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HomeMy WebLinkAbout0659DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23.10 -1 -1 BOX 8 L 4 ♦� 6 r' il 00659 PUTNAM COUNTY HEALTH DEPARTMENT DIVISION OF ENVIRONMENTAL HEALTH SERVICES OFFICIAL USE ONLY -R -Job -off SITE LOCATION Jl 0EALaN Sew.i'TA4 ik%LA -'?-0 TM# 0­r 7,'a- OWNER'S NAME '1 -r PHONE : - % 7,y` f MAILING ADDRESS SAME c A-is©yc- Fi4; e' i -rXW , lYq ! &S- 6-.:� - PERSON INTERVIEWED PCHD Complaint # ame & Relationship i.e., owner, tenant, etc. DATE TYPE FACILITY PROPOSED INSTALLER PHONE 91tA- 234114 6S ADDRESS 444 pt--o poST 27 _ B&oi:oa'b N�REGISTRATION# �o 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. -t,, poSezf Se-,p�lc & A&A 4a in Jo 7 Pj ,,,4 Iue// cLmge loo 4Lok4 {�,,' ✓- ~�-rr � i Vt g �c �-e��`�' -� - f,_,.__�!': 01` '���t�' ' c, %a �' .27 Fv' -tom„ f 3 D �is�ra7��i4 b�X .� ��►�rit�li¢!Z e,n JgR .0-f IV' +hiclk , S,peee %eve-leos 4t, be c4dc e 4- ., .b ,- L ?,X , I, as owner, o reported age f owner agree to the conditions stated on this form. SIGNA TITLE COP�a I DATE—*!1I0S 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 e. Installers' name and number. 3. System repair to be pe ormed in accordance with the above proposal and conditions. Proposal approved Inspector's Signature & Title COPIES: White (PCHD); Yellow (Town BI); Pink (applicant) PC -RP 99M[L 7 /i+-S /®Sr DATE } - OZ CON JI'11 Tti k/OOOJ, T r1Z E0 OCZO..Offi 7, /985 A S HAf' n NO 208.3. LOT 0 -,,,E OF FE.y c /00.00' »EST .. 1' 30C'Th' • � o° ' /A'E O «EACf ZA, - R 6:50 3 � EAST J CrCRETE v J .:A 7.0-04--f � ANGtE rG ,H % MAVo `� � OlfENGE qq .4flDiTfo 31 6 I Si -AIA5 Mo J -= O 1 t 1 O V o +R �co 1 N 119Z M o' ,b N STONE WAIL' HIE 1 MAC � 7"1W —� /00AO' /IA C<DAN —DT_ 4000 PC/E ' STi4EET (1411VA �- COIY JN1 TN H/« RoA 11 i 0 co N S 70 ,,FiNA t s PZ-ACON J141I T11 WOOD RZ ED OCT�.5fR 71 1985 A NO 2063..:. LOT D w0:.Z POS 7' 2 $OU7'i/ Alf ' O V t i�f PA 6f id O MNCRE fE �4 r. Q O ANGtf OF FENG H w�4r4. u NAND Z.4e Nrp, r pg vpves E Aporno �f ' To S�PftG. V 0 co N S 70 ,,FiNA t s PZ-ACON J141I T11 WOOD RZ ED OCT�.5fR 71 1985 A NO 2063..:. LOT D &Kf'647%5 "E x /00.00' o`c N Alf Zleffq 6:50 V t i�f PA 6f id MNCRE fE �4 r. Q ` ANGtf OF FENG Q O/Y.Li/►vr a' w�4r4. u NAND Z.4e Nrp, r pg vpves E Aporno �f ' p �... 4X :EK; e2 025 - e� ✓iri � � �� v . 0 C77, a I� WAJL ell VINO OWNER'S NAM SITE LOCATION'__�2 MAILING I ADWMSJ PERSON INTERVIEWED PM, Canplain t Q Name & Relationship (i.e, owner#,tenant, etc.) DATE TYPE FACILITY PRC)POSED INSTMZM 1716 (J r-P K-1 C 0 4-:: C V ni PHONE REGISTRATION # Proposal (include sketch locating all adjacent wells): Nam ' 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. ,-- - //,0, .1' -,- 1,- 7 4 b "0, ,n-/ a/ --0 -V ( .-Z ) Proposal approved Inspector's Signature & Proposal Disapproved 5 roposal approved With the following conditions-L 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 61 diem. x 61 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 TITLE White QW; YeUrw (Tam HE); Pirk Qnilamt) DATE DEPARTMENT OF HEALTH Division Of Environmental Health Services 110 Old Route Six Center, Carmel, New York 10512 (914) 225 -0310 January 30, 1992 Mr. & Mrs. John Grioli Dog Street a /k /a Deacon Smith Hill Road Patterson, NY 12563 Dear Mr. & Mrs. Grioli: JOHN KARELL Jr., P.E.. M.S. Public Health Director Re: Proposed addition - Grioli, Dog Street (T) Patterson TM #73 -2 -7.2 I have received and revieved the plans for the proposed addition to the above mentioned residence. The plans indicate that the second story rill be enlarged to alloy the relocation of the existing dovnstairs bedroom to the second story. The first floor rill be renovated and the existing bedroom rill become part of the living room. The survey indicates that sufficient area exists to expand or repair the sevage 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 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 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 WH /jp cc: BI (T) Patterson