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SITE
Pa1D Complaint # G?�
NameA Relationship (i.e, owner tenant, etc.)
2 G. TYPE FACILITY.
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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 eaginear or .
registered architect.
s -� �a s .c �, S /was d / S X s1 �-•- '7 1
wo
Proposal approved I Proposal Disapproved
Inspector's Signature & Title
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
d. System description (e.g., 1250 gal.-concrete septic tank,
drywells surrounded by one foot + gravel).
e: Installer's name and number.
Da .
(e.g. house corners).
three precast 6' diam.'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.
SIGNAZURE 1�7 /� (�G "C' TITLE / lJ S Xf&'
OOMS: Vbite (POND); YeUr w Chan 8I); Pink O plio3nt)
12 �7 � 7 '/s" *--7
SHERLITA AMLER, MD, MS, FAAP
:
--Commissioner of Health ' ° = "
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Town Legal Bedroom Count
ROBERT J. BONDi
County Executive
Re:drd M z (Owner's Name)
Tax Map #:
Address: s�
Town:
Year Built:'
According to records maintained by the Town, the above noted dwelling,
is _- �r in compliance with Town Code.
is not in compliance with Town Code.
Legal Bedroom Count is:
This information has been obtained from:
Certificate of Occupancy:
Other:
� /UC
Building pect Date
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678
Nursing Home Care Fax (845) 278 -6085
Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner ofHealth
DEPARTMENT * OF HEALTH "
1 Geneva Road, Brewster, New York 10509
o210 -C 430
ROBERT J. BONDI \
County Executive
L-IM
ADDITION APPLICATION RESIDENTIAL ONLY
4
STREET &�`'A � St • TOWN TAX MAP#
NAME PHONE o? — � PCHD#
8y�s- y9� y�sy
MAILING
ADDRESS
DESCRIPTION F
ADDITION G_ U
S
NUMBER OF EXISTING BEDROOMS PROPOSED # OF BEDROOMS o2
(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., 1 Geneva Rd,
Brewster, NY .1.0509, Phone: (845) 278 -6130.
Certified check or mone y order for $ 100.00.
2 Sketches of existing floor plan (drawn to scale, all living area including basement)
+o ska4' 3. Two sets of proposed floor plan (drawn to scale - with name, street and tax map #)
$5„O, *Non - professional sketches are acceptable
11 Copy of survey showing well and septic locations to the best of your knowledge.
Include date of installation if known. Label all wells and septic systems within 200 feet
of the property line'. Contact this office with any questions.
5. Copy of Certificate -of Occupancy fiom Town or Certification from Building
Dept. with legal bedroom count of dwelling.
OFFICE USE
COMMENTS
Environmental Health (845) 278 -6130 Fax.(845) 278 -7921
Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085
Early IaterventionMreschool (845)278 -6014 Fax (845) 278 -6648
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, ^MSN' y -
Associate Commissioner of Health
July 26, 2006
Lauren Drummond .
35 Gates Drive
Patterson, NY 12563
Dear Ms, Drummond:
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
ROBERT J. BONDI
County Executive
✓ROBERT MORRIS, PE
Director of Environmental Health
Re: Addition- Application Incomplete
Drummond- A- 236 -06
35 Gates Drive, Patterson
TM # 25.71 -2 -13
Review of the plans and other supporting documents submitted at this time relative to the
above- regarded project has been completed. The following was not submitted with your
application:
1. Sketches of existing floor plans (drawn to scale, noting all rooms on all floors,
including basement). Non - professional sketches are acceptable. Kindly add
owners name, address, and tax' map number to the sketches.
2. The proposed floor plans need to show and note all rooms on all floors including
... _ basement.
3. The proposed floor plans need to show the tax map number.
4. The survey needs to show the well and septic locations to the best of your
knowledge. Include date.of installation if known. Label all wells and septic
systems within 200 feet of the property line.
5. Plans have been returned to you for your own use.
Upon receipt of a submission, revised to reflect the above comments, this application will
be considered further.
GDR:mcb
Sincerely, /
Gene D. Reed
Senior Engineering Aide
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Water Supply Section (845) 225 -5186 Fax (845) 225 -5418
Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678
Nursing Home Care Fax (845) 278 -6085
Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648