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36.31 -2 -48
BOX 18
+ q-,�
01992
PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES D
i PROPOSAL F.OR SEWAGE TREATMENT SYSTEM:. REPAIR .�}
YES NO Internal Use Only PERMIT # (? _Q (o �-
❑ /'Repair Permit issued in last 5 years El at in Watershed
❑ . ,L -�/ Repair.withimBoyd's Corners, W. Branch or Croton Falls Res. 9' Delegated
❑ Repair within 200 ft. of a watercourse or DEC - mapped wetland ❑ Joint Review
SITE LOCATION ;/� ?j'�j r�,.;th 1a\g� W -TOWN f Q + V Q,f .s ufi TM # 3� , �% J- Yk
OWNER'S NAME ��hc� r �;ec.i1 S�t�nh0>>� PHONE# k4'S- a�-
MAILING ADDRESS �c� 't4\ 1 cry, k rt JJUl 0,1 Ai;J_j
APPLICANT 0 19.1 'N yz_
Name & Relationship (i.e., owner, tenant, contractor)
DATE I 0 FACILITY TYPE I-j o 1101 e PCHD COMPLAINT # e�
PROPOSED INSTALLER 111 PHONE #/ V 7 -0(%
ADDRESS 3 � -r? ' ^r REGISTRATION /LICENSE # N7
)OS;
Proposal (include a separate sketch loca tng the house, property lines, all adjacent wells within 200
feet of repair and the location of existing and proposed system)
NOTE: The Department may require submittal of proposal from licensed professional depending on the
nature and extent of the repair. c� C
L
I, as owner,agree to the conditions stated on this form
SIGNATURE TITLE DATE IY /g
(owner)
_1, the_ septic.installer,. agr. tg com a conditions of this permit.for the.septic system repair y
SIGNATURE TITLE DATE
(installer)
Proposal approved with the following conditions: ,
1. Procurement of any Town Permit, if applicable.
2. Submission of as built repair, sketch by the septic system installer within 30 days of the repair, in duplicate showing:
a. Owner's name, Site Street Name, Town and Tax Map number
b. Location of installed components tied to two fixed points
c. System description (e.g., 1250 gal. Concrete septic tank, etc.)
d. Installers' name and phone number
3. System repair to be performed in accordance with the above proposal and conditions
4. The proposed SSTS repair is considered a best fit design and there is no guarantee to the duration at which the
completed SSTS repair will function.
5. No completed work is to be backfille!jruntil authorization to do so has been obtained from the Department.
Approved
re & Title
INTERNAL USE ONLY
Proposal Denied
is in compliance with applicable codes
COPIES: PCHD; Owner; Installer
PC -RP 99ML
❑ l
ddb sz� A,
Date Date ' Expiration
Yes ❑ No 9-1
Rev. 2/07
�uG� `
�. .� . Sheet of
PUTNAM COUNTY DEPARTMENT OF HEALTH
-..._ .:VIVISION OF ENVIRONMENTAL HEAT-L-14 SERVICES
W Y� FIELD ACTIVITY REPORT
TP1• .
ADDRE S:
Street Town State Zip
PERSON N CHARGE
nR TNTFR V.TFWF.T) Tlata i (�l
Name and Title ;..
TYPE OF FACILITY: '
FINDINGS:
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iCPF('T(1R: rT
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ig Iture and Title
RF_-Pl1RT RF( FT",,-Pt) BY: l_:..ioil e-,'�'
I acknowledge receipt ofthis report: SIGNATURE;
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•CHRISTOPHER-' BORYK, -IAID
Assessor
Telephone
(845) 878 - 9300
Fax (845) 878 - 6343
March 17, 2010
Robert Stanhope
Susan Stanhope
33 South Lake Drive
Patterson, NY 12563
TOWN OF PATTERSON, NEW YORK
TM #'s: 36.31 -2 -48, 36.31 -2 -35, 36.31 -2 -47
Dear Mr. & Mrs. Stanhope,
-?A- TERSON• TOWN ifiALL
P.O. Box 470
Patterson, N.Y. 12563
Our town code has a provision that a lot, which is non- conforming, and is under single
but separate ownership, be combined with the main residence site. Your properties
--located at 33 South -Lake Drive and 55 Eastwood Road fall into this situation.
Previously your properties located at 33 and 35 South Lake Drive were combined into
one parcel as 33 South Lake Drive prior to this above mentioned recent combine.
Therefore, for the 2010 assessment roll, all three of the tax maps will be merged into one;
36.31 -2 -48. Your first bill with the parcels combined into one, shall be September 2010.
If you have any questions, please. do not hesitate to call me at extension 25.
Yours truly,
Amanda P Tomp ins
Clerk to the Assessor
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