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BOX 31
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04043
PUTNAM COUN'T'Y HEALTH DEPARTMENT
DIVISION OF .HEALTH SERVICES_
PROPOSAL FOR SEWAGE DISPOSAL SYSTEM REPAIR
OWNER' S NAME atA e e & Ai PHONE
SITE IACATION k D 0 i4 We- '�c+ � A S rtli A i /V
MAILING ADDRESS
PERSON INTERVIEWED POM Canplaint #
Name & Relationship (i.e, owner,tenant, etc.)
DATE r .- 2 9s' - TYPE FACILITY
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 I
,�' `" , ,-
ture &
with the
Proposal Disapproved
conditions:
S
1. Procurement of any Town permit, it appiicabie.
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' diem. 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 DATE
MMS: Vbite (PQD); Yellow (Tain HI); Pink Lk#hint)
a.
Division
4 Geneva
DEPARTMENT OF HEALTH
Of Environmental Health Services
Road, Brewster, New York 10509
(914) 278 -6130
CERTIFIED RETURN RECEIPT REQUESTED
Acting Public Health Director
December 15, 1994
Vincent & Jean Perna PLEASE REFER CORRESPONDENCE TO:
41 Doe Road NAME: Robert Morris
Putnam Valley, NY 10579 TITLE:: Public Health Engineer
PHONE:. (914).278 -6130
OFFICIAL NOTICE OF NON COMPLIANCE
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
your residence, by a representative of the Town of Putnam Valley Building Department.
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 laundry to be washed off the premises 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 o' cease ?- allridr.y. Was ?,Ti, � - =P!ovi3mder 18 =, ���94= ancF fur�lier', to -cof"rect this ~condition. by
November 28, 1994 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 yot
will cooperate by securing the correction of this condition.
For Acting Public Health Director
Ver ruly� yours,
Bruce R. Fol R. S.
Acts Public Health Director
JK /RM /jp By: Robert Morris, P. E.
Enc. Permit Application Public Health Engineer
cc: BI (T) Putnam Valley
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ROBERT R. KRUSE
PLUMBING & HEATING `
o j ! 51 MATHIS STREET j
LAKE PEEKSKILL.,N.Y.10537 ;
fe ley 4 41,