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PUTNAM COUN'T'Y HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
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OWNER'S NAME - `
PHONE
SITE LOCATION AV O i A �t� � k ) J� �diS�'V 6V • � � T1
MAILING ADDRESS G 6 x 4 -7 A1 Vt. S,0 -,-J
PERSON INTERVIEWED PCHD Complaint #
Name & Relationship (i.e, owner,tenant, etc.)
DATE TYPE FACILITY
PROPOSED INSTALLER (3- o t ';��. PHONE
REGISTRATION #
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 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 components 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 owner, or reported agent of owner agree to the above conditions.
SIGNATURE 14 /✓t U'4 -1-L TITLE
IP1 V&be (PO:D); YeUcw 013,n HI); Pink (Pnl amt)
DATE
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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
January 27, 1995
Laurie & Joseph Verde
North Street
Patterson, NY 12563
Re: Addition Verde
North Street
(T) Patterson
Dear Mr. & Mrs. Verde:
I have received and reviewed the plans for the proposed addition to the above
mentioned residence.
The plans have been approved as per plans bearing this Departments stamp and
dated January 26, 1995.
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:
1. The total number of bedrooms must remain at three without prior approval by
this Department.
2. The sewage disposal system must be reconstruced as approved on January 18,
1995 (R- 20 -95).
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 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.
WH/j p
cc: BI (T) Patterson
Very truly yours
William Hedges
Sr. Public Health Sanitarian
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PUTNAM COUNTY HEALTH DEPT
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4 Geneva Road (814) 278 - 6130
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Breweter,,NY 10508
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