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25.54 -1 -32
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SITE LOCATION
OWNER'S NAME _
MAILING ADDRESS
PERSON INTER
DATE
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
OFFICIAL USE ONLY
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TM# 2 _ -3-C
PHONE 1'2' 2
f. PCHD Complaint #
_ --Name & Relationship i.e., owner, tenant, etc.
TYPE FACILITY
PROPOSE IND STALLER Sir PHONE 2 i• y' U G =
ADDRESS
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.
I, as .owner, or report 4g t of er agree. to the conditions stated on this form...
SIGNATURE �� &L�--- TITLE DATE r%
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
DATE
... ., .. ....J
DEPARTMENT OF HEALTH
Division of Environmental Health Services
4 Geneva Road
Brewster, New York 10509
Tel. (914) 278-6130 Fax (914) 278-7921
PROPOSED ADDITION APPLICATION (RESIDENTIAL ONLY)
BRUCE R. FOLEY
Public ' Health - Director
5-5-6)
STREET � OWN TX MAP #
NAMES PHONE 0?-7S-''Pe11e4CHD #
MAILING ADDRESS
DESCRIPTION OF A
NUMBER OF EXISTING BEDROOMS of PROPOSED # OF BEDROOMS
(FROM CERT. OF OCCUPANCY OR
CERTIFICATION FROM BUILDING INSPECTOR)
*Any addition which is considered a bedroom requires formal approval of plans (Construction
Permit) prepared by a Professional Engineer or Registered Architect in accordance with
applicable sections of the Putnam County Sanitary Code.
Please submit this form and the following to Putnam County Health Dept.; 4 Geneva Rd:,
Brewster, NY 10509, Phone 278 -6130. —
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1. Certified check or money order for $100.00 `�►"�� v'e't -�
2. Sketches of existing floor plan (drawn to scale, all living area including basement)
* Non - professional sketches are acceptable
3. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map #)
* Non - professional sketches are acceptable
4. Copy of survey showin well and septic location, to the best of your knowledge. Include date
of installation If known. Label all we s and septic systems within 200 feet of the property line.
Contact this office with any questions.
5. Copy of Cert. of Occupancy from Town or, Certification from Building Dept. with legal
bedroom count of dwelling.
OFFICE USE
Comments
Feb 98
-x-011
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DEPARTMENT OF HEALTH
Division . Of Environmental Health Services
4 Geneva Road e, York 10509
(914) 278 -6130
Putnam County Dept. of Health
4 Geneva Road
Brewster-, NY 10509 - -
Gentlemen:
BRUCE R._FOLEY, R.S.
Acting Public .Health Directoj
Re: _
esidence
Tax Map o / -�o� �SS-'�- LP
According to records maintained by the To` ri, the above noted dwelling
IS
i'
IS NOT
in compliance with Town code and the total number of bedrooms on record
is IZ
This information has been obtained from:
CERTIFICATE OF OCCUPANCY:
ASSESSORS RECORD:
OTHER �_(./.!/d�✓��
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uilding Inspector
04 -29 -1999 03 :44PM FROM TO 92787921 P.02
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HARRY W NICHOLS JR.. R.E. CONSULTING SIT& ENGINEERS
FAX TRANSMISSION SHEET
Date: or 1 �g119
Job No:
Dumber of pages P
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FAX No.:
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BRUCE R- -FOLEY.... -. -_ ....:.._.._........_
Public Health Director
Patrick Roche
3.6 Newburgh Rd.
Patterson NY 12563
Dear Mr. Roche:
LORETTA.. MOLINARI_ RN., _M.S.N. - .
Associate Public Health Director
Director of Patient Services
DEPARTMENT 'OF HEALTH
1 Geneva Road
Brewster, New .York 10509
Environmental Health (014).218'-6130 Fax (914) 278-7921
Nursing Services (914) 278 - 6558 Fax (914) 278 - 6085
Early Intervention (914) 278 - 6014 Fax (914) 278 - 6648
WIC (914) 278 - 6678 Fax (914) 278 - 6085
April 30, 1999.
Re: Addition- Roche - Newburgh Rd.
No Increases in Number of Bedrooms
(T) Patterson Tax # 25.54 -1 -32
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 from this Department dated April 3Q. 1999. 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 of the existing sewage disposal 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.
ML:kg
cc: BI
Very truly yours,
Aa _111
Michael Luke
Public Health Technician