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PETER C. ALEXANDERSON
County Executive
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(914) 225 -0310
August 22, 1988
Russell Woron
Maple Avenue
Patterson, New York 12563
Re: Field Inspection of
sewage disposal serving
residence on Maple Avenue
Patterson, NY
Dear Mr. Woron:
A field inspection of the sewage disposal system serving your
residence, was conducted on August .19, 1988.
I—
ENID L. CARRUTH, M.P.H.
Public Health Director
JOHN SIMMONS, M.D.
Deputy Commissioner
JOHN KARELL Jr., P.E.
Director
At the time of inspection the sewage disposal system appeared to
be functioning properly. There was no evidence of sewage on the
surface of the ground, and there appears to be adequate room to
expand or repair the system should it become necessary in the
future.
If you have any questions concerning this matter, please contact
me at your convenience.
Very truly yours,
William Hedges
Public Health Sanitarian
WH /jp
cc: BI (T) Patterson
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TYPE ON COMPLAINT FORM
Yes No
r. INFOPUMATION FOR COMPLAINT FORM
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COMPLAINTANT :
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COhIPLAINT :
DIRECTIONS :
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REFEPURED TO
DATE:
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PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
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SITE LOCATION 7 PM i-t 0 Az
OWNER'S NAME j� U`)? .i 6 E <6
MAILING ADDRESS :.Ar OA i
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OFFICIAL USE ONLY
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PERSON INTERVIEWED PCHD Complaint #,
Name & Relationship i.e., owner, tenant, etc.
DATE i I — S -e = TYPE FACILITY
PROPOSED INSTALLER dh j- N-� \
607-,.3 2 - 23
ADDRESS h4 4 tr_ ivit 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.
C_
I, as owner, or reported agent of owner agree to the conditions stated on this form.
SIGNATURE y'/ -uc ILA X�01 TITLE C3 LU 41 f__ r� l DATE LL ].; — 0
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 components tied to two fixed points (e.g.,house comers).
d. System description (e.g., 1250 gal. Concrete septic tank, three precast 6' diam. X 6' deep
e. Installers' name and number.
3. System repair to be performed in accordance with the above proposal and conditions.
Proposal approved
Inspector's Signature & Title
COPIES: White (PCHD); Yellow (Town BI); Pink (applicant)
PC -RP 99ML
-2,
DATE