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Home My WebLink About0036DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 1 -1 -59 BOX 1 Iry J,rIL ,� �' ' 61., ' '• 16 ,4 .� I : , . O'I 'I Ir 6 IN, - ' � I NI ■ �- r'' I 00036 PUTNAM COUN'T'Y HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES X73sI -Ts OWNER'S NAME � � f >lx.�%" �P l' Ya r o PHONE SITE LOCATION 71$ MAILING ADDRESS 3 6 PERSON INTERVIEWED PCHD Complaint # Name & Relationship (i.e, owner,tenant, etc.) DATE aZ "I I X TYPE FACILITY PROPOSED INSTA1JM J U V, 'tom PHA 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. a. C) IAA4V -v & Z �.4c '�;. 4 Proposal approved '' �salas�pr__..... Inspector's Signature & Title . Date 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 canponents tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diam. x 6' deep dzywells 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. I, as owner, or r rted agent`of owner agree to the above conditions. SIGNATURE TITLE DATE Y TP16: V&te (FAD); YeUcw (inn ED; Pink (AppUa nt) Oltmos NAME �,-,Tt SITE LOCATION X9 MAILING ADDRESS PERSON INTERVIEWED PUrNAM COUNTY HEALTH DEPAR24M DIVISION OF ENVIRONMENTAL HEALTH SERVICES f-1-t PHONE � 7 7-:?Y TO 1.J ® ah1,.Ic, 2 PCHD Complaint # & Relationship (i.e, owner,tenant, etc.) DATE YI (}1Z G k Co I `7 R 1 TYPE FACILITY Jc 0 1°CA-- S PROPOSED IAISTALLER e- f A„l PHONE REGISTRATION # `% E-8- 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. n _ / - L yCIS4,,J6 /}i-,;4,q L 3,eel.0 2iq r2 4w LL GAL ZA .,1 o a - 72( 617,1 /1�S St ,. S= N v G 0 S nn o'�,.1 vi ky Cr� 6: , A 1.4 4 -9.0 C e> u 2 C ? S cI S—i—c1." Proposalqgjr-�ved 7`-- Proposal Disapproved is Sicrnature & tle Date roposal 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 camponents tied to two fixed points (e.g.,house corners). d. System description (e.g., 1250 gal. concrete septic tank, three precast 6' diam. x 6' deep -drywells 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. I, as own Woreport!edent of owner agree to the above conditions. l SIGNATURE TITLE u (r J DATE n:1ES: V& be (PQD): Yellcw (fin HI); Pink (4#iart) za.a.q. 0 P.O. Box 621 CARMEL, NEW YORK 10512 (914) 225 -6277 8v 3 ??�-- ?? 3� �QtL� a9 � ® -well 6200% 1 R X v� �L � ga' , V Anderson/Ferrara Route 292 Patterson NY 12563 Dear Mr. Douglas: BRUCE R. FOLEY, R.S. Acting Public Health Director DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 May 17, 1996 RE: Addition - Anderson/Ferrara No increase in number of bedrooms 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 latest revision date of May 17, 1996 and this Department's approval stamp. . Based on the information submitted the above mentioned addition is approved with the following conditions: I . The total number of bedrooms must remain at four wi'ithout 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. Very truly yours, William Hedges, Jr. WH:mk Sr. Public Health Sanitarian cc: BI (T) Patterson DEPARTMENT OF HEALTH Division Of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 ADDITION APPLICATION - (RESIDENTIAL ONLY BRUCE R. FOLEY, R.S. Acting Public Health Director STREET:- R-Tc q �_ TOWN _- 4'i'Te,z. S� cit) TX MAP # 3-_1-15 NAME: ,4 PHONE elk 77 3 PCHD PERMIT # MAILING ADDRESS Wre R i2- F��' i �C r�-S �i �y,�7 j Z,-Y&3 Description of Addition AiTcti Number of existing bedrooms Proposed number of bedrooms 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 DEPARTMENT, 4 GENEVA ROAD, BREWSTER, NY 10509, Phone 278 -6130 with the following information. 1. Certified Check for $100.00. 2. Sketch of existing floor plan (all living area including basement, if any) Non - professional drawing is acceptable. 3. Sketch of.proposed floor plan. Non professional drawing is acceptable. 4. Copy of survey showing well and septic location, to the best of your knowledge. Include date of installation if known. Include all wells and septic systems within 200 feet of property line. Any questions please contact this office. OFFICE USE Comments and /or conditions application August 1995 I�lovJ ocZ �oQM c1z -��1 L-1 C r v+ -7 50� cP S80 $• 'c of r �ZEro,.�l iUCq "p sta -moo_ ^ CWw� 0 A B21G)✓ EUT2y �Y • �"3� U F�GC� 4 , • 6Nray � 09 ,rte., � � Ay'�p6� \ •� P2EPA2En Pot TOW�.J OG PATTl =2 S0�.� R.J'T�ATh GovtilT�/, U�I - rjCtal...E_ '. 1 = `-� Gt..T013 E G•� 2 l � I CI Ci 2 '. IT IS NE260y CERTIFIED T} -4[�T TI-11S SV2VEy yE` Q. 9 � }aAS �1✓EIJ P'zE PA2G O FOLLOW 11.1 C� GccGEG'l -ED {} �� r�� PROFESS \OI -JOL ST�.I�.IDG.2DS i=02 TIT LE SU RV E�/S, +�* ,�I GE:ZTI DIED Tt7 {I/ G No. 49366 �N`StD 1pitD `• )qF . 111 SVR,oti1c� c_ol✓\P1� -��/ { REPV�.L2E0 6y . , ....... �z_3oC KJ4-7 G4Z--fE ITS sucr�SSo�S ? /o�- aSSIG>.1S T.V./IL.LIAM KOMISA2� L.� -.S. — �TUta2T ��E�SO>`.1 32 -3�.{ 1- Ea.t4HT ,dvErJVE - P/>T2 \GIL �' =oQ�� PoVC- rNKEEPSIE�1�iEWyorzVL 12CoO�S (a1,14) 1-165 -2r- 2r0 MOT E.'. 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