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631- 589 -8100
83.66 -2 -2
BOX 31
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,SHERLITA AMLER, MD, MS, FAAP
. Commissioner of Health
Associate Commissioner of Health
Clark
77 Lake Dr.
Lake Peekskill, NY 10537
Dear Mr. & Mrs. Clark:
ROBERT 1 BONDI
County Executive
DEPARTMENT OF HEALTH
1 Geneva Road, Brewster, New York 10509
January 28, 2005
Re: Addition — Clark, 77 Lake Dr.
No Increases in Number of Bedrooms
(T) Putnam.Valley, TM #83.66 -2 -2
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 January 25, 2005. The addition is approved with the following conditions.
1. The total number of bedrooms must remain at two without prior approval by this
Department.
2. The area of the existing sewage disposal system, and its expansion area, must be
maintained.
3:::A1l.pltM1lxibir:g fixturr must be..un tln later saving I vices, i,e.;
toilets, restrictors for shower heads and faucets, etc.
Any 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: hn
cc: BI (T) Putnam Valley
Sincerely,
Q
Michael Luke
Public Health Sanitarian
Environmental Health (845) 278 -6130 Fax (845) 278 -7921
Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085
Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648
'LORETTA MOLINARI
Public Health Director
DEPARTMENT OP HEALTH
I Geneva Road, Brewster, New York 10509
Environmental Health (845) 278 - 6130 Fax (845) 27 7921
Nursing Services (845) 278 - 6559 WIC (845) 278 - 6678 Fax (845) 278 - 6085
Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648
PROPOSED ADDITION APPLICATION (RESIDENTIAL ONL
ROBERT J. BONDI
. County Executive
STREET 71 Astke &100e T Lab �WttTxMAP
NAME #p
LPHONE '-
MAILING ADDRESS Ze �.If
- �r7
DESCRIPTION OF
NUMBER OF E)USnNG.]BEDROOM
(FROM CERT. OF OCCUPANCY OR
CERTIFICATION FROM BUILDING INSPECTOR)
PROPOSED # OF ]BEDROOM
*Any addition which is considered a bedroom requires fbm-&77, (Construction,
Permit) prepared by a Professional Engineer or ce with
--7%
applicable- ssectionsof the Putnam Cpt�7,:,
Please submit this form and the fd Rd.
Brewster, NY -10509, Phone 278
\0,
V
1. Certified check or money order f
t
2. Sketches of existing floor plan'(dr
Non-prof6ssional sketches are ac
3 d
. Two sets of proposed floor plan A -5;
Non-profes8ional sketches are acce',
4. Copy ofsurvey showing well and sep
'e
.of installation if known. Label all well -erl
Contact this office with any questions .
5. Copy of Ceft. of Occupancy from To g Dept. with legal
bedroom count of dwelling.
date-
v line.
LORETTA MOLINARI
Public Health Director
ROBERT J. BONDI
County Executive
DEPARTMENT OF HEALTH
I Geneva Road, Brewster, New York 10509
Environniental Health (845)278-6130 Fax(845)278-7921
Nursing Services (845)278-6558 WIC (845)278-6678 Fax(845)278-6085
Early Intervention/Preschool (845)278-6014 Fax (84.5)278-6648
Putnam County Dept. of Health
I Geneva Road
Brewster, NY 10509
To Whom It May Concern:
Re: 0- 1- A [-Z Ic-
Residence
Tax M 3, a - 2''Z
Town n1 t%n VA L.L. E'l
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:
7
OTHER:
Building Inspector
houseguidefines
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PUTNAM COU TV DEPARTMENT OF HEALTH
HOUSE PLANS AP ROVED FOR
BEDROOM GOUNT iVLY;
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2c4 wall construction
R -13 insulation
12 inch sheetrock
27'4
7' 511 T 7'5
7' 6'5 2'4 6'9
PUTNAM COUNTY DEPARTMENT OF HEALTH
HOUSE PLANS APPROVED FOR
BEDROOM COUNT ONLY,
_ 2' BED13OG1�9S
�]T;,,.
s /�2s /a S Signature & Daf�
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PUTNAM COUNTY DEPARTMENT OF HEALIM
HOUSE PLANS APPROVED FOR
BEDROOM COUNT ONLY,
BEDROOMS
des Properties Reporks Special Proces�ng Options Syem 'Cash Processing PI)A Help
_. ._. ..... ... . .... _._.. _.. .._...: ..
i ..
finer; CLARK MARL LESLIE PrO a TransactlO sk .` 0 0 0 =0000 t
M
"rottY Permits (1 j Vanatx a (Oj Events (Oj Safety Inspectror (oj History (1 j f Pictures JQj s
?
Itfl(�3r.As'd T' 1:; a j ter, ProarE} L�olted t Cre sd 1172000
�-
Name 1 CLARK MARC & LESLIE QUILL
_ .._ Historic Land Artark
Zone.. RS
" Name 2 77 LAKE DRIVE
�
Pr la 10
op C ss
Ward
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6
Addr 1 LAKE PEEKSKIL . NY 10537
a
°Fronts' F 60.00
Depth 133 00
,
e
Addr 2
Acreage
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A�ddr 3 z
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Acc Number 012050 Hvm® Rh
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Addr,
Co Name & Addresi`f The * d vvs.Cli board
Legal Address Info
Permit No
Permit
77
:Orrgirial
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-Lot Group
Address LAKE DRIVE
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mail Addr
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Prop U se
t Notes
�=Prrnt L,�tt`er
Locate By:yanance Locate Bp Permit
�� Paint Sc r;
O locate
I
�a
LAKE PEEKSKILL
—s�ace c�_aF�
C,
m
LAKE
O N OF AITAUAf VALL --Y 7Zr ,f✓z l
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= 7BoS .SF.
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CERTIFIED TO: /�/ANUFAGTU/LE.2J¢ %110EZS
%2urr Co /xr succcsso¢saN��
02 A&/&V r .4ws.P.,UN TITLE 1.vJ. eO
Amc- T /TLE fi46Nc Y .1NL
SURVEYED: rC-7-0— /B, /98B
BROUGHT TO DATE
BROUGHT TO DATE
JOHN SALVATORE ROMEO
Consulting En jIneer & Land Surveyor
1 NORTHRIDGE ROAD
, pp PE/E,K /SKILL. N. Y.
P. E. & L. S. NYS LIC, NO. 027846
ENCROAi:HMENTS BELOW GRADE IF ANY NOT SHOWN
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DRAIE
Certifications hereon are valid for Bank,
Title Co. b Owners for this transaction
only. Certifications are not transferable to
subsequent Bank, Title Co. or Owners.
All certifications hereon are valid for this
map and copies thereof only if said map or
copies bear the impressed seal of the sur•
veyor whose signature appears hereon.
"It is hereby certified that this survey was
prepared in accordance with the existing
Code of Practice for Land Surveys adopted
by the New York State Association of Pro.
fessional Land Surveyors."
9Z .93 4 94 A-Er s AWA' av i A"10 EV"ML
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L'.7�til� GF T//G COUNTY CLsee, ID7AA
CouArrY G? mEL IVY .MW.2.P.1929 es
SURVEY OF PROPERTY
FOR
MARC 8 LESLIE 0
CLARK
SITUATE IN THE
- re..vN OF pG ?:4!0.7." I%AL.LEY
PC/TNAM COUNTY
NEW YORK
SCALE: I = Zo
SURVEYED AS IN POSSESSION
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PUTNAM COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
El
C'
Internal Use Only
Repair Permit issued in last 5 years ❑ Not in Watershed
Repair within Boyd's Comers, W. Brbnch or Croton Falls Res. ❑ Delegated
Repair within 200 ft. of a watercourse or DEC - mapped wetland 1 ❑ Joint Review
Evil
�y/� 2 -2
SITE LOCATION Lr/ F�ij �r2 t izt �.. L S!t'_►Ll�,�y TM #
J ,
OWNER'S NAME i'Irf l tom` -'i ✓L r C:��'� �C _ c� ��, PHONE # `tw) 12_
MAILING ADDRESS 1 C; [C D,21 1;`r L- ('+ tL� fit-( rte, i�% �/ JL •.i �3 -
APPLICANT.C1 -kt�,�
Name & Relationship (i.e., owner, tenant, contractor)
DATE FACILITY TYPE PCHD COMPLAINT #
PROPOSED INSTALLER � i n,�,'� -iL�� I �". SC'f� 6i1t\A7 &LrC,i7J>,?H0NE # Pj1-/
ADDRESS Ml ,E, a_kaAN >.l REGISTRATION /LICENSE # GAtof
Proposal (include a separate sketch locating the house, property lines, all adjacent wells within 200
feet of repair and the location of existing and proposed trenches)
NOTE: Repair must be in same location and of same type as original sewage disposal system.
Different location and proposed pump systems will require submittal of proposal from licensed professional
engineer or registered architect.
A�n =r
A/.: I- _Pb, Ale, Pli:L
I, as owner, or reported a ent� 'ner agFee to the conditions stated on this form
i
SIGNATURE Ati /"`` TITLE D(,t/ya Z
Proposal approved wifh the following conditions:
1 Procurement of any Town Permit, if applicable.
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
d. System description (e.g., 1250 gal. Concrete septic tank, etc.).
e. Installers' name and phone number
3. System repair to be performed in accordance with the
above proposal and conditions
d osal Approved Proposal Denied Gu,��' . ector's Siqnature & Title Date
COPIES: White (PCHD); Yellow (Town BI); Pink (Installer), Orange (Applicant)
PC -RP 99ML
Rev. 8/05
DATE
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As Built Draw* g
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PUTNAM COUNT' DEPARTMENT OF HEALTH
° °...�- ..-,-• n1'aV�Sai�l�'0�'' EFL'' ��- ��; ��' iE�' ff' ��,° �i��Tie�SER�f(�5.:�:o�o�.:��; �:. -.m._ .
FIELD ACTIVITY REPORT
NAME: Tel:
Ann , P, ss PIL lvrl-1111IM4
Street Town State Zip
PERSON IN CHARGE / %1 /p ,►
!1D TAT'r DAlTClxrVn- /VJ� ��D c / T)AtP:
Name and Title
.namr -'.r r. A nn TT[7 . C•oYf-r j.T.402-4/./%
LO
4& E.�
SignaUfz;elnd Title
RFPCIRT RFC'FTV -T7 RV:
I acknowledge receipt of this report: SIGNATURE;
02/96
Rev.
Title;
Page No. of Pages
LEONARDI & SON CONSTRUCTION, INC. Q� 0, ,3��5`'�
OWNER: LOUIS LEONARDI
ffl 0, Wtj 9 1Y NDT
.93
(914) 736-9010
LIC. #WC-3112-1-190 • WC-SEPTIC LIC. #00067 e LIC. VC-560 (CERTIFIED)
PROPOSAL SUBMITTED TO
PHONE
DATE
STREET
JOB NAME
LP,
CITY, STATE and ZIP COD SI
(IR
JOB LOCATION
ARCHITEM
DA OF PLANS
JOB PHONE
We hereby submit specifications and estimates for: 00 C 4rfrld
.
�or I
t
........... ,,e_..._
. . ....... ..... ........ ... ............................... 1- ............................. : .. . .............. . ..................................... .. ............... ........... .............. . v --- 4n..... I ......................
- -1- 1
V.
X* ..................................... ............................................................................................................_..............................................................._........................................................_...._.................................... .........................o..... .
............. .......... .......... ................. . ...................................... ............................ I .............. I .................... ... .............. I ........................................ �.......
...................... I ....................................................... I ................................ I .......... ......... I ................................. I .................... 7 ........... .................. ......................................... f .................................................................. I ..............
................ I ............ I ..................... .... .......... I ............. I .................................................................... .... ............................... ... ............... ........... ................ ..................... I ...............................................................................................................................................
.......................................................................................................... ............................... ....... I ................................................................. ...... .......... I ............................................................................. ... ............................................................................................
41::!?
............. ................ .......... I .................. % ............................ ............................... ..... ............................... ................. ..............................................................................................................................................................................................
........... ..................... ............................................................................................................. ........................ .............................. ............ ............... ........... .......... ............................................. ....................................................
............ ...
................................... ........................................................... ...... . ... ..... — ......................................... . ........................ ...... . ................ ..
........... ........... ...................... ....................................................................................... .......... .... ............... E, 2� 11:2XV .... .. . . ... C Avxm . .................... •
............ I .......... I ........... ................... .......... ............... .............. ...... ...................... .......... .... ...... . . ...............................................................................................................................................
.......................................................... ................. .......... ....... ........ . ........ .. .......... . ...................................................................................................................................................................................
PLEOM-NOTE :..................: SYSTEM' I-ONGEwATY.-IS-NOT--GUAFIAtfi-M-UNLESS-DESIGNED-BY-A-UGENSED-PROFEESIONAL--ENGINE-ER:I ..................................................................................................................................
*TANK TO BE PUMPED BY OTHERS AND PAID SEPARATELY'
I *W LANDSCAPING RESTORATION, OTHER THAN GRADING DISTURBED AREAS, IS INCLUDED UNLESS SPECIFICALLY STATED.*
We FroPOSt hereby to furnish material and labor — complete in accordance with above specifications, for the sum of:
. dollars ($
Payment to be made as follows:
A FINANCE CHARGE OF 1'/,% PER MONTH WILL BE ADDED TO ALL UNPAID BALANCES.
CUSTOMER IS RESPONSIBLE FOR ANY AND ALL COLLECTION FEES.
ALL DISPUTES ARE TO BE SETTLED THROUGH BINDING ARBITRATION.
All material is guaranteed to be as specified. All work to be completed in a workmanlike
manner according to standard practices. Any alteration or deviation from above specifications Authorized
Signature
involving extra costs will be executed only upon written orders, and will become an extra
charge over and above the estimate. All agreements contingent upon strikes, accidents
or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Note: This proposal may. be
L C%— — fidh, --A k,, %A/—L---� 1--- withdrawn by us if not accented within days.
Arceptuare ®f proposal — The above prices, specifications
and conditions are satisfactory and are hereby accepted. You are authorized Signature
to do the work as specified. Payment will be made as outlined above.
Date of Acceptance: Signature
PUTNAM COUNTY DEPARTMENT OF HEALTH
DIVISION OF ENVIRONM -E TWL -4 ' %` SE VICES 1�12 t) 7 SECTION A. GENERAL INFORMATION
Name of Subdivision 5,�/,G -� (T)(V) County
Site Location
Distance to: Public water supply Public sewer system
Building construction begun Extent _
Is property within NYC Watershed ? ................. Yes a No
SECTION B. TOPOGRAPHY (Please check all appropriate boxes)
1. F7 Hilly F_� Rolling F_� Steep slope F7. Gentle slope F7 Flat
2. F7 Evidence of swampland F7 Low area subject to flooding Bodies of water
F7 Drainage ditches F7. Rock outcrops
3.
Do water courses exist on or adjoin the property? ............................
0 Yes
F]
No
4.
Will these affect the design of the sewage treatment facilities ?..........
F_� Yes
F7
No
5..
Do watershed regulations apply in this development ? .......................
Yes
No
6.
Will extensive grading be necessary? .................................................
0 Yes:
.0
No-
`-
Wuttxtcnsive fall b e necess~ dry? .................................
Yes
No I
8.
Do filled areas exist in the tract? ....................... ...............................
Yes
No
F_�
F__J
If yes, what is the condition of the fill?
SECTION C. SOIL. OBSERVATIONS
9. Appearance Of soil: Sand Gravel Loam Silt Clay Hardpan Mixture
10. Observed from: a Borings Bank cut F� Backhoe excavations
11. Soil borings /excavations observed by on
12. Depth-to groundwater on
13. Depth to mottling on
14. Soil percolation tests made by on
15. Soil percolation tests witnessed by on
SECTION D. DRAINAGE
15. Will proposed grading materially alter the natural drainage in this or adjacent areas? Yes No
l7. Will groundwater or surface drainage require special consideration ? ....................... F7 Yes O No
„1
8. Will gullies, ditches, etc., be filled and watercourses be relocated Yes n No
SECTION E. REMARKS
19. If a common water supply is proposed, has an inspection been made of the
existmg ' or proposed source and facilities? ................................................ F7 Yes -7].No
Inspeetion.4
20. Have previous sections of this proposed realty subdivision been approved? ............ F7Yes F-] No
If yes, describe
21.
Will there be additional sections of this subdivision? ..................................... I ........
F-] Yes
� No
22.
Is it probable that the total number of lots will exceed 49? ...................................
[7 Yes
F__j No
23.
Additional comments
24. Site observer/inspector and title
25. Date(s) of observation(s)/inspecti.on(s)
PIT MOFILES
Hole # Lot # Hole '# 'Lot # Hole # Lot #
.Depth to water Depth to water Depth to water
Depth to mottling, ,VI Depth to mottling Depth to mottling
Depth to imp.
.roc. I . ... . �I)6'pth-b 5 _610
15'er, rack/ o roc imp.
G.L. G.L. G.L.
.0.5 0.5 0.5
1.0 1.0 1.0
2.0 2.0 2.0
3.0- 3.0 3.0
4.0 4.0 4.0
5.0 5.0 5.0
6.0 6.0 6.0
7.0- 'CIO 7.0 7.0
8.0 8.0, 8.0
9.0 9.0
10.0 10.0- 10.0
r� N
0�d -
WX