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' f PUTNAM" COUNTY DEPARTMENT OF HEALTH i
Division 'of Environments/ ;L/ealth Services; .Carmel N , <Y, 105.12
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CONSTRUCTION PERMIT FOR SEW GE DISPOSAL SYSTEM.,
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To
or, V�Ilage
Located at ^' � f% ^• d AJ �+ Section.
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Subdivision Lot f� ob
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J
Owrier £ N ( . �i Address r \ % iF l
Iv
Building Type
Lot Area
4Number of Bedrooms Total Habitable' Space k{ kf SquereFeet
a
s Separate Sewerage System .to consist f Gal Septic Tank lineal feet X width trench, "Y
/ ' f
To�ge� constructed Eby �2 • ��"" � � .�� � � ��� � Address - -
- -
Water Supply Public Supply Frohi _
Private Supply be dril ed by J� 'r7� i
CAddress ti
i
Other Requirements ` �:_ V _t.'1" 1 1 �TP;P
I represent that I am wholly m on
and copletely responsible for design and locati of the proposed system(5� _,1) .that tkie separafe sewage disposal system',
i above .-described`will be:consteucted as shown_;on the approved amendment thereto and �n acco }dance w fh the standards, rules an_.r_egula ions o a r' u, nam.:_ >.-
Countyx Department, of Health, and .that on; completion thereof.a "Certificate Nof Construction :Compliance' satisfactory ,to the Commissioner of,Wealthw�ll
_.
`.be ..subii fitted to the Department, , antl a written guarantee will be furnished the owner,; his successors; heirs or _assigns by =the�b eri that said t u_ilder will;
r _
,place in good operating, condition.any part`,.of said ^sewage - ;disposal" system
1 ance; of the. approval, of the. Certificate of Construction Compliance .of`the
will,be located as shown on,the approv`ed'plari and that seitl well will be installed
( County Departm of Health t
i 'Date' 2, Signed
;
Address
APPROVED FOR CONSTRUCTION: This approval expires one .year from tiie
f,6ocable for cause'br -may be amended or rnbdified "w,hen considered:riecessary.
requires a new permit Approved for disposal of domestic:sa ar %%/L,I%%%.,,,sewa
Date
wnn, [ne scanaacgs wruies a_na regu lar ons; -f•or cne.•, r�uinam-
a F �Y$v Y
Y k
` License'NO' T
nless construction' of the building has been' Undertaken and is
rissioner of Health'; =Any change or alteration of construction;
water supply only,.> � T
_..
.. . } i
PUTNAM COUNTY .DEPARTMFN T OF HEALTH
DIVISION OF ENVIRON=- TTAL . HEALTH SERVICES %
i
Date
Re: Property of -}a A ,—rl -A ��� �,c`� eta � °l/vf'Il
Located at �IfA W O A/
Section Block Lot> 3
Gentlemen:
This
letter is to authorize
a duly licensed
professional engineer or registered architect..
(Indicate)
to apply for a
Construction Permit for :a s.eparate sewerage system; to
serve the above
noted property in accordance with the standards, rules
or regulations
as promulgated by the Commissioner:of the`Putnam County
Department of Health,
and to sign all necessary papers on my behalf in
connection with
this matter and to ,supervise the.construction of.said
system or systems
in conformity with the provisions of Article 145 or
147, Education
Law, the Public Health Law, and the Putnam County Sani-
tary Code.
Very truly.your.s.;
Signed.
.
Owner of PropertV
Countersigned:
Address
P.E.; R.A., #'•��-
Telephone
_
(Seal)
Address
Telephone
.l • 1
PUTNAM COUNTY DEPARTMENT.OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
DESIGN DATA SHEET - SEPARATE SEWAGE'DISPOSAL SYSTEM FILE NO.
�J yy r� Address , Z- .
Owner �t'C%'�i f" 4�E�'l�.f L:l? +'{is �� ii�i.� %o %Z Al 7ra�; P:,p„S'-e'A! 14�
1.
Located at (Street)_ Sec ._' G Block Lot :_A
(Indicate nearest cross street.)
Municipality Watershed
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH:APPLICATIGN:
Hole
Number CLOCK TIME 'PERCOLATION PERCOLATION
Run Elapse. Depth to Water Water Level.
No. Time: From Ground Surface in Inches Soil. Rate.
_ Start Stop Niin. Start Stop ...Drop in Min/in drop
Inches Inches Inches
ZZ
3.
4
5
1
2
4' \
Notes: is
1) Tests to be repeated at same depth until approximately equal soil rates are ob-
tained at each percolation test hole. All data to be submitted for review.
2) Depth measurements to be made from top of hole
DEPTH
G.L.
6?
12'1
18"
2411
3 OTT
36i1
.42 T?
48 TT
5 47
6 OTT
66TT
72"
8 4'1
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED ,
INDICATE LEVEL. TO_WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED
TESTS MADE BY Date
DESIGN
Soil Rate Used -" Min/1" Drop: S.D. Usable Area Provided`jj �
No. of Bedrooms Septic Tank Capacity �C) U Gals.. Type
Absorption Area Provided By�L.F.x241i 3611 width tre ch. Other
,Uri ,2� 1 -- -=
Signature
Name z f
Address SEAL.
PUTNAM COUNTY DEPARTMENT OF HEALTH
Soil Rate Approved Sq. Ft. /Gal. Checked by Date
cd
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;Y
BRUCE R FOLEY
Public Health Director
DEPARTMENT OF HEALTH
1 Geneva Road
Brewster, New York 10509
LORETTA MOLINARI R.N., M.S.N.
Associate Public Health Director
Director of Patient Services
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 218 - 6085
Early Intervention (845) 278 - 6014 Fax (845) 278 - 6648
Preschool (845) 228 - 5912 Fax (845) 228 - 6113
August 30, 2002
Mr. & Mrs. J. Colombo
69 Harmony Hill Rd..
Patterson, NY 12563
Re: Addition - Colombo, 69 Harmony Hill Rd.
No Increases in Number of Bedrooms
(T)Patterson, TM #3 -1 -64
Dear Mr. & Mrs. Colombo:
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 approval
stamp from this Department dated August 30, 2002 The addition is approved with the
following conditions:
1. The total number of bedrooms must remain at three 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 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
WH:lm Senior Public Health Sanitarian
cc:BI
BRUCE R FOLEY
Public Health Director
DEPAR.TNIENT OF HEALTH
1 Geneva .Road
Brewster, New York 10509
LORETTA MOLINARI R.N., M.S.N.
Associate Public Health Director
Director of Patient Services
Environinental Health (845) 278 - 6130 Fax (845) 278 - 7921
Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648
ADDITION APPLICATION (RESIDENTIAL ONLY
STREEI�q 4- nz'V)W cr TOWN PON TX MAP#
NAME PHONE 1J : &l&- -Fd-
�PCHD # Ass, q b �,
MAMING ADDRESS
DESCRIPTION OF A
NUMBER OF EXISTING BEDROOMS - PROPOSED # OF BEDROOMS HO C.t 04Pt4E'
(FROM CERT. OF OCCUPANCY OR
CERTIFICATION PROM 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., 4 Geneva Road, Brewster, NY
10509, Phone 278 -6130,
1. Certified check or money order for $100.00. .
2. Sketches of existing floor plan (drawn to scale, all living area including basement)
*Non - professional sketches are acceptable.
3. Two sets of proposed floor plan (drawn to scale, with name, street, and tax map #)
*Non - professional sketches are acceptable.
4. Copy of survey showing well and septic location, 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 Cert. Of Occupancy from Town or Certification from Building Dept. with legal bedroom
count of dwelling.
OFFICE USE
Comments
Feb98
BFhouseguidelines
BRUCE R. FOLEY
Public Health Director
LORETTA MOLINARI R.N., M.S.N.
Associate 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 (845)278-6014 Preschool (845)278 -6082 Fax(845)278-6648
Putnam County Dept. of Health
4 Geneva Road
Brewster, NY 10509
Gentlemen:
Ck) combo,
.'Re: �Pq r- igMt )OW
Residence
Tax Ma
Towne
According to records maintained by the Town, the above noted dwelling
IS
IS NOT
in compliance with Town code and the total number of bedrooms on record is
This information has been obtained from:
CERTIFICATE OF OCCUPANCY:
ASSESSORS RECORD:
OTHER.
Building Inspector
BFhous.eguidelines
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