truly yours, Loretta Molinari Public Health Director> D By: Michael Luke Public Health Sanitarian ML/ky Enc: Permit Application cc: BI (T) Patterson m SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, -RN, MSN f Associate Commissioner of Health William Beltran 40 Shore Dr. Patter n, NY 12563 Dear Mr. Beltran: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive June 15, 2005 Re: Repair — Incomplete, R- 146 -05 Beltran, Shoreham Dr. (T)Patterson, TM #36.49 -1 -25 Review of plans and other supporting documents submitted at this time relative to the above - regarded repair has been completed. The following was not submitted with your application: 1. The permit and sketch submitted to this Department has been returned. Please fully complete the permit under the Proposal Section. The information required on a Repair Permit is any new components that are going to be - - - - -installed.- The information on-the, sketch musi.include the location of -all adjoining wells, location of existing pits and/or trenches and septic tank. The sketch must also include the location and type of new components and labeled as proposed. If you have any questions, please contact me at (845) 278 -6130 ext. 2261. Upon receipt of a submission, revised to reflect the above comments, this repair application will be considered further. Sincerely, - t�, �2 GR:lm Enc. Gene D. Reed Senior Engineering Aide Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 a - ..e OWNER'S NAME ea�� - 1-2,s- PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES PROPOSAL FOR S&QGE DISPOSAL SYSTEM REPAIR 3{ ! 4' ;J L' PHONE ��., rI �% SW (C, SITE LOCATION TO MAILING " MAILING ADDRESS 15' h Ll 1� c''-" � //-) 1'Yl D l 1/ & 13W -e-- ") S t-&- PERSON INTERVIEW PCHD Complaint # Name & Relationship (i.e, owner,tenant, etc.) IATE TYPE FACILITY PROPOSED INSTALLER to::: eA tom- a R 0— I 'N REGISTRATION # proposal (include sketch locating all adjacent wells): Nam: 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. V) Proposal approved is & Title r- 1 Proposal Disapproved L' c � Ate roposal 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 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 owner agree to the above conditions. SIGNATURE TITLE T&'IES: White (PAID); Yellow (fin HI); Pink (An2ja nt) DATE �A AP0 ToW tJ o F <, FAi2FIEEL CCN .n Sys° W'-00"E- 1,!S. -7 (o TCN-IQ OF s Pa.TrEeS T>, 17-1, PM ca, Q Y PIPE 0 ,5L, S�uTN � 1� EAST Q 10 NyZ ° -3U Oo E .�,j O (o�(oLAo N'O-1 1� V Co(o5 PIPE FMD. Pot_E(_ t 9 'x DL2 4 1: .'o - 14 L2 STOQY � � F'LA &A E. E—►L AKA 1. Zr1 r 1 (02 i 4Z PiPE. F1.1D. Cd.50 SOUTH O.Z1I EA5T i F 553° 3y = 36 tom./ i t� q� �) I -4ECUE OvEQHEgD \ tt '' :50, `a , \ V11 Q E'S IV �w- ZS�- \!J -SUP- Y E-Y (OP Q® E2- 9 g PQEPAZED F02