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631- 589 -8100
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"BRUCE R. FOLEY~
Public Health Director
. r LORET V1M` OLINARI
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)27.8-6558 WIC (845)278-6678 Fax(845)278-6085
Early Intervention (845)278-6014 Fax (845) 278 - 6648
Preschool (845) 228 - 5912 Fax (845) 228 - 6113
May 17, 2002
Thomas Clifford
36 Sylvan Rd.
Lake Peekskill, NY 10537
Re: Accessory Apartment, Clifford, Sylvan Rd.
Three Year Approval
Town:Putnam Valley, TM #91.25 -1 -25
Dear m r, 61";e-44.,
I have received and reviewed the plans for the proposed accessory apartment at the above -
mentioned residence. The proposal for the apartment has been approved as per plans bearing the
approval stamp form this Department dated May 16, 2002. The apartment is approved for three
years with the following conditions:
1. The total number of bedrooms in the apartment must remain at one without prior.
- approval -by this department.
2. The total number of bedrooms in the main house must remain at -Ihree without prior
approval by this department.
3. The area of the existing sewage disposal system, and its expansion area, must be
maintained.
4. 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 Putnam Valley.
If you have any questions, please contact me at your convenience.
ML:lm
Very truly yours,
Michael Luke
Public Health Technician
... ... - I
BRUCE X FOLEY .
Pnblie Alaa/lh Dlractor.
LORETrA MOUNARI RAT., M.S14.
.6scelate Public Health Director
�+ q q�+A •per MCOOr of POWnt Ser►kee .
1 Cienevva Road
Brewster, New Yozk 10509
Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921
Norsin Services (845) 278 - 6558 w1C (845) 278 - 6678 F= (845) 278 - 6085
Marlp fateeventlan (845) 278 - 6614 Wien (845) 278 :6668
kre%cbnol (845) 228.4912 Fau (845) 229 - 6113 .
ACCESSORY ENT APPL C AMS
Date A.
Renewal 0 E(
n Yes No
6v'
STREET l Q I a P Cj T® afuk'T1X --mA?# o
f lS axe 97
NAW C -1464 mas PROD -3-fa .o PC.i1D # 0'd
MAILING ADDRESS Rd
�O'S 3 -7
RAILING ADDRESS OF APARTAEI�1T� S
Ny
NUMBER OF BEDROOMS Iii MAIN HOUSE-!-
]Please submit this forth. and the requirements on page two to the Putnam County Health Dept:, 4
Geneva Rd., Brewster, MY 10509, Phone 278 -6130.
Approval 9s effective for a three great° pefiod. The applicant trust reapply at the end of each
period to renew the legal status of the apamnent.
(/ Sijiutu� f Applicant
_.�...® Approved Date. S / ID to
ley
Comments
Nbv. 2000
ACCESAVr
Title
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PUTNAM CO! NT'I DEPARWENT OF HEALTH
HOUSE PLA% APPROYVE-1) FOR
BEDROOM C01.1,NJ
A
Signature & Title Date
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PUTNAM COUNTY DEPARTMENT OF HEALTH
HOUSE PLANS APPROVED FOR
BEDROOM COLINIT ONLY:
BRUCE R FOLEY
Public Heclth 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 Semites (845)278-6558 WIC (845)279-6619 Fax (845) 278 -6085
Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648
Approval is effective for a three year period. Please submit the following
1. Certified check or money order for $100.00
Sketches of floor plans for both main house and apartment (drawn to scale,.all living area
Including basement)
Non-professional sketches are acceptable
oHform Bacteria water sample results from the apartment drinking water supply.
eptic tank pumping receipt plus letter from pumper that tank is in satisfactory'condition.
Cop of site plan showing well, septic, and parking area. Include date of installation if known.
L el all wells and septic systems within 200 feet of the property line.
opy gf.Certificate of: �ccu arl fro l �vn.o . e n-€rc .frog With _-
_ r'C I a ate '" inept=° 'leggl"°'
bedroom count of dwelling.
Approval by this department is for the water supply and subsurface sewage treatment system
only. The applicant must apply for and receive approval from the individual town to occupy the
accessory apartment and must comply with all applicable rules and regulations set forth by the
town.
Failure to supply adequate quantity and quality of drinking water or a failure of the subsurface
sewage treatment system may result in the immediate revocation of the approval by this
department.
Pg. 2
Nov. 2000 Qv�
JUNE.....1.. �. ......... 119.72 TOWN OF PUTNAM VALLEY
14®5 " 1
Zone District .... R2 .. ............................... li✓ E RI!@ T RECORD
pplication is hereby made for........ BLD!a ............................................. .................Permit Work to start........ AT...QNC.E.........
- scription ...... �..... FAMILY... FRAME .................................................................................................... ...............................
... , ..............................
Location of Premises — Street or Road...... rSn! V1V... D ................................................ ............�.7........... ::......t.....�.. ...................
....
SEC.....P ..................: BLOCK 4.6................... LOT94 77.1 Q...... FRONTAGE ..P .e.r....plot plavepth ........................... Rear ................
ACRES (other description) or number of square feet .......................................................................................................................... ...............................
SUBDIVISIONNAME ..... ............. I! Ca .... PEEKSKILL...................................................................................................................................................
OWNER LEDNARD .... L. PUB .......................................... ............................... ADDRESS ..2. 344. ... E ....... 2.3j.rd .... S.t.s.....Ek1 y- n..................
Dimension of Building
Kam. "-�•. - �'I
Widtf26X48 Depth Stories 11�
Type Foundation ............. ..Black........................
Size & Use Each .! .............:.................
Room with Window Area ............. �.o+
Sewerage Type .. S. e. e....a.t.t....Plaxn............
Size of Septic Tank ............... !!.......I.....................
Lineal Ft. Drainage .................. ti ..............................
<f�fi
� , Y�YY�? Y�Y, YifY�Y: Y�YY�YY�Y, Y�6Y�fYifY�YY�fY�YY�fY�` fY�GY�Y, Y�YY�YY�YY�YY�YYif, Y�LY�Y, Y" �YJ' �YYiflifY�Y, Yif„ Y�YY�YY�YY�YY�YY�YYi (YVfY�YY�f,Y�fY�YY�GY
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
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USE
CONST.
ROOFING
LAND
11 Family
'Wood
:Wood Shingle
Paved
2 Family
i Steel
. Asb. Shingle
i Dirt
Log Cabin
Brick
Tile
i Oiled
Bungalaw
Concrete
Metal
Swamp
iApartment
Stone
Brook
FNDTNS .
INTERIOR
Lake F.
ESStI.-ree Apt.
Stone
6; Rooms
. Dams
Store & Office
Concrete
': Apt. Rooms
Sw. Pools
Office
X
j Blocks
i Apt.
:Ten. Courts
Gas Station
Brick
Attic Open
4
1 Fin�
A�R tt�ic
i OTHER BLDGS.
i
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4��
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n�
Dimension of Building
Kam. "-�•. - �'I
Widtf26X48 Depth Stories 11�
Type Foundation ............. ..Black........................
Size & Use Each .! .............:.................
Room with Window Area ............. �.o+
Sewerage Type .. S. e. e....a.t.t....Plaxn............
Size of Septic Tank ............... !!.......I.....................
Lineal Ft. Drainage .................. ti ..............................
<f�fi
� , Y�YY�? Y�Y, YifY�Y: Y�YY�YY�Y, Y�6Y�fYifY�YY�fY�YY�fY�` fY�GY�Y, Y�YY�YY�YY�YY�YYif, Y�LY�Y, Y" �YJ' �YYiflifY�Y, Yif„ Y�YY�YY�YY�YY�YY�YYi (YVfY�YY�f,Y�fY�YY�GY
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
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3D View of Your Deck
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Sent By: HP LaserJet 3100;
Christine Clifford
17 Lakeside Drive
Valhalla, IVY 10595
914 2731289; Apr -24 -02 9:51AM;
Inspect A Home, Ltd.
80 Business Park Drive
Armonk, New York 9 0504
(914) 273 -2736 Fat (994) 2T3 -1268
Rcf: Physical inspection of. 36 Sylvan Road, Lake Peekskill, NY
Inspection Date: 4/17/2002 Time; 4:30 pm Alter t:
Dear Christine,
SEPUC DYE TEST
Page 22/22
April 23, 2002
the maxim watelr suppRy as Iran folr mppiroxlimateRy one (1)
houir with the fofiowft results:
A septic dye test was conducted with no evidence of any dye surfacing. As a result
of the dye not surfacing, it is anticipated that-the gro p.d_�bsorpt fort -rate and -fields . -
�r ± "� care -rj->— of'irrg 6rjer.` `iic)wevdt; triereyis always the ptissitiiliYy of the dye not
malting it to the fields for one reason or another. This step is an added measure in
an effort to disclosure a possible septic problem and only to the extent that this dye
can be routed to the problem area and surface.
CE1 /CES Certification #13892
Sent By: HP LaserJet 3100; 914 2731288; Apr 24 02 9:51AM; Page 21!22
Inspect A Home, Ltd.
80 Business Park Drive, Suite 305
Armonk, New York 10504
Building & Property Inspections • Engineering - Environmental Phises
Phone:: ( 914 ) 273 -2736 Fax: ( 914) 273 -1288
WATER ANALYSIS REPORT
NAME / ^ =7� !��1 SAMPLE ADDRESS y
REPORT DATE o
TYPE OF ANALYSIS C011 FP -M SAMPLE LOCATION 1.
SAMPLE PICK UP TIME:
SAMPLE PICK UP DATE: aa- RESULT OF SAMPLE: 1. SEE BELOW
TYPE OF COLLECTION
DEVICE: /e, SINGLE RESULT: /
AGE OF BUILDING: N/A
COLLECTED BY: 9�.
WAS PROPERTY OCCUPIED? zo
o -_., •...�.....�. ems-., ---v.� ".� ._ • : -• •.�; �:� -• ..- :�`''......:...:.. _ _.,. �,.n. -- .;,.. :. :•: - ._ —•• -. ; , -t•;• .... _..;c•
CONCLUSION IIOF WATER ANALYSIS:
These results indicate that the water was) L}of a satisfactory sanitary quality
according to the New York State and VIA Federal Drinking Water Standards, for the
parameters tested at the time of collection.
DATE PROCEDURE RESULT NORMAL RANGE
1. ��'��e 2 MF T Collform Absent
2. ' 1171 > y MF Fecal Collform Absent
3. Y1/71 pa— E. Coli Six-/ Absent
Results Recorded by: ELAP 410323 (A,nalysis)
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Building Type
Municipality
.Se :coon i /� Aw
d Zv-
Block
Lot
GUARANTY OF SEPARATE SEWAGE-SYSTEM
I represent that I am wholly and completely responsible for the
location, workmanship, material, construction and drainage of the sewage
disposal system serving the above described property, and that it has been
constructed as shown on the approved plan or approved amendment thereto,
and in accordance with the standards, rules and regulations of the Putnam
? County Department of Health, and hereby guaranty to the owner, his succes-
sors, heirs or assigns, to place in good operating condition any part of
said system constructed by me which fails to operate for a period of two
years immediately following the date of initial use of the sewage disposal
system, or any repairs made by me to such system, except where the failure
to operate properly is caused by the willful or negligent act of the occu-
pant of the building utilizing the, isystem...._ z• __.._
The undersigned further agrees to accept as conclusive the de-
termination of the Director of the Division of Environmental Health Ser-
vices of the Putnam County Department of Health as to whether or not the
failure of the system to operate was caused by the willful or negligent./"'
act of the occupant of the building utilizing the syste /
Dated this 15 day of :ice 19,'� Signature
Title
If corpgl ation, gyve name
and address )-
ia-
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMPLETION WILL BE ISSUED.
GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
Division of Environmental Health Services, Putnam County Department of Health
Ownjer.or
Purchaser of Building
"Constructed
Building
by
Lo-tca ttion
- Street
&Sl ed
Building Type
Municipality
.Se :coon i /� Aw
d Zv-
Block
Lot
GUARANTY OF SEPARATE SEWAGE-SYSTEM
I represent that I am wholly and completely responsible for the
location, workmanship, material, construction and drainage of the sewage
disposal system serving the above described property, and that it has been
constructed as shown on the approved plan or approved amendment thereto,
and in accordance with the standards, rules and regulations of the Putnam
? County Department of Health, and hereby guaranty to the owner, his succes-
sors, heirs or assigns, to place in good operating condition any part of
said system constructed by me which fails to operate for a period of two
years immediately following the date of initial use of the sewage disposal
system, or any repairs made by me to such system, except where the failure
to operate properly is caused by the willful or negligent act of the occu-
pant of the building utilizing the, isystem...._ z• __.._
The undersigned further agrees to accept as conclusive the de-
termination of the Director of the Division of Environmental Health Ser-
vices of the Putnam County Department of Health as to whether or not the
failure of the system to operate was caused by the willful or negligent./"'
act of the occupant of the building utilizing the syste /
Dated this 15 day of :ice 19,'� Signature
Title
If corpgl ation, gyve name
and address )-
ia-
THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE
CERTIFICATE OF COMPLETION WILL BE ISSUED.
GUARANTOR IS REQUIRED TO FILE NOTICE OF DATE OF FIRST USE OF SYSTEM.
Division of Environmental Health Services, Putnam County Department of Health
Y3ELL C070UPL[7<ON REPORT rUTNAM{:OUNTY 0EPARTIMENT OF qE4LT|
V
Division of Evv no^ mc^*|Hro/,x Services
COUNTY OFFICE yu/LmmG'CxoNIsL, NEW vonp
i
�
This report is to be completed by well drifler and submitted ta('Ounty Health Department together with laburatory report of
mp|o indicating water isofedofuotory bacterial qua|�yheKxeconbf�mmu(oonoru�t}onoomp|ia000 b i" �uod. una\ydsnfputerm
. '
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OWNER
NAME ADIIPE$S
LOCATION
-OF WELL
(No. a Saw) ffown) (Lot Number)
BUSINESS
WELL
jPROPOS�u
DOMESTIC ESTABLISHMENT TEST
FARM
Usr. OF
SUPPLY INDUSTRIAL CONDITIONING (Specify) I
COMPRESSED CABLE OTHER
11 R1 PERCUSSION El
r-QUIPIAENT
POTARY AIR PEPCUSSION (Specify)
JEL
TEST
BAILED PUMPED COMPRESSED AIR
WATER
__�ING YIELD TEST [feel)
MEASURE FPOIA LAND SURFACE- STATI1ZISpecif 6U
Depth of Completed Well
71ee,)
MAKE LENGTH OPEN TO AQUIFER (feel)
SCREEN
DETAILS
SLOT S17E _T JAMETER ?I-ncht- L Diameter of well including GRAVEL SIZE jinches,111ROM (1001, _ITO(180"
gro�el pack (inches):
I;EPTH FKOM. LAND sup.r.o.cE
7-7
FORMATION DESCRIPTION
Sketch ex3ct loc;,tion of well with distances, (a -.1 lua,!
two peirn,,nent landmarks.
FEET to FEET
Abo
If yield was tested at different depths during drifiing, list below
FEET
GALLONS PER MINUTE
P
DATE WE.' L CO,,. PLL)D
DATE OF REPORT
L.ER
X
s� A 32281
PEEKSKILL MEDICALLABOR'ATORY
}1879 "Crompond Rd M6ple,167ace- Bldg, A
+ Peekskill, New York .Pr 7- Q.777••
DATE COLLECTED: -
RESULTS -OF EXAMINATION OF. ' ,WATER
WNER _ HDATE RECEIVED
72
CITY VILLAGE TOWN & /OR'NAME QF SUPPLY - xDATE REPORTED
t�
e.; Peekskill, 1yoYe.': n ]2 -13 -72
SAMPLING POINT
3ACT'ER•IA IPER ML (Agar plate count at 3500.)," COLIFORM GROUP (Most - probable No /iobmi - RESIDUA'L CHLORINE AS RECORDED AT
1 r'` 6_ ` IL2SS_ tYlan 22 s SAMPLING POINT ' I, POINT OF TREATMENT
HLOR•IDES ('CI) rng /1 NITRATES- (asyN)
LOURIDE
F.
these results .:iridicate fhat the water -was" yes of a• satisfactory sanitary quality when the sample was collected "
Pero Cr,0 Road A. H.- PADOVANI' M•. T. (AS P)
in
PUTNAM COUNTY DEPARTMENT OF HEALTH
DESIGN (DATA G
Owner E01ko
COUNTY OFFICE BUILDING, CARMEL, N. Y. 10512
SHEET -//SEPARATE
44' LIv;
Located at ( Street z-�
Munici lit ' o.
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ca
SEWAGE DISPOSAL SYSTEM FILE NO.
410
Address Z�5 G -" r1i �� akll�i�.�7 N
Block 1 Lot
�est s ree,
LZr' Watershed /i� �'r4 LL aj�vooi�
SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS
Hole
Number CLOCK TIME PERCOLATION PERCOLATION
apse Depth to Water WaTer ve
Time From Ground Surface in Inches Soil Rate
Start -Stop Min. Start Stop Drop in Min. /in drop
Inches Inches Inches
�o .
4
4
5
5
1
2
Notes: 1) Tuts to be repeated at same depth until approximately equal soil
rates are obtained at each percolation test hole. All data to be submitted
for review.
2) Depth measurements to be made from top of hole.
TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION �
:IB S -,..:._: �a:
DEPTH HOLE NO. HOLE NO. /° HOLE N0. P,5 lv
611 K.
12" ��1ViJ t��l� / l� ^� `� �%v� �y (...- ✓,�'G" / ♦ :l.f.`- l.. %1.•��1 (r �,!s:•� /i�T`i v�°
1811
3011
3611
4211 � -� ��� �� '�F L• y � ���'
4811 f
54 1.
r � e..
6011 �M. coU
66 rr_- ' ,
2„ phi, a, ' 1 "-.,1
781, mss`
8411
__.,.• °INDICATE LEVEL-- AT-WHICH.- GROT_IND 1nrATP�,R._yTS- ENCOUNTERED :- _GL •% "lGo� _.:t.:,.Y,
'PESTS MADE BY te r" ,7�J4;%—' I .Date
DESIGN +
Soil Rate Used -Min/1 1IDrop: S.D. Usable Area Provided
No. of Bedrooms Septic. Tank Capacity / =' Gals,.•: = ..Type[ ��=
Absorption Area Pr� By1(��i L.F.x2�+1� width trench
Othex
Name . ,� bignature
11 1 �6
Address ARRAMAP P/ 141 01 InEnI SE
THIS SPACE FOR USE BY HEALTH DE
Soil Rate Approved Sq.
3 a?
Date
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APPROVED
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,DEC 261972 rJ! Su
/UFNAM COUNfl
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APPROVED
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,DEC 261972 rJ! Su
/UFNAM COUNfl
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SURVEYED & PREPARED BY
ALEXANDER BUNNEY
,71cW1Z_ 27 1_970
. P.C.
LAMM ff
, SURVpit
go -wood*'
/97z
40534
FILE NO.
SURVEYED �AS "IN' POSSESSION
M: Y,. S. LIC. No. 28694
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