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25.78 -1 -46
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JUL -10 -2007 07:33AM
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FROM - ENVIRONMENTAL HEALTH 9452787921 T -743 P.001 /001 F -209
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DIVISION OF ENVIRONMENTAL HEALTH SERVICES
0 / Repair Permit Issued in last 5 yeets ❑ fyat in Watershed
0 [ —�'/ Repair within Boyd's Comers. W. Branch or Croton Falls ROS- jj— dMlegBted 60. C/O
13 Repair within 200 fL of a watercourse or DEC- mapped wetland ❑ Joint Review
SITE. LOCATION % A4 yd j T TM # � �� < ✓
OWNEf;'$ NAME r� PHONE #
MAILING ADDRESS�,�
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APPLICANT CJ� J/-
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' Name & Relatlof Shlp CIA -, owner, tenant, o0nb2eter)
DATE I FACILITY TYPE V PCHD COMPLAINT:#
PROPOSED INSTALLER l PHONE # �A 4v/
ADDRESS U i$TRATION /LICE=NSE #
Proposal (include a separats sketch locati- the house, property lines, all adjacent wells within 200
feet of repair and the location of existing and proposed trenohas)
NOTE. Repair must be in same location and of same type as original sewage disposal system.
Different location and proposed pump systems will require submittal of proposal from Licensed professional
engineer or registered architect. _ / i1 ' Id- /.0 L r, � �, _�ti � . .✓�
owner; or mapeorted.egent ef.owner agree to tie conditions statad.on this form.... _ . _
SIGNATURE E DATE
1. Procurement of any Town Permit, If applicable.
2. Submission of as built repair sketch in duplicate showing_
a. Owners 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, etc.)
e. Installers' name and phone number
3. System repair to be performed in ce with the
above proposal and conditions.
Proposal proved Pro osai Denied
Inspector's 81 n = & r, tle Date
COPIES: White (PCHD); Yellow (Town BI); Pink (Installer), Orange (Applicant)
PC-RP 99ML
Rev. 8105
"DAOty Calls"
SEP -TECH Inc.
_ _ . __ ,•_.; �� ,, P.O. Box. 1;97 — Stormville, New York 12582
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845- 221 -9771
845- 226 -7606
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P.O. Box 197 — Stormville, Ne r York 12582
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LORETTA MOLINARI _R.N.,. M_ .S_N.
Acting Public Health Director
Director of Patient Services
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention /Preschool (845) 278 - 6014 Fax (845) 278 - 6648
J. DON'DI
County Executive
April 21, 2003
John Buonarobo
501 Village Drive
Brewster, NY 10509
Re: Two Bedroom Single Family Residence
15 Summit Drive
(T) Patterson TM #25.78 -1 -46
Dear Mr. Buonarobo:
I have received and reviewed the existing floor plan for the above - mentioned residence. I
have also reviewed our records and discussed the residence with the Building Department
of the Town of Patterson.
Records indicate the residence was originally constructed in 1940 and reconstructed in
1986. Our records indicate that this residence is a legal two (2) bedroom single family
residence.
should- -you -have any questions, please contact me at (845) 278 --6130 ext. -2168.
Sincerely,
William Hedges
Sr. Public Sanitarian
WIMP
cc: BI (T) Patterson
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