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HomeMy WebLinkAbout3220DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 73. -1 -5 BOX 26 03220 ✓ " Division of Environmental Health Services, Carmel, N. Y. 10512 CONSTRUCTION PERMIT FOR SEWAGE DISPOSAL SYSTEM v t A'''� v �wn or vi►►agee c�� jiXr- WILL. A� Section 1 Block Located at 5 tt J �IfLGN f,tl LLS _- Lot - Subdivision Job Subdivision : 4 =P A3 ' 1' oA-A Building Type -r ` � Lot Area 25 Number of Bedrooms -7 _ Separate Sewerage System to consist of 2� Gal. Septic Tank To be constructed by 4�>�. /A. r water Supply: Public Supply From _ Private Supply to be drilled by -' Address d Other Requirements - AJ lineal feet X Total bitable Space Square Feet ,Zoo i o.t width trench ct+c1- c �;4%'; 1 Address 1 I represent that 1 am wholly and completely responsible for the design and location of the proposed system(s); 1) that the separate se �,,, above described will be constructed as shown on the approved amendment there to and in accordance with the standards, rules an —regulations o e u nam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Commissioner of Health. he submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said bf t .will lace in good operating condition any part of said sewage disposal system during the period of two (2) years immediately following the date of the issu y�ce of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto; 2) that the drilled well described above ' '"III be located as shown on the approved plan anLthat ai d well will be install in accordance ith the standards, rules and regulations f the Putridm �unty Depart 161 Healt�hj. y �/ �� p P.E. - R A a '+, Signed Address ..f /L License No. 7VED FOR CONSTRUCTION: This approval expires one year from the date issued unless construction of the building has been undertaken and is a le for cause or may be amended or modified when cons4d nece ry by t Colmmissio Health. Any change or alteration of construction w <r a new permit, Approved f tsposal of domestic niter s age By Title y PUTNAM JCOUNTY DEPARTMENT OF HEALTH Division of Environnpnta/ Health Services, Carmel, ' N. Y. 10512 . CERTIFICATE OF COtXTRUC I01V..C_ 11.. �: �.,, —.` FOR SEWAGE DISPOSAL SYSTE14 All F n nv +�� Located at C 14QZC.8 k'o q i> <z Z -T-� Section Owner. 1 1C.�S IGLU. ' ( Lot -Separate Sewerage System built by - !�'�►' Li Cis DS'j' �N 1 ZSD Address Consisting of Gal. Septic Tank 2 lineal Feet X Other requirements Water Supply: i Public Supply From ✓ Private Supply Drilled By Address Building Type No. of Bedrooms_ Date Permit Issued Has Erosion Control Been Completed? I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed work (copies of which are attached), and in accordance with the standards, rules and regulations, plans j11--a nd the ermit i ued by the Putnam County DepartmenE of_ hjealth,' Date - �0N 1L_.. 17.. (q -I�j Certified by �-_- - P, E. � R A: 4 Ca g Address Ste-, �01- 1cense No Any person occupying premises served by the above system(s) shall promptly take such action as may be' necessary to secure the correction of any unsanitary' conditions resulting from such usage. Approval of the separate sewerage system shall become null and void as soon as a public sanitary sewer becomes - available and the approval of the private water supply shall become null and void when a subject to modification or change when, in the Judgment of the Com 1 'oneq of public such water t nylmotlef cateon available. change is necessary. va`Is are T`' e- Date By Title -" PEEKSKILL MEDICAL LABORATORY A, Apt. 1. Peekskill, New York 10566 ° . T PE'7 877 DATE COLLECTED RESULTS OF EXAMINATION OF WATER )V0NER DATE RECEIVED v .,.R* t . S d- .'ITY, VILLAGE,'TOWN VOR NAM$ OF SUPPLY DATE REPORTED,:. SAMPLING POINT .} HACTERIA•PER•ML. (Agar plate count a-3-5-5 —C). 7 OL-IFORMGROUP (.Mgst,probable-�N6; /t00m1:) -` ; ~, " -'ppm' - - .... DETERGENTS - ppm NITRATES (as N) - gpm IRON, TOTAL - ppm. Al, >': PUTNAM OOUN'i'Y EM%LTH DEPARTMM C J -n-t � � � � � �9 DIVISION OF ENVIRONMWAL HEALTH SERVICES y PROPOSAL FOR- DISPOSAL SYSTEM REPAIR OWNER'S NAME M IC_4 e L i INt r SYv► t -rrt -E PHCNE �; Z �- - 6 5,7 SL SITE LOCATION --'� ':? - 2, C l4 vAe- 14 TO 7 11 - f - L t\1 :-f PERSON INTERVIEWED _ .�— PCHD Ccaplaint # Name & Relationship (i.e, owner,tenant, etc.) DATE �l� ®/ 1�� TYPE FACILITY lS kK} cep' PHONE 5 % A g7i'j;77 REGISTRATION # ( Proposal (include sketch looting 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. ...7. A-R1;A S11 u^ Lo(ATcn At rto r Ta 's Signature & Title :)ved 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 acv 11-1 mod-- DATE ( t FEES: Write MV; Ye].lc:w M3a EU; Pink (APpliawt) PUTNAM,COUNTY DEPARTMENT OF HEALTH C m 1nt NOo419 COMPLAINT OR SERVICE REQUEST RE ORD TAKEN BY BH TELEPHONE.-CALL IN PERSON LETTER CONFIDENTIAL REQUEST FROM Jerry Putnam Val 1 ey TELEPHONE (Q1 4) �26-22 7 ADDRESS Town Hall ENVIRONMENTAL HEALTH: Sewage Nuisance x Publi Chemical Emergency Indi c Health Nuisance vidual Water Other CODOTAINT OR REQUEST Failing SSTS on 273 Church Road, (T) PV Tyr ax Man #7 '1-_1_c; Taac failing last year and correc ed_ Problem exist: again this year_ (Chester & Mi .hel i e Smi t4 - Z Z- ?5­7 q ACTION TAKEN BY %�'% r L.�. DATE 7 FINDINGS f-G r I""e 065--P- y ej a- Srr� ic� d' s r c�C�.vrc R �o RyQ - V� +�-e -fie -5')� 4'o n -e . �'�l /�. 5✓�, r'fZ. r•z�v, -y-zol �ti.a.°r �� sr y�� o- FG'aeL�►a DATE_ w2, % 5,�9 �,_•w °._..- FINDINGS .. _..�oS rY7'�iv�C (,�ro� ^ �teS'� ©bS�.�d'�',�` - - - -- ---= •.._...s ..._. DATE 0✓ -h 6e- Si FINDINGS PROBLEM ABATE DATE 4 1 14 PERSON NOTIFIED ESTIMATED TOTAL MAN HOURS SPENT PC- CR 97 q' 4 coee INZ-OR�L!.TJO.N FOR STREET: ZZ Directions: T a' - -:_ n by:. Referred to: Late: 5 K....... :. ,.�:•uL lr c z "ALL IN ORM.A.TION MUST BE CO:,: .-:'LETS PUTNAM COUNTY DEPARTMENT OF HEALTH omplaint NO. 50-98- ,, y v COMPLAINT OR SERVICE REQUEST RECD '1'cJW1V - Putiiain 'va'l'ley DATE- 2'/�2/ -98v`. ' TLr;�'rKfir;l� TAKEN BY TN CONFIDENTIAL TO _ .. - i✓� - TELEPHONE.-CALL X IN PERSON LETTER REQUEST FROM Susan Gallo TELEPHONE (91 4) 526 -2542 ( Home# ) ADDRESS 275 Church Road, Putnam Malley (914) 721- 2146(Wk #)until2 ENVIRONMENTAL HEALTH: Sewage Nuisance Public Health Nuisance Chemical Emergency Individual Water X Other CC?4PLAINT OR REQUEST Chester Smith owner of property - Complaintant said that this is the 2nd year that the owner has this problem - septic has a very bad ordor and green is running on to lawn.. The owner tries to cover the spot with leaves c -" 715 -1-1�7 ACTION TAKEN BY DATE 9 FINDINGS FOIe,T.OW ?1P INSPECTI.0 (s) DATE FINDINGS _. DATE FINDINGS PROBLEM ABATED DATE B $ PERSON NOTIFIEDC- I'A /�'lr3, ESTIMATED TOTAL MAN HOURS SPENT PC- CR 97 U7 Code C-- L) -N 0 RMA i 0 .-OR FORH co=plaimtant: 11 A M S T R T TOWN: FMK=' 'S 5C9 N Aron-vmous cl-m-c-laintz) -7,at-c) /-Y-6 Direccio:is: !-sr by to: MUST HE CO-*-!?.LETE r.11 � Sheet of PUTNAM COUNTY DEPARTMENT OF HEALTH GNIM FIELD ACTIVITY REPORT N A AAT • C h e s -4- �;VIK4 T h TPA: Ann RFCQ' Z7 Street Town State Zip PERSON IN CHARGE /fl `1 i? Name and Title TYPE OF FACILITY: FINDINGS: ` l S2la r ~t S �i S fem �c S b e e C'. i r�c- be- ✓-i Y �b., � -T" h.� %G.. ✓ � .�-� - , 1 Gam.., c-2� 1 /� TICPF.CTOR! TFT; �" 7 f _� ,( 3 cD Signature and Title RFpnRT RF('FTVFTI RY' I acknowledge receipt of this report: SIGNATURE: 02/96 Title :, Rpu. PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmenal Health Services Facility: Town: Time: Date: Telephone # Caller's Name: 52�- BS-7Y DISCUSSION: {�'1 r • S',� -, , 714 .e ►gas re c eive� 0 LIL /`4 SGT c G( ^ 4L / / 7� GQ r t� ® Q /J ��m 0.S NCOCZ�, G s ,C�cs sp % C c _ Signed: Date: 2 4 7 Rev. 6/97 J} qq dd�� F�L( �� w� �� ((''yy.. .M ,�('�(•��j�y_��.� /p�� p' ,� (^�' �j yr '�'rrrG�� •�} 'q. r?.-.�•,>'a.. .rtiv.n,.r +I'sLit. .'�'w ),-.. RP• �•:.W.r:6�.'w�{•uV Vf�Y-t /Y• ,��1 Y8`V� �+u •1V �/I• Y�LBY A�L \AI .•.,�P'r - � �%•...iP.:: +4.4• r �••r�- -iF .�w aA -.. PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environnmenal Health Services Facility: 7 -% 3 C �,.t rc.�: �� Town: 1 V` Time: �3- % S Vate: Telephone #, Caller's Name: /1'1, k-e. L'Jc -e- `�a c� , �- S", ,, ( DISCUSSION: S,,,-,t4 5-" /- U 4✓ C,,J sz-' 8S1) `i° Signed: "�L � Date: Z- 1 % �6 Rev. 6/97 ,..�- sFn,:•.::,;:.pw'xn. ry :;'wir »= .:'.- ei ^:.i•r. ?: r. >, a•' ri._-_.. .,a:n<a.�:...:'�..•.;r :L'�z��• DEPARTMENT OF BRUCE R. FOLEY r::.,a - . - - ; i•:':F•..`�i= w•n.ii.- :'so -.� = +^`CC'�ij.v� ?�'Ccilt:�'`�ir'� rw •. -�: .A L"t vP' Imo' 1 Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6130 Fax (914) 278-7921 CERTIFIED RETURN RECEIPT REQUESTED Chester Smith 273 Church Road Putnam Valley NY 10579 February 6, 1998 PLEASE REFER CORRESPONDENCE TO: NAME: Mike Luke TITLE: Public Health Technician PHONE: (914) 278 -6130 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 273 Church Road, Putnam Valley NY (TMT 73 -1 -5) by a representative of this Department on February 5, 1998 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. _APPr�,vxl- e�`.pr-oposed repair nnvat 'oc o ta. ned from -this Department pr -u , an � qtr —atron �srreb ► d rr existing disposal systems. An application is enclosed. Failure to pump the septic tank by February 16, 1998 and further, to correct this condition by February 27, 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 Heali Diirrec�or By: Mike Luke Public Health Technician DIVISION OF ENVIRONMENTAL HEALTH SERVICES COUNTY OF PUTNAM- STATE OF NEW YORK IN THE MATTER OF THE COMPLAINT AGAINST: RESPONDENT(s), Pf\L Arising out of the Alleged Violations of the Public Health Law of the State of New York, the Sanitary NOTICE OF FEARING Code of the State of New York, the Sanitary Code CASE # 018 -98 -19 of the County of Putnam, and Administrative Rules, Regulations and Standards Promulgated Pursuant Thereto: TO: Chester Smith PREMISES: 273 Church Road 273 Church Road (T) Putnam Valley TM #73 -1 -5 Putnam Valley, NY 10579 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 3rd: day of June 1998 at 10:45 AM in the Hearing Room, located at Route 3.12, 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 matter will be rescheduled to a date certain and a Formal Hearing will be conducted _thPrPon,.and a:record of.all the proceedings- vYi.1'1r- e •nadz witnesses wi 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. PUTNAM UNTY BOARD OF HEALTH DATED:May 4,1998 BY: Brewster, NY 10509 Bruce R. Fo ey, R.S. Public Health Director -;- ";&', � R I %�w; 'VE.Wy -,-.z - -:;- . , --.— I.-- --RECORP--O-F, IcAT101� PUTNAM COUNTY DEPARTMENT OF HEALTH . Division of Environmenal. Health Services Facility: Town: (e� Time: Date! 3 Telephone # Caller's Name: DISCUSSION: re e- s cto r- r 'I L )C- V. -73 440 /Jo Signed: Date: SLIVzq� Rev. 6/97 r .�.._r-..;:�-- .. ?-- .r -..,:: �-sa. ,...n►w. -ru :.v ..,..n. .; -.:�.: .- -- ;A:i�.. .=.=.> y .. c' y:, o����+r -' �.. s:"�; �. a � .. ♦ O ^' r. .. s. .. PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmenal health Services s, Facility: �a �r G ``L► Town: Time: ' S Date: �Z "9� Telephone # Caller's Name: V r DISCUSSION: 11,1I, Signed:_ Date: Rev. 6/97 Sheet (of PUTNAM COUNTY DEPARTMENT OF HEALTH DTV..IST-QN_0F NV.T..>RONMENTA.T, HF:ATL jT SERVICES ,.., _ _ r . ...�r., ._. FIELD ACTIVITY REPORT NAM .� iM E• i1h Tel: ADDRESS' Z* 3 C A ,;" Street Town . State Zip PERSON IN CHARGE ? C)R TNTFR VTF.W PTA: Tate: -_ / 3 � Name and Title TYPE OF FACILITY: FINDINGS: n'I �L L c< �C.z �r U. Z % 3 C i1 u,• c t� S , CS 2J, -�' ! S p ��.•. n ;,� "�o � Ste.- �.-�.. �,cs,. ✓.. TNSPFC TQR: TFT Signature and Title RFPQRT RFC F,TVFT RV` I acknowledge receipt of this report: SIGNATURE: 02/96 Title: Rev. RECORD OF TELEPHONE CONVERSATI®N PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmenal Health Services Facility: C G( Town: 19' v Time: /(: 3 Date: c/ /? S Y Telephone # Caller's Name: iC�-� -g S DISCUSSION: m S--k, Signed:_ / Date: /// 0/" Rev. 6/97 .�_....... -... ..... .,.e ... e.. -__.. -: e�wl r.ei s.. F�-V - 1'� ff f[`i "CAA,%'Vi:.twc�l -i'��' \� PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Enviroamenal Health Services Facility: �- �� Town Time: d Date: � v Z 9 Telephone # j Z "? %L� Caller's Name: DISCUSSION: S., wCLs aYtA�. SQY S e- J(, r. C, t it- L S �- L.1- a 4,e-(( M -. S-" ,� -r- C- (( A4--0- . Signed: Date: 'ILL, � Rev. 6/97 SEPTIC SERVICES ..w ..: r .. � -.1!.. s-• ��,-e:a-�... r_-s,.�ay.v ..- ........a - .,-;...;.. _...;. ... .:........ .._. mss.- ..:..�...•. � ^::;. - �. - ... r � .c....a�i r ..n . •.:Go- _.... . ADAMS, FRED JR. INC. 691 Farmers Mills Road Carmel, N.Y. 10512 ALL PRO ROOTER,INC. — purchase Road / Lake Carmel,N.Y. 10512 FREBAR COSTT. CORP. Maple Avenue 225 -8123 Lincolndale, N.Y. GRAGERT, HOWARD 225 -2745 296 Oscawana Road 232 -8888 Putnam Valley, N.Y. 10579 ALL SEASONS CONSTRUCTION Jack Harney Crane Road Carmel, N.Y.10512 628 -5304 ARROW EXC. INC. 38 Red Hawk Hollow Road 528 -4395 Wappingers Falls, N.Y. 12590 248 -5444 526 -2595 HONEY DIPPERS SEPTIC SERVICE 701 N. Division Street Peekskill, N.Y. 739 -8725 LEONI CONSTRUCTION 325 Peekskill Hollow Road Putnam Valley, N.Y. 10579 528 -0063 LYONS,HAROLD BATES, STUART W. INC. Route 9 Starr Ridge Road Cold Spring, N.Y. 10516 265 -2189 Brewster, N.Y. 10509 279 -8952 MAHOPAC SANITATION BI- STATE, INC. Joe Mantovi PO Box 592 Kennicut Hill Road Brewster, N.Y. 10509 278 -7565 Mahopac, N.Y. 10541 628 -4526 BOTTGE, SEPTIC INC. O'CONNOR, BRIAN Sodum Rd PO Box 621 Brewster, N.Y. 10509 279 -6069 :Carmel, N.Y. 1051.2..,, _2.25- 6277._:.:. -_ -. CLEARWATER COSTT. CORP. SAF Baxter Road Todd Road North Salem,N.Y. 10560 265 -2189 Katonah, N.Y. 10536 232 -3188 CORTLANDT SEPTIC TANK TYNDALL SEPTIC SERVICE 109 Albany Post Road Ivy Hill Road Yorktown, N.Y. 245 -3700 Brewster, N.Y. 10509 279 -8809 COSTA & FERREIRA 311 Railroad Avenue Bedford Hills, N.Y. 10507 VALLEY EXCAVATING, INC. Jim Galbrath 632 -3046 Old Jefferson Valley Road Jefferson Valley, N.Y. 245 -2276 PLEASE NOTE: This list is in noway exclusive! You are urged to contact several contracters before accepting a bid. �- _tea —;;{� — Y:-�sT ; '� 7.ra �x}p�c, �{[v -t. yv a, ;,. � -�•1 _.# '_ .._ ....-�. :....,- w::. :�. �. =:.�.: -- ?•1.[.i:'+v3i'�i"i�vl� i'''. iii: tial' J�. j `v��LillY'�:"�'�1'iiTYi`Yia:%i� , ~r_•,..,. '�•......:.::�c�- �:_..... ,.:.:'... -. PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmenal Health Services Facility: C�`""` Town: Pv Time: Date: JIV Telephone #, SZ 6 - $s -7y Caller's Name: DISCUSSION: `T�� Y-, 5,,-,4 Signed: %� Date: y'�9� 9� Rev. 6/97 Facility: �i3icSTY�ia PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmenal Health Services Town: Tinge: < Date: Ll %$ Telephone # S2 Y - g I -( Caller's Name: L:�.oIL, DISCUSSION: i ��� ��✓( (Date: Signed: �� Rev. 6/97 �- .ti::,F..�,"t.•... •.._.,�m;;...:.v: -fir v...�.. �'7.C:. ?`..^,i:..;- ::�c:�: ey.v .. -..�, - ::y.�.. t, BRUCE R. FOLEY - v. .:.:v�a'rc'i•: : o::' i.�d�'i- ::+�•�i'.r��+ °1��Cw�7.T '.`TS`'S"'.'EC`i U'f''^"."'( «sa =..�s 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 March 2, 1998 Chester Smith PLEASE REFER CORRESPONDENCE TO: 273 Church Road NAME: Mike Luke Putnam Valley NY 10579 TITLE: Public Health Technician PHONE: (914) 278 -6130 ( *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 273 Church Road, Putnam Valley, NY (TM# 73 -1 -5) by a representative of this Department on February 5, 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. rr �o:P,rlc2v J ��f �r�� �s�d:rPpai.rs_?���.ti�tjhe.: fl ta.in -:d from tnhs-T c � tr�`et t_ ?riot to:ari� •a resat �Jn'`& re ttddC ng ,of existing disposal systems. An application is enclosed. Failure to pump the septic tank by March 11, 1998 and further, to correct this condition by March 25, 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 Sheet _I Of j PUTNAM COUNTY DEPARTMENT OF HEALTH FIELD ACTIVITY REPORT NAB', �rn� j�ls� Tel: Street Town State Zip PERSON IN CHARGE Name and Title TYPE OF FACILITY: FINDINGS: SS 77S -313111? IP7 TT7T • Z Signature and Title RFPCIRT RFC .TVFTI RVs I acknowledge receipt of this report: SIGNATURE: 02/96 Title. Rev. - ._.__...........__:.._..._ .._.:� 0 �• ...... .+r >... _.p s_:�. -4,.,. a •. -., •.:.. -. �.T�. ���'T., }�� y� [�`t�'•A,�,` p .�*r n - rm� ... ;w _. .:,�i.• :f`+.r <: -.. «•: ". j4:JLJ�Y�`iYCJI�it11���YWCCYCf 1� i�ll'�"•`- r• -a... +a•:, �. ra `t.`^'.. •"p PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Enviroumenal Health Services Facility: Ste`` Town: Time: 5J Date: >I Telephone 5- 2 -'� -- BS ?L Caller's Name: DISCUSSION: l' s�'-` ` S �z� - �� e s LIJ 0 _r- (c ' & va N S 4-0 Cn•� I 1._R %� Q�CL l j. Signed:�L� Date: Z2 6) / 0' Rev. 6/97 Sheet . of PUTNAM COUNTY DEPARTMENT OF HEALTH FIELD ACTIVITY REPORT NAME, Tel: AT)T)RF..q.q: 2 i 3 V, AJY Street Town State Zip PERSON IN CHARGE W nR TNTFRVTP-VirFT)• . T)Rtf,- Name and Title TYPE OF FACILITY: FINDINGS: 4 5 ST S 5M Signature and Title RFPnRT RFC F.TVF-T) EY.' I acknowledge receipt of this report: SIGNATURE: 02/96 Title: 1) A— T-C-rD, ^ate 'L^^ .L':DE CdA �T7°„'�y ,! - s . .- - .. .:.. -. ...._� ....... ,.. _ .,.. . . �?.%:.•• �..y fi7 r.:., a9� rLv.�L• 'i: 1l' °a i.i:u <y�'YE:�:Z ,. ... .. ,.. . _ ...n .. K .. PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmenal Health Services Facility: Z� 3 G(nurc.� Town:_ V Time: % r Date: 311 c 8 Telephone # S 7 q Caller's Name: 11'f fie- L41� �`� Ge S S• 'f�. DISCUSSION:_ Me, 5 .-ri`, 744 ,r � y Signed: n2� �� Date: �� /� Rev. 6/97 acr.co.iu 64 ,:Ej -uE, Pi$ N d. O N V ti: X11ON .. _ . PUTNAM COUNTY DEPARTMENT OF HEALTH Division of Environmenal health Services Facility: z Town: t° V, Time: Z =� �' Date: -5 / O A Ir Telephone # Sz8 — S 7t-( Caller's Name: M i L-c L DISCUSSION:') i Signed: Date: 3 /i �,g 8 Rev. 6/97 Sheet j of PUTNAM COUNTY DEPARTMENT OF HEALTH FIELD ACTIVITY REPORT N A M-F., Tel: AT)DRERS', 2 7 lov ./vy Street Town State Zip PERSON IN CHARGE Name and Title TYPE OF FACILITY: - q FINDINGS: doo-e- S S S s - TMqPFr'Tn'R' TF.T.! Signature and Title T1. T'nf%'n Ir Tl T-fnTTl rT-T-% TJ XI's I acknowledge receipt of this report: SIGNATURE: 02/96 Title:, Rev. tsar ...:..s •fv�.nW'p- t!• .. e ..— � <:,_._: �.. � �P � - c.•'_�.t ' - . i _4: . � .�-... i:.W' , ... n.:� � ..'ewi-� � BB+ - n �n -°. VQ Owner or Purchaser bf Buil ing Municipality e�op �A iA ts T le Building Constructed by P Section C�b oC� Q Location - Street V0,116 0 . Building Type l IaA Block Lot GUARANTY OF SEPARATE SEWAGE-SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage disposal system serving the above described property, and that it has been constructed as shown on the approved plan or approved amendment thereto, . and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guaranty to the owner, his succes- sors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of initial use of the sewage disposal system, or any repairs made by me to such system, except where the failure to operate properly is caused by the willful or negligent act of the occu- pant' of the building utilizing the system. The undersigned further agrees to accept as conclusive the de- termination of the Director- of the .Division of Environmental Health Se•r- vQtiity "iri ":,rJc�' tTi:;i1t' iVi" Gai Ll a� t3` "wile�iliel— OI' 'T1Gt` tile' failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated this 3 day of 19 -A/ Signature TitleIf corporation, give name✓ and address) THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMP.TTETION WILL BE ISSUED. GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM. Division of Environmental Health Services, Putnam County Department of Health U YELL COMPLETION REPORT PUTNAM COUNTY DEVARTNIMT OF NEALT11 171 Division of Environniontal F1cimi ; rrvicus COUNTY OFFICE UUILOING • CA11MEL. NEW YORK ' a +t lI.�D. h'� sr c'�� `tx ;,i�;(�;ilf ^,� J,la }.i:1_i :'i,(r'CI !(iry `�y'G�' i' =� �i Ilr C,a TS o•13 r ". -w r � 1 t. `. � U" k i ' _ �. . ,:� :;.. . -''= _ r:�:' •. ��:^-C �9kn , +�6= 4�?w�'i•- °K3'��1L.�utt'3i� m analysis of water sample indicating water is of satisfactory bacterial_quality before certificate of construction compliance Is issued. REPORT MUST BE SU, ; %111'TED l'r'ITHIN 30 DAYS OF :ELL COrAPLETION OWNER LOCATION OF WELL NAME '/ (1 1 (� ADDRESS 1I f,.. ( 1� r•�k'il('AIV) C 30 ��� �C 1� V ^,l�C my �OS ✓� ( (ILO. SUOOlJ Town l JJ I ,� (Town) (tot f:::naar) Gl�)� PROPOSED USE OF YJ EII BUSINESS DOMESTIC l� E TAEIISHMENT � FAR)A ! - � TEST WELL j AIR SUPPLY !� INDUSTRIAL CONDITIONING (Specify) DRILLING :OUIPTrENT ROTARY L�A COMPRESSED CABLE HE R PERCUSSION PERCUSSION Ope.ify ) CASING DETAILS LENGTH (feet) '� -j' -- I DIAMETER(rnches) - -" j� — WEIGHT PER FOOT " -' "�'� X� THREADED WELDED D:tVE SHOE ,� YES FI NO ((V.,I ASING C= OUT€6T__ L']I YES U NO YIELD TEST HO CAILED PUMPED COMPRESSED AIR I7 G.Pah. ` YIELD (G `�Al.) 1JATEP. LEVEL MEASURE FROM LAND SUiFACE- STATIC (Specifyfect) DURING YIELD TEST jtcot) Deplh of Comple':d Well (n feet below land surface: — _ SCREEN DETAILS 6tAKE LENGTH OPEN TO AQUIFER (leaf) SLOT SIZE DIAMETER (Inches) (F GP,AVEI Diameter of well Including GRAVEL SIZE (inches)IFROM fleet) ITO (feet) PACKED: gravel pack (inches): ►I FCGM LAND SU:sACEI 1 FORMATION DESCRIPTION ( - - _ - :kotch exact loca::on of :ell wi!� a %stances, to at least two permanent lanamerks. -FEEL iv i:i:i If yield was tested at different depths during drillinj, list below FEET GALLONS PER MINUTE `•• "'o��)`f/eu L)AIE OF NLPt1rtT r e l r wat t rmtf 1 f•'fl r- ,n:,.r,....v 7 P+ APPROVE"D ..41 oT 0 C T 2 0/197 O1 0 D;1,';.SiON 0' r! �a *I iv'wIRON NTAL H[AI .T)4 r K T Te, rJ t ev7 t-LI T I C5 V --PEE T. ot r q PUT 'AN Cr.('` "IT DF:PA•`77NT nF' ffrAr.,TIf • _ . _ . - .'.. . :'.. ::.. �;,1 ". " -:... , :. -.y�y. � - y �:Sr3• o�"- %�a�= "q�j n ..r .7�wii��_.:+.as T TN' F'ff' \T:�1.`IFF.ITAII SPMI[CP.S Date > s� Re: Property of Located at f3 eety 1ilel ,�J1�ai�ISiy�l �N /3ut;� A�.Y• Section ., Block Lot l Gentlemen: This .letter is to authorize A,i�:���%� a• "duly licensed professional engineer or registered architect. (Indicate) to apply for a Construction Permit for a separate. sewage system; to serve the above rioted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in s connection with this matter and to supervise the construction-of said system or systems in conformity with the provisions_.of_.rticle. > -? •47, education Law, the Public Health Law, and the Putnam County Sani- tary Code. �''D�R���SSlJ1�Af • !. Rq4, �fi� ` Very truly yours, Signed w �� 5194f� Q ner of Property Countersigne P.E., fi.A., /CI Z4 42, t/ Address 1' wd��6-67915-IC A 12('01 W-4-_. ¢6 Telephone Address A-B Telephone PUTNAM COUNTY DEPARTMENT OF I-EALTH _DIVISION OF ENVIRONM TITAL HEALTH SERVI -CES `000N'. `Y° 'GFTF CEI BUILDING, CARMEL; N. Y. 10512 DESIGN DATA SHEET- SEPARATE SEWAGE DISPOSAL SYSTEM ;FILE NO. Owner % k %Ji%1Lo/+le 62e Address ; �!7 G'i cS�1� ► .A/9nPW,,'1V_ F«s AJI Located at (Street 611,1441 Qlw Sec. Block Lot %Z �Indicate neares cross s treet) Municipality ?;rjA q 11A1.tcy . i�J. ;% Watershed T r SOIL PERCOLATION TEST DATA REQUIRED TO BE SUEMITTED WITH APPLICA ^IONS f c=2G �SjS � R'6 1-e Number CLOCK TIDE PERCOLATION PERCCLATION apse Depth to Water Water. eve No. Time From Ground Surface in Inches Soil Rate Start -Stop Min. Start Stop Drop in Min. /in drop Inches Inches Inches Z7-13& X7, 2 6. 33 '�t%_ /� it �(% '/9j a 14, 31 r 3 Zf 6,'4 -1 �l l�-r� . l v �� Z A h 5 - 3 ,- Z y ;. 4 5 7 N i or Ge t 2 /,5, 3, Notes: .1) Tests to-be repeated at same depth until a-proximately equal soil rates are obtained at each percolation test hole. Al data to be submitted for review. 2) Depth measurements to be made from top of hole. ' TEST PIT DATA REQUIRED TO BE SU11N;1TTrD WITH APPLICATION DESCRIP`I'I.ON OP' SOILS .,PJ1C0U;\T`.1'ERED IN TEST H0L- S i b DEPTH BOLE NO. HOL,E N0: HOLE NO. 6�� r 1211 1811 2411 3011 361 42" 48" 54 11 60" 66" 72" 7811 84" INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOli -;TES TESTS IvIA.DE BY Date Soil" Rate Tsed'5T?, Min/ 1 "Drop: S.D. Usable Area Provided e No. of Bedrooms cAS-� - Septic Tank. Capacity 1`Z '50 Gals mac Absorption Area Provided By200 L.F.x2411 '—�,�" lvame - pA.,jitL- J . ICANDAL L- iii.. bignature Address 24- 4o! -we- -'DR,ve SEAL Sit' N 12(c 0 1 �A� 51946 THIS SPACE FOR USE BY HEALTH DEPARTMENT T ONLY: Soil Rate Approved Sq. Ft/Cal. Checked :by, Date