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13. -1 -34
BOX 4
00104
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00104
MAR.21.2001 2 :24PM CHUBB COMPUTER PROGRAMERS NO.261 P.2i3
SITE LOCA
OWNER'S I
MAILING A
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH, SERVICES
PROPOSAL FOR SEWAUISPO$ iA_�CYSTRM REPAIR
C4g7*c*f'b) OMC1AL USE ONLY
3114101 S'fonc. LW AU 3 ?rr+ld�
1 `! B���w,w � •f%t�.cl�• �/�f'M# - --3Y
PHONE s 62-1-3207
PERSON INTERVIEWED A*E j b jwN a cam, LL!kLA rT� PCHD Complaint #
N=C a Remonslup (lie., owner, tenant, etc.
DATE TYPE FACILITY
PROPOSED INSTALLER C -F--F� _ PHONE
ADDRESS _ 9A," ev �� 6A 77js-A&'O REGISTRATION#
$=Sal (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.
I y_�GD vTrN �- A-1A RZAV "ov &- 1*kJt* RA 4,,a — SC-.I» G AUV ofd ` AW A
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l�itpv� byu-f, _ Wore.: l7` N�rcl 6fl.Ef /•tolQ.� lnJ R�
I, as owner, or reported agent of owner agree to the conditions stated on this form. .
SIGNATURE TTTLE wA//`.�t DATE p &f& -t
Praggsal aonrovcd 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 $treet Name, Town and Tax Map number.
e. Location of installed components tied to two fixed points (e.g.,house comers).
d. System description (e.g., 1250 gal. Concrete septic tank, three precast V diam. X & deep
e. Installers' name and number.
3. System repair to be performed in accordance with the above proposal and conditions.
Proposal approved,_
d
Inspector's Signature Title
COPIES: White (PCHD); YeAow (Town BI); Pink (applicant)
PC -RP ME
DA
MAR.21.2001 2:25PM
a a r
BRUCE R FOLEY
Public Health Dhwrar
CHUBB COMPUTER PROGRAMERS
DEPARTMENT OF HEALTH
1 Geneva Road
Br maW, New York 10509
NO. 261 P.3 /3
LORETTA MOLINARI RN., M.S.N.
Associate Public Heahh Director
Director of Patient Services
Environmental Health (845) 278.6130 Fax(845)27$-M1
lgvrslag Sernlcei (845) 278.6558 WIC (845) 278.6678 Pax (845) 279. 085
Eariy Iatervontion (84S) 278 - 6014 Preschool (84S) 228 - 6108 Fax (845) 278 - 6648
February 28, 2001
CERTIFIED RETURN RECEIPT REOUESTED
Werner Schmidt- Stumpf PLEASE RETURN CORRESPONDENCE TO:
142 Topland Road NAME: Michael Luke
Mahopac, NY 10541 TITLE: Public Health Technician
PHONE: �% 78- 613013XT.2127
OFFICIAL NOTICE OF NON - COMPLIANCE
YOU ARE HEREBY NOTIFIED that non- ,ompliance with Article III Section 4 of the Pgmam County
Sanitary Code where evidence of sewage onto the surface of the ground was found at 61 Baldwin Rd.,
(T) Patterson, NY TM #13 -1 -34 by a representative of this Department on February 27, 2001.
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
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 to pump the septic tank by March 7, 2001 and further, to coned this condition by March 17,
2001 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.
WIP .
enc.. Permit Application
cc: BI (T) Patterson
For the Public Health Director
Very truly yours,
Bruce R. Foley
Public He h D'
By: Michael Luke
Public Health Technician
Cn ��
7/27
/ Sit- 0 t/