Loading...
HomeMy WebLinkAbout3902DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.16 -1 -42 BOX 30 rq ''��, - , 1 :; �L4 it L � f • �y ; . rIL 03902 PUTNAM COUNTY HEALTH DEPARTMENT ' DIVISION OF ENVIRONMENTAL'HEALTH SERVICES YES O Internal Use Only PERMiT.f/. ❑ Repair Permit Issued in last 5 years ,_,/W ❑ Repair within Bgyd's Comers,, W. Branch or Croton Falls Res. (Q ❑. Repair within 200 ft. of a watercourse or DECmepped wetland SITE LOCATION ?�� (�nx� J,1L 0 TOWN P, OWNER'S NAME MAILING ADDRESS ` q a - ,, �.J'J_ Pal- J6 , APPLICANT Name & Relationship p.e., DATE -&3 I I _ j 1 PROPOSED INSTALLER FACILITY TYPE of in Watershet Delegated .11. Joint Review. . TM PHONE # 4i Ll _ dUn �PCHD COMPLAINT# . . _ PHONE #._%i$7136=9 1 f /LICENSE # O ;) . 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 ekdent of the repair. I, as owner,agree to the conditions stated on this form SIGNATURE MAI " ''AA7 TftLE i.lQ[,P1' DATE (wed - - -0; tlhe ��rti^rire !lns, afiree s:p; 1mt r:th :eiiditions cf tlita.permit fbr the seNtiu'sys-terwrepeir' SIGNATURE TITLE o ` DATE..' : I (Installer) Proposal =roved with the 4nllowing 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 sand Tax Map number b. Location of installed components tied to two faced 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 backfilte� until authorization to do so has been obtained from the Department 7 INTER' NAL USE ONLY Proposal Approved & Proposal Denied ❑ Inspector's Signature & Title to iratio Date ,Repair proposal is in com lianbe with applicable codes _ Yes No ❑ COPIES: PCHD; Owner; Installer PC-RP 99ML Rev. 2/07 P Sheet-1—of I PUTNAM COUNTY DEPARTMENT OF HEALTH '" '` +"'D')(VISIUlY®I' ENViI2�Ni1�TA `T��'AI.,TIYS�I2�ICES FIELD ACTIVITY REPORT Street Town / State Zip PERSON IN CHARGE It Name and Title TYPE OF FACILITY: '5���vo . Aker 3�yy►r� cccz[/ rn� uJ,�� 'I�e ✓u�,��8,� �sc�s h 4k C- 1 T 0 U TNCPFC'TQ ' I�. F'e % TFT Signature and Title REPORT RF.C:FTVFT) RY: I acknowledge receipt of this report: SIGNATURE: 02/96 Title: Rev. ALLEN SEALS, M.D., LD Commissioner ofHealth iiofl Director ofEnvironmental Health March 27, 2015 DEPARTMENT OF HEALTH I Geneva Road; Brewster, New York 10509 Phone # (845) 808-1390 Fax # (945) 278-7921 Mr. Ibrahim Bruncaj 38 Brookdale Road Putnam Valley, NY 10579 Dear Mr. Bruncaj: MARYELLEN ODELL County Executive Re: Intermittent Septic Failures at 38 Brookdale Road (T) Putnam Valley, TM 83.16-1-42 As per our conversation at your residence on March 23, 2015 the following was discussed to help prevent further septic failures at your residence. First prevention measure was to eliminate the existing junction box and reconnect the existing pipes with new solid pipes. ..--Second . mevention measure was -to djg,.4 shallowArencli (apprQximatply, 4" 672 11 the septic system along the property line, to divert surface rain water around the system to the road. As your septic system still experiences failures during rain events, it is 'strongly suggested that the above recommendations be considered to help prevent said failures in the future. If you have any further questions, please contact me at (845) 808-1390 ext. 43261. Sincerely, Gene D. Reed Principal Environmental Health Engineering Aide GDR:cml ALLEN BEALS, M.D., J.D. Commissioner of Health ROBERT MORRIS, P.E., WH Director ofEnvironmental Health December 22, 2014 DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York .10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 Mr. Ibrahim Bruncaj 38 Brookdale Road Putnam Valley, NY 10579 Dear Mr. Bruncaj: MARYELLEN ®DELL County Executive Re: Intermittent Septic Failures at 38 Brookdale Road (T) Putnam Valley, TM 83.16 -1 -42 As per our conversation at your residence on May 12, 2014, the following was discussed to help prevent further septic failures at your residence. First prevention measure was to eliminate the existing junction box and reconnect the existing pipes with new solid pipes. second pre'untion measure, was to dig. a .shallow trench. (aip roxi.r�iately..4 ": d es upbil l .o.£ the septic system along the property line, to divert surface rain water around the system to the road. As your septic system still experiences failures during rain events, it is strongly suggested that the above recommendations be considered to help prevent said failures in the. future. If you have any further questions, please contact me at (845) 808 -1390 ext. 43261. GDR: cml . Sincerely, Gene D. Reed Principal Environmental Health Engineering Aide PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL'HEALTH SERVICES .- :.-PR0P -- ,9AL ..FOR�SEWA► :-REA ME4T >SYS1TE Internal Use Only PERMIT Cy, rZ,.. Lf Repair Permit issued in last 5 years �0 of in Watershed Lff 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 APPLICANT Rh-e DATE ,Z- -1I -i1 PROPOSED INSTALLER TOWN P a-. VV TM# col & —i'Y-\ PHONE # q90 -A a- - -51;) PCHD COMPLAINT # PHONE #j --13b ADDRESS 2,N,, REGISTRATION /LICENSE # i� �- 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. C 4 ca i ...- 0 iK __ N I, as owner,agree to the conditions stated on this form / SIGNATURE 6 6L,7 % ThE DATE / (owner) I -thy s9ptic ine?r, iag,te2p tmply with tl. onditicrts of r �-;,s permit-for-the septic s-ytrrr repair _ SIGNATURE TITLE DATE (installer) Proposal anoroved 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. 7 INTERNAL USE ONLY Proposal Approved Proposal Denied ❑ Signature & Title Dfite —/ iratio Dai osal is in compliance with applicable codes Yes C� No O COPIES: PCHD; Owner; Installer PC -RP 99ML Rev. 2/07 P 4/5 20%03-1112:01 PRECISION EXCAVATING 18457360571>> 8452787921 0 wo I b Stye Homeowner: Vic and Bobby Bruncaj 3813rookdale Road . Putnam Valley, NY 10579 (914) 980-5952 Town of Putnam Valley Tax Map: 83.16-1-42 Installer Philip Leonfortc (License #1022) Precision Excavating Inc. 3 Rocharnbeau Road Garrison, NY 10524 (845) 736-0571 Description of ]Repair to System: Installation of 90, Septic Fields With I Y2" Washed Stone ­6 62A roo rn (Aes:ckencx- - e -0 - - � 0 TP n K 30 1 :cam 2011-03-11 12;01 PRECISION EXCAVATING 18457360571>> 8452787921 Public ficalth DbVidar P 2/5 LOR=A MOLINAN RN., hCS.N. Anoolage Public NmM Dl ;; Dirmw of FdtkW souk" DEPARTMENT OF HEALTH I Geneva Road • - -BMWsK New York WSW I ATTENTION: 0 JOSEPEF PARAVATI 'GENE REED All information below must be hft completed prior to any scheduling. DATE: ENGLNEER OR FMM-, 9(40-i 1-no 5-x r a LIA I n G1 -- PHONE #. REASON: JWM; X PERCS: 13 PUMP TEST: a ROAD)STRUT: 2% V-�A TOWN: R.A-VnAM k W�O-A k TAX MAM Sil'i k6 - 1 -4Q SUBDIVISION: LOT#-. OWNIX- \Lt'eP- Ar,,� L-'�43n, RkWaYal).111 0 01A "In X 11*141la-6 *11 Vi I AIMAUIXIJ 4 0 YES NO ,Opftw Ss Proposed SSTS witch 50 feet of a reservoir, reservoir stem or control [okr- a a Proposed SSIS witMa 100 teat of 4 watercourse or a DEC wetlamd, a ❑ Proposed SM design flow greater than 1000 galleaVday or SPDES Permit required. U 13 Proposed SM for a commes hd Project. It is the responsibility of the design professional to provide the above information prior to son testing. Ufa Department will determine the NYCD)EP project status (Joint or Delegated) based on the response. U you answered jW to any of the quational NYCDEP must witaw the soil tests. This Department will coordhate a mutually suitable time for fleld testing with the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent Information indicates NYCDLT It required to witness the soil tots, it will be the sole responsibility of the design professlowd to schedule re-whnewing of the soil testing with NYCDEP. FOR COMM M MY TM- g"i rg! COMMZM: ME=Es,n m : v{ rJi.•. vvwN....t.' �. w�u:.u..- n..viJn:'avourMVlli:w. filial.: n•:•."..:••«:••.:.- h�ixYlYav1N+ 6eiw'. 1tYL3fWIrihL3: ��%•^-• �•• •.•• i. a. v` 13tl16hhWiiMVYiV� :liidHdWiil13(tiii" "'uVi :•- � IM.aut.wY .. wuay.. a... v+. Ln.. nrwr+ wsu�x�. �wLuu. .ovYw...lv.in.b.d.v....u..'Wy,y µu.F TEST SPIT DATA DESCRIPTION - DESCRIPTION OF SOILS ENCOLWI TERED INN TEST HOLES JL IY, HCLL R -l- HOL —E= H0L- HOL_T 1.0, J 1 a. Or 2.0' S 2.5 M� 3.5' 4 4.� rJctu� Y�'I E.� 7.0' .. ..e. � ..► ..71. J'..e• a. a..k....eo _.. ...... .. ...-:. ... .. _ .... .. _ .. � ....:rr - .._ . ... - ... tee- � ...._.... ._.. .. ... . ,+.al 1D.0' Lnd :cat,..ev,,. at which zot+ndwater is acount.._..� 3 O LZdicate level at which mottling is observe 3. L.2 &„ Indicate Level to which water level rises ifter being encountered Deer ho le obser ✓atiom made by: `P, c, g,� _ Date 3 2 2 Design Professional Narne: Address. Si, gnanize : 2011-03-11 12;01 PRECISION EXCAVATING 18457360571>> 8452787921 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICE'S —PROP AL Qjj.§EWAGE TREATMENT SYSTER REPAJR YES N Internal Use Only PERMIT # Repair Permit Issued In law 5 years ❑ Not in Watershed U U Repair within Boyes Comers, W. Branch or Croton Falls Res. U Delegated ❑ ❑ Repair within 200 ft. of a Watercourse or DEC - mapped weOxxt ❑ Joint Review SITE LOCATION OWNER'S NAME MAILING ADDRESS APPLICANT Name & Relationship (i.e., , tenant, contractor) TM 0 NE# '. .. - . — k Q COMPLAINT COMPLNT 0 DATE FACILITY TYPE PROPOSED INSTALLER PHONE 0 ADDRESS REGISTRATION /LICENSE# Pmomal (Iftlude a separate sketch I=Mlrvfj the house, property lines, all adjacent wells within 200 feet of repair and the location of existing and pmposed system) NOTE: The Department may require submittal of proposal from licensed professional depending on the nature and G?Ident of the repair. C_ 1, as owner.agree to the conditions stated on this form –SIGNATURE. Ia. 2f 1, the septic installer, agree t mply with th riditions of this permit for the septic system repair 1h SIGNATURE TITLE rj DATE Proposal amoved with ft folkWoo conditions: i . Procurement of any Town Permit, 0 applicable. 2. Submission of as built repair sketch by the septic system installer within 30 days of the repair, In dupflcMe showirg 0. Owners ram. Site Street Name, Town and Tax Nlap number b. Location of Installed components bad 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 ft completed SSTS repair will function. 5. No completed work is to be backfilled until authorization to do so has been obtained from ft Department. INTERNAL USE ONLY Proposal Approved ❑ Proposal Denied ❑ I Inspector's Signature Expiratf6ii-ffa—te Re it is in compliance with applicable codes yes ❑ NO ❑ COPIES,. PCHD; Owner-, Installer Its.. hE117 P 3/5 2011-03 -11 12:01 PRECISION EXCAVATING 18457360571» 8452787921 P 115 Precision Excavating Inc. 3 Bo ..... sti Bead ld*rd"W NY 10524 (84b) 7364371 "Cavedusaveducamet To: Gene Reed From: April Leonforte - Date Sent: March 11, 2011 Regarding: Test Holes No. of Pages: 5 Gene, Hope- v tr inter: a . a goad ;epe: We are-sE re Iasi :to.l�e done Wth- snow shoveling- : 38 We have mailed in a permit forgBrookdale Road, Putnam Valley which you should receive Monday or Tuesday. I wanted to know if you could tentatively put us on your calendar for the deeps (pending receipt of permit). These people have a complaint on file with you but they couldn't seem to produce a complaint number for me. Please call me at your earliest convenience at (845) 736 -0571. Sincerely, April Leonforte a.; a: j: a 1 i a' • 2827 111 07 NEW 01.08 8810004306 MUNLT VKULK CHASE-*.".,.:` __ ._ .. - 98481 0091 9 aao Date 03110/2019 Pay To The �•. $ ®r+dao OQ�-{� I a: Pay ONE HUNDRED FIFTY DOLLARS AND GENTS NOT VAUD FOR MORE THAN 51000.00 c°�7- NEW A1P �1orSS► ise Sank, N.A. 4 • I! I o..:.v fj°48i4ja LD09 Lgvo imL.4000O37e: 1?586 , L 28411® N C J Q w ' N a M rn rn n 0 z Q n a z c� 00 A V w rn a cn r v A N3 N V ccl �r.1.: .� .�..�.t:P ry �+.. % .r nr �Nw /.p�c ", C9'�•. j` .. .r ♦ Via... w... .... •� �� Homeowner: Vic and Bobby Bruncaj 38 Brookdale Road Putnam Valley, NY 1 0579 (914) 980 -5952 Town of Putnam Valley Tax Map: 83.16 -1-42 Installer: Philip Leonforte (License #1022) Precision Excavating Inc. 3 Rochambeau Road Garrison, NY 10524 (845) 736 -0571 Description of Repair to System: Installation of 90' Septic Fields With 1 %2" Washed Stone 30 G� ti �d. Public Health Director DATE: DEPARTNENT I Geneva -Brewster, New LN JLCTMEMA MOLDITAM. I associate Public Health Director Director Of Patient Saw= OF HEALTH Road - - York 10509 ATTENTION: ❑ JOSEPH PARAVAn XGENE REED All information below must be fft completed prior to any scheduling. DATE-- ENGINEER ORFUM: PHONE #: 24S-Tl� �`a'71 REASON: DEEPS: )( - PERCS: ❑ PUMP TEST: ❑ ROAD/STREET: LOO�a�e_ RA. TOWN: TAX MAP#: SUBDIVISION: LOT#: YES NO ❑ ❑ Proposed SSTS within the d rainage basin of West Branch or Boyda Comer Reservoirs. ❑ ❑ Proposed SISTS within 500 feet of reservoir. re-serypAr stew-orgopt, 1, is k. ro V * ❑ ❑ Proposed SSTS within 200 feet of a watercourse or a DEC wetiand. ❑ ❑ Proposed SSTS design flow greater than 1000 gallous/day or SPDES Permit required. ❑ ❑ Proposed SSTS for a Commercial Project It is the responsibility of the design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered yg to any of the questions, NYCDEP must witness the soil tests. This Department will coordinate a mntually suitable time for field testing with the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP Is required to witness the soil tests, it will be the sole responsibility of the design professional to schedule re-witnessing of the sod testing with NYCDEP. (FIELDTEST) FOR COUNTY USE ONLY 0 WO I Homeowner:, Vic and Bobby Bruncaj 38 Brookdale Road Putnam Valley, NY 10579 (914) 980-5952 Town of Putnam Valley Tax Map: 83.16-1-42 Installer Philip Leonforte (License #1022) Precision Excavating Inc. 3 Rochambeau Road Garrison, NY 10524 (845) 736-0571 Description of Repair to System: Installation of 90' Septic Fields With 1 Y2" Washed Stone Installation Complete: 3-21-11 A t3 Legend: A -1 =19' B - 1 = 17.5' A -2 =27' B - 2 = 23.5' A -3 =34' B - 3 = 30.5' 30 Sheet 1 of PUTNAM COUNTY DEPARTMENT OF HEALTH FIELD ACTIVITY REPORT NeMF.• ►ZV�IC.AY Tel: AT-)T)RFCC Street Town State Zip PERSON IN CHARGE OR TnTTFRVTRWFTI• �i�i� /LG tr— �c-4AVAZ�i✓� natP •3��5��// Name and Title TYPE OF FACILITY: S S S (�- t�l� / /•Z FINDINGS: l r/5'r.�lL T.lfZ,ry •low ©F /�EZC��/�T�� Y� /% //� l9/G4 Signature and Title REPORT RECEIVED BY: I acknowledge receipt of this report: SIGNATURE: 02/96 Title: Michael Budzinski Fr3t:. Lisa Seymour • : r Sent: Friday, December 12, 2014 3:2S PM To: Michael Budzinski Cc: Gene Reed; Marianne Burdick . Subject: 38 Brookdale Gardens Lake Peekskill Hello Mike, I received a complaint again for this location. This was the one you went out with Gene on this past May. Gene said you told them to enclose the pipe in the junction box at the time of the visit. They have not done this to date. ' I inspected today and did not see anything. leaking. The complainant said leaked beginning of week, note the system leaks with torrential rains (which we had this week). When it leaks runs down the road near brook. Since the junction box is not below grade(new system put in a couple years ago) can you write a letter asking them to enclose pipe in box ( consider adding or enforcement action will result) since system leaks under excessive rain conditions? Please let me know. Thanks Lisa Seymour Public Health Sanitarian II Putnam County Dept. of Health` 1 Geneva R oad _ .. :..., Brewster NY 10509 E -mail address: lisa.seymour @putnamcountyny.pov Tel: 845 - 808 -1390 extension 43162 Fax: 845 -278 -7921 0 1 ALLEN BEAD, M.D., J.D. Commissioner ofHealth Director ofEmironmental Health Mr. Ibrahim Bruncaj 3.8 Brookdale Road Putnam Valley, NY 1.0579 MARYELLEN ®DELL County Executive DEPARTA ENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Phone # (845) 8084390 Fax # (845)' 278 -7921 Certified Return Receipt Requested Please Refer Correspondence to: Name: Lisa Seymour Title: Public Health Sanitarian. II Phone: (845) 808 -1390 Ext. 43162 Date: May 16, 2014 Official Notice of Non- CornDliance YOU ARE HEREBY NOTIFIED that non - compliance with Article III Section 3.4 of the Putnam County Sanitary Code consisting of a discharge of sewage on the surface of the ground was found at your residence, 38 Brookdale Road, Putnam Valley, NY 10579, TM #83.16 -1 -42, by a representative of this Department on May 16, 2014. 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 thst the,sewage overflow cease,- . - ..... - °`" ` li arranging g` for the septic tank to be' urii `ed out and maintained - um ed until the proper er re airs are made Y P P p p P p p P 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 along with a list of licensed contractors. Failure to pump the septic tank immediately and further, to correct this condition by June 29, 2014, 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. The septic system is required to be maintained / pumped until repairs are. 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. Please call me at (845) 808 -1390 ext. 43162 if you have any questions. LS:jmg Enc. Permit Application cc: BI (T) PV M. Burdick M. Budzinski, J. Paravati For the Commissioner of Health len ZBals, M.D., J.D By: Li eymour Public Health Sanitarian II a o -61-0- 7� rl� 7-Ire rNCA) .. K z • .,;♦, i � °vy w.r��"'y' � r �"Yj� ^+�'zy, . '*±w�� �� , � • •" x ,T S,4 a Mf �i � uc. a.� Ya, F � P: i- °.r9 µ� t.'`.�� �'.2^a'J ;.r iC'�. •�w '' 4� r 1. �'� �� u R ,..i ,rr ,� � �� +� � � „ 8 s• R i � j "��, t ' �,�` ,ro "�",a 1-ai`� ' � a' ; �,� , e r*'v��+.�1' ".%;.a; � . ,:» ,"' �._.. 4 _.. _. « •,� r �', a .,��'�'. � Yap' T r,.a .�t ���� �t�i:;�,s�"! y° _^c^+ . - ��r •a� c' �'' '' :'�" ♦ Y' t ,..w � ,y^ i ° YT rt �� ¢ �ka�, w„�•�$: } ,� +�,�,, a ��,'.�'. � ,,;,�a�aE�a �¢, e ¢a���*•w�,_ 9 4 d ,�",e s _ t: `, / •'. '•:a 4 ,+ .iY,:t r'`: iB saY....� -fig, +uj +r 4 }# ,,.3"g'��' .�m',i iL�(ty -�{.�� x p'yg`4pt* ..-. -` K°s *:st «a.,�«• .1 -"4 • ryNr} a ;`e i f�� .,,,� ;Ma"� �e {"]'� 'u S §� .* $"�kE ;.i- �4'4t4 "�v :�;. fi;x�!�"`,aT w4�{e i` .. •:1# P � ; ♦' -$. . y � + ixii .t' T� w�: + • � ..,v'� �, j.'"b, x•- ..�:^i* . � #'��:.� tg '�k �.ia �P��,, # • t° .w',,a wY A �avxa d� 4,dw l a n Mt 6 .S d}•r ► s� .. vw fir. � � d r � .� '`.jc�`*J�`�".yr�� �y� v�w',s =n:'Om..'�•,`. f ,�, ,,, ...�� x�a, Fr ate � , � ,`. i' i , r' �* y",,a. #'"� c� x f,,r^ � -. -�.n +Ye:. -,1 La - 4°•..3 � r D. ♦ �4 ;.a y i �3 .� -��r`t ...J..w ,e• par ,rap* - r.# `;...} :�` P` :S, p"�- ';�'�`rf^ . e•, tom.. ' Sheet of PUTNAM COUNTY DEPARTMENT OF HEALTH FIELD ACTIVITY REPORT MAX4'Ff & 6ru"Cet1 Tel, AnT)R'F-,RR-, t-c>57q Street Town State Zip' PERSON IN CHARGE 4, QR TNTF-RVEFWF, NLA- - L,,,, 0 -b Date, Name and Title TYPE OF FACILITY : &Cseb,—H,( S-97T C141q FINDINGS: Ld PiAA eu-kr_ Qud z;-s L"LP. F. 0,'re cl, 4- 4ktj I acknowledge receipt of this report: SIGNATURE: 02/96 Title: Rev. ALLEN BEALS, M.D., J.D. AR YE LLEN ODELL . of Health, * i4 County Executive ROBERT MORRIS, P.E. Director of Environmental Health RG�D DEPARTMENT OF HEA 6 I 1 Geneva Road, Brewster, New York 10509 Phone # (845) 808 -1390 Fax # (845) 278 -7921 Certified Return Receiat Requested Mr. Ibrahim Bruncaj Please Refer Correspondence to: 38 Brookdale Road Name: Lisa Seymour Putnam Valley, NY 10579 Title: Public Health Sanitarian I1 Phone: (845) 808 -1390 Ext. 43162 Date: June 14, 2013 Official Notice of Non- Coninliance YOU ARE HEREBY NOTIFIED that non - compliance with Article III Section 3.4 of the Putnam County Sanitary Code consisting of a discharge of sewage on-the surface of the ground was found at your residence, 38 Brookdale Road, Putnam Valley, NY 10579 :T�NI #83 2, tTy epresentative of this Department on June 14, 2013. .that you are responsible for correction of this condition. If you are not responsible, you are imnector above indicated. w cease ' I s . . 1-1q-� - pt �Mx 1 � C 2<-1— Sheet_ Of___�__ PUTNAM COUNTY DEPARTMENT OF HEALTH DIV - SION•.O.F .EN_- VIRON1V. ENTA]F HEA.TLI.I.S:ER- F.IC.ES-- � .... ;{.�. -o-.f, .. .m.- Cr.., >ro. 1, :-_ _ ..•.� _ � . .., r'^a..- "- ';�_�. :n-.i .• -a .� "..- :ay:: .. -+.-,yi'.1: % -iir. :�..: FIELD ACTIVITY REPORT Street Town State Zip PERSON IN CHARGE nR TNTF.R VTF.WR ; ®evi4e %�i f . }r ('t/l�G� a Date, Name and Title TYPE OF FACILITY: FINDINGS: 1_-72^ c, 'S aya-s ey-6LO& r'� -lam ��o-t�[e�✓1, ,i,�d'� i� 7--0 t'���eez'e �'it.� r'�ot- �t1TTer" fi ra-i a 4-vi a4- d1 r e�c-TS E &,4cr °-,, e-4r Signature and Title REPORT RF.rFTVRTI RV: I acknowledge receipt of this report: SIGNATURE: 02/96 Title Rev.