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631- 589 -8100
25.40 -1 -4
BOX 10
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MAILING ADDRESS S-✓�.Q
PERSON INTERVIEWED PCHD Complaint #
Name & Relationship (i.e, owner,tenant, etc.)
DATE �`� TYPE FACILITY
PROPOSED INSTALLER PHONE v �•;' � i J� k�
Pro (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.
4 Or F76- 77
's
1"k 161/ue
ture & Title
Elf,
Proposal aDOroved 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
d. System description (e.g., 1250 gali concrete septic tank,
drywells surrounded by one foot + gravel).
e. Installer's name and number.
Date
(e.g.,house corners).
three precast 6' diem. x 6' deep
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
MW: % to (PAD): Ye]1ov (kkin BE); Pink (Anila3nt)
BRUCE R. FOLEY
Public Health Director
Helene Summo
400 Haviland Dr.
Patterson, NY
Dear Ms. Sammo:
DEPARTMENT :OF HEALTH
1 Geneva Road
Brewster, New York 10509
LORETTA MOLINARI R.N., M.S.N.
Associate Public Health Director
Director of Patient Services
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648
Preschool (845) 228 - 5912 Fax (845) 228 - 6113
July 18, 2002
Re: Addition- Sammo- 400 Haviland Dr.'
No Increases in Number of Bedrooms
(T) Patterson Tax # 25.40 -1 -4
I have received and reviewed the plans for the proposed addition to the above - mentioned
residence. The proposal for the addition has been approved as per plans bearing the approval
stamp form this Department dated July 17, 2002. The addition is approved with the following
conditions:
1. The total number of bedrooms must remain at Two without prior approval
by this department.
- -2:. -- The'area oftfie esting sewage dispos al system, and its expansion area, must be
maintained.
3. All plumbing fixtures must be updated with water saving devices, i.e., new low
flush toilets, restrictors for shower heads and faucets, etc.
Any other permits or variances required are the responsibility of the applicant and the jurisdiction
of the Town of Patterson.
If you have any questions, please contact me at your convenience.
Very truly yours,
William Hedges
WH:kg Senior Public Health Sanitarian
cc: BI
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COT 38 78
R LOT NUM13ERS ARE AS SHOWN
ON Z" LA N T1TLED �SIXTH MAP
Of MEy. OF OUTMAN LAKE' AND FILED
ABEL. A. c,'�A�a�1°LC �� AS iAAP No. 149 —E
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PUTNAM COt)N' CDEPAR'�t�I' 2 .
HOUSE PLANS APPRO QED F:?F
B ROOM COUNT QNW;
�. BEDROOMS
LOT 3875
DRIVEWAY
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R. LOT NUMBERS ARE A$ SHOwN
ON -ILAN TfTLED SIXTH MAP
00 EOf�JYF�, OF 3UTRAN LAKE' AND FrLED
IABEL A. cs'�S►�"'r «_ro.s iAAP No. laS —E
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LOT NUMBERS ARE AS SHOWN
SURVEY FOR ON ZL.AN TITLED SIXTH MAP
of NFy. OF 31UTNAN LAKE" AND FILED
t y AS MAP No. 149 -E
EDWARD H. 8 MABEL A. yt'Qp�LDL
i SMITH ,t
TOWN OF PATTERSON
PUTNAM COUNTY tAdD
NEW YORK
'AUG 17, 19P.5 sd -12 GILL i� -
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THIS SURVEY IS ACCURATE AND CORRECT
BY:
GERALD L.LYNN WAPPINGER FALLS.H7
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THIS SURVEY IS ACCURATE AND CORRECT
BY:
GERALD L.LYNN WAPPINGER FALLS.H7
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DEPAR 11 Iti i OF HEALTH
DIVWon of Environmental Health Services
4 Genava Road
Brewstar, New York 10509
Tel. (914) 278.6130 Fax (914) 278 - 7911
BRUCE R. FOLEY
Puh"C Haaltir
PRODOSEI, ADDITION 6PPLICATIONN 1. �►1� • •
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• e -,f • ��1/f MAY
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NL4MLN(a ADDRESS
DESGRI"TiO�:` OF P.DDiTION
NUMBER OF EMST1NG BEl)ROQNA5-,,2-- PR0P0 ED # CF BEDRO0XS<D
QOM CERT. of GC: UFA,1Cle OR
CL-;RTIFiCAT -10`+ MOM BGILOLNG ItiSPECTOR)
*Any '; edition which is cons derod a bedroom requires formal approval of plain (Construction
Perritit) prepa:ltd by a Frcf= ssional Engineer or Registered Architect in accordance with
applieab: sections of the Pumar,i County Sanitary Code.
Please Submit this ferr:: ar.d tha fo:lowing to Put= Coun*y Health D17-pt., 4 Gereva Rd.,
Bmwster, 'NY" 10509, Phone 2717S -F130. -
Certified check or money order for S100,00
Sketches of existing floor plan (drawn to scale, all living area including basement)
" Non - professional skerc'n=s are accept =1010
3. Two sef�; of proposed floor plan (d aw71 to scare, with name, street, and "X. r-.---.p T)
* lion- ptofcssionai sketches are acceptable
4. Copy of s aryq sAhowing well and septic location, to the best of your k ►owledge. Incl,.lde date
of installation if kno, n. Label all wells and septic systems within 200 feet of the propel lire.
Contact this office wit any questions.
5. Copy of Cer►. of Occupancy $ern Town or Certification fra_r! Building Dept. with legal
bedroom court of dweIlingg.
QF i :E
C:ornmel:s
F:b 93
DEPARTMENT OF HEALTH
Division . Of Environmental Health Services
Cer,eva' Road, Brewster, New York 10509
(914) 278 -6130
Puts; Courty Dept. of Healy;
4 Genova Load
Brewster, NY 105C9
C
:endmen:
BRUCE R._FOLEY. N c
Aeting PUNIa Neaith Dire•tap
/' &I
Rcsi�len /"'
Tax Map
Acce►aing to records maintained by the Tows, tl c above noted &Mtling
iS
in compiian", N114jth code and thte total number of bedrooms on record
is
This info=, ation ,gas beer, obtailed from:
CERTIFICATE Or OCCUPANCY:
ASSESSORS RECORD:
0_11'HER
Building ins;
May 16, 2002
RE: Survey of Property
C�- -errs cnr� �1� -v�,•� L�r l
To Whom It May Concern:
Helene and Rocco Summo has my permission to have my property
Surveyed at 400 Haviland Dr Patterson, NY 12563.
Sincer ly,
Luis Rodriguez