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01395
SITE
PHONE
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MAILING ADDRESS
PERSON INTERVIEWED � PCHD Canplaint #
Nam & Relationship (i.e, a teriLnt,, etc.)
DATE A)10 V -:57— /9� TYPE FACILITY
PROPOSED INSTALLER I pt;Ve_ S p; c-k_ PHONE
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.
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Proposal approved
Proposal Disapproved
Inspector's Signature & Title Date
Proposal approved with the following conditions:
1. Procurement of any Town pemit, if applicable.
2. Submisqion of as built repair sketch in duplicate showing:
a. owner I s name.
b. Site,Street Nam, Town and Tax Map number.
c. Location of installed components tied to two fixed points (e.g.,house cornei�4-).
d. system description (e.g., 1250 gal. concrete septic tank, three precast 61 diam. x 61 deep
drywalls surrounded by one foot + gravel).
e. Installer's name and number.
3. System repair to be performed in accordance with the above proposal and conditions.
\.as owner, or reported agent of owner agree to the above conditions.
d4 TITLE DATE
TURE jk�
be (PGD); Yellow (Tim HI); Pink Lagilamt)
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PETER C. ALEXANDERSON
County Executive
Irma Bloom
Fair Street RD #9
Carmel, MY 10512
Dear Ms. Blooms
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(914) 225 -0310
September 28, 1989
Re: Proposed addition A- 178 -89
Bloom b Fair Street
(T) Patterson
ENID L. CARRUTH, M.P.H.
Public Health Director
JOHN KARELL Jr., P.E.
Director
I have received and reviewed the plans for the proposed addition to the above
mentioned residence.
The plans indicate that a 12' x 25' addition will be added to the south side of
the existing residence consisting of a family room.
The survey indicates that sufficient area exists to expand or repair the sewage
disposal systbm, should it become necessary in the future. Therefore, based on
the information submitted, the above mentioned addition is approved with the
following conditionst
_ ......1. - ..Thar total number- of bedrooms must remain at- three- 0) 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 replaced or updated with water saving devices,
low flush toilets, restrictors for shower heads and faucets, etc.
Approval is granted for sewage disposal only. 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
Sr. Public Health Sanitarian
cc: BI (T) Patterson
a. 3
PETER C. ALEXANDERSON
County Executive
Irma Bloom
Fair Street
RD 09
Carmel, MY 10512
Dear He. Blooms
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
110 Old Route Six Center, Carmel, New York 10512
(914) 225 -0310
October 2, 19x9
Rea Proposed addition
A- 178 -89
Fair Street, Patterson
ENID L. CARRUTH, M.P.H.
Public Health Director
JOHN KARELL Jr., P.E.
Director
I have received and reviewed the plans for the proposed addition to the above
mentioned residence.
The plans indicate that a 121 x 25' family room will be constructed in place of
the existing deck. The rest of the house will remain the same.
The survey indicates that sufficient area exists to expand or repair the sewage
disposal system, should it become necessary in the future. Therefore, based on
the information submitted, the above mentioned addition is approved with the
following conditions:
L The total number of bedrooms must remain at three 3 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 replaced or updated with water saving devices,
i.e., low flush toilets, restrictors for shower heads and faucets, etc.
Approval is granted for sewage disposal only. Any other permits or variancef
required are the responsibility of the applicant and the jurisdiction of the Town
of Patterson.
If you have any questions, please contact we at your convenience.
Very truly yours,
William Hedges
Sr. Public Health Sanitarian
VH/jp
cat BI (T) Patterson
e: 7+
Bi -State Inc.
Septic Tank Service
Starr Ridge Road
BREWSTER, NY 10509
(914) 278.7565 (203) 778 -4247
1"91 PZ'ACA I
13
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