Loading...
HomeMy WebLinkAbout0800DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 24. -2 -22 BOX 9 No oil , r 4 . ,, T po PUTNAM COUNTY. DEPARTMENT .OF HEALTH : • .ENG I NEtk -MU T Division of Environmental' HFaa /th -S�'oes, . armsl, N Y.. 1061? . PROVIDE y P ERMIT,:# CERTIFICA E- OF CONSTRUCTION COMP..LIANCE "FOR SEWAGE DISPOSAL.:SYSTEM �7 Town or. Village Located at _ - _ == J�G�J� 'C�f a( �7 p /LJ Block. i i - Tax Map 1 Owner— • - ./ Formerly - Tax Map LotlA+r�t�SUbd. Lot p Separate Sewerage System built •bY ,C Address ''-���•' Consisting of ael. Septic Tank and f ' s Other requirements, ' Water Supply: Public Supply From _f_Private Supply Orilled .By (/� - Address ; :. Building Type No. of Bedrooms Date Permit ,Issuetl Has.Erosion Control Been Completed? Has garbage grinder been installed? I• certify that the'system(s) as listed serving the above premises were constructed,eesentially as shown on the plan o the completed work ( copies of which are attached), and in accordance with the standards, rules and regulations; in acco dance with the file lan and the permit issued by the Putnam County Department Of He'lth. Date Certified by 7 P,E 0 —' R.A. Address _ ` License No. Any person occupying premises served by the above = system(s) shall promptly take such action of may tie necessary to secure the correction' of any unsanitary conditions resulting from, such usage. Approval of the separate sewerage system shall become null and vold'as soon.as a public sanitary sewer becomes available and .the approval of the private' water supply shall become n volt when a public ws pply becomes available. Such approvals are subject to modification or change when, in the Judgment of th Commissi r. of Health, such ocatl n, modification or change Is • essary. � r Date BY Title 'Rev. 6/85 ti. . �• ! _... ,. _ __ -.. T. I_l 77.1 KEAR ST.; YORKTOW14 HEIGHTS; N:Y, 10598 215 12(11 321 K Citr Slit Ct (] 201 BUTTONWOOD AVE.. PEEKSKILL. N.Y. 10566 737$777 Yorkltown Fie ights, N. Y. ),0593 {7 -195 MAIN ST., MT. KI$CO. N.Y. 10549 606.,•1735 (914) 24! -321)3 ' L�STONELEIGH AVE. (N AR HOSPITAL): CARMEL. N. 1'; 10512 ?7n•91 =!+ I:Jirc:ctur: AIbcrt H. ,Padovani M. T. (ASC) � 0' (pf,: GATE TAKEN: DATE.RECEIVED: on. ATE I : DATE Rf_PORTED: (, ;;AMPLE S0Un,CE:_. )ark ' Ldel /' •— �Q�I• + C. 7 ( REFERRED BY: (� . 11x/ "L,GV J• ' E-/' °n ` �• �i� �' �� (� c U l l e C t UL ' 33 POLA30RATORY RE ' I G / • `�r�'7F`]�.'i'.S' • r • m9 /L ❑ A6DITY .....,. .................. ............................... ❑ ALUMINUM ... .......:................................................ :.., ❑ At.KAukal'iv P= •_.......- -_..A= ............+......... ❑ ANTIMONY ............................... ............................... b.- BACTf_RIA,'TO7AL /n(L .................. ......:... ❑ AfISENIC ...................... :............. ......... BOD, 5 DAY ....... : ............. ....... C) nnit(Urt .. .....I . .............. . ❑ BROMIDE . ❑ [IF IIYLI.IUI.1 ❑ ,CARBON D10Y,IDE..,FREE ........... ......... L.1 BISMUTH .......... ........ ........................ ( ❑CHLORIDE C -1 BOHON ..... .. ❑ CHLORINE ............................ ......................:.... :... ❑ CADNIR.W ....................::. " ......... .... CALCIUM ..................................... ............................... ❑ COD ............... OmIL)m ItoI.) ❑ COLOR ( u nit s O Clul ❑.CYANIDE' ❑ CHROMIUM 0w� avalent) ........................ ............................... ❑ DETERGENT, ANIONIC .: ..................... ..................... ❑ COBALT ....... .............. ❑ FLUORIDE . .............. U COPPER ❑ HARDNESS ......................... : ................. :............... ❑ COLD ❑iv1PN COLIFORIbt COUNT/ 100 nil : ............................... ❑IRON .,( ..... ............................... COLIFORMCOUNT/ 100 rnl .......0 ................ [..) L CA D ........................................ ............................... 1 VI'IFIRMATORY i -EST ............ .............................. ❑ LITFIIUh•1 ..........................:......... I.............................. ❑ NITPOGEia,.Af,1K`IONIA ❑ MAGNESIUM ............ .......... ❑ NITROGEN, KJELDAIiL ................................. :............. ❑ MANGANESE ................. :............................................. ❑ NITROGEN,'fJITRA E . ............ ............................... ❑ MERCURY .. ..........................:...: ❑ NITROGEN; ORGANIC ..................... ❑ ODOR (un i t S : ................ ............................... ❑ PALLADIUP.1 ................................ ............................... ❑ OIL & GREASE ❑ PH ( 11'11.1 t S ) ...................... ............................... ❑ RHODIUM ............. : ............. .......................................... PHENOL ....... :................ ... ❑ SELENIUM ❑.PHOSPHATE (ortho) ...:........... ❑ SILICON .. ............................... .................................... ............................... 3 ❑ PHOSPHATE (condensed) ............:.... ...... ❑ SILVER ......... :...................................... ❑ PHOSPHATE (total) ............ ❑ SODIUb1 ❑ SOLIDS, SETTLEABLE, ml /L .... ......I ........................ ❑ TIN ......................: ❑ SOLIDS, SUSPENDED ... :........................................ ❑ ZINC .............................................. .............................. ❑ SOI_IQS, DISSOLVED ............. ............................... ❑ .............. ❑ SOLIDS. TOTAL ............................. : ................... :... ❑ .................................................. ............................... ❑ SOLIDS, VOLATILE. . ............. ..................t....::...... ❑ FlF.i�tARKS:............... ❑ SPECIFIC CONDUCTANCE (uhmo s / cm) ..........:.... .... ❑ ........ .......... .....................:..... ... ........ ......................:........ ❑ SULFATE ............ ................ .. .........................: ❑ ...... ............................... a r. ............................... r ............. ❑ ❑ SULFITE ...................... ......... ................ ❑ .. ... ........................................................................ ❑ SURFACTANTS _ ................................ ................... ❑ ......................................... ........... . .................,............. ❑ TURBIDITY (}d'TU) ............... ............................... ❑ ............................ ............... ............................... . THESE: RESULTS INDICA`T'E THAT THE WATER WAS OF' A SATISFACTORY SAIirnll'y QUALITY' WHEN THE SAMPLE' WAS COLLECTED. 7— THESE RESULTS IPIDICATI; `1'11AT THE WA`PEi; n.TP IMl;I;T T1IF 'ATUF'ACTOPAY CHEM ICAL QUALITY OF T111, NEW YOPK' STAVE AD;X 1. N l :;TRATIVE 11ULES e, RI'GULATTONS , 1)11I14KI14G WATE1; :*-TA 11.IIARW; .( VA HT I; I'Illi 'I'll 1-: 1'AHAl•I1 ?'t Eit:: W11 IEN 111 E? ;;A}•II'1,1-: t'!A': !'01,1.1 ""J,I,.(I N /A. = not applicable A11foiI II, i1wk*1410 Ill I I., :t 11k"'! I PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION. OF.'ENVIRONMENTAL HEALTH SERVICES - COUNTY OFFICE BUILDING, CARMEL,.N. Y. 10512 DESIGN DATA SHEET - SEPARATE SEWAGE DISPOSAL SYSTEM FILE---NO. - OwnerJJP�c�� Addre s s Located.-at-(Street �c: (_c>9 Block Lot 4clicate neares cross s ree Municipality Watershed A_) SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WITH APPLICATIONS Hole Number CLOCK TIME PERCOLATION PERCOLATION– Him— Eiapse Depth to Water Water Level No. Time From Ground Surface.in Inches Soil Rate.:,; Start -Stop Min. Start- Stop Drop in Min. /in drop Inches Inches Inches 2� Z4 5 , 1 2 3 4 5 Notes: 1) T6ts to be repeated at same depth until aroximatelyy equal soil rates are obtained at each percolation test hole. All pp data to be submitted for review. 2) Depth measurements to be made from top of hole. DEPTH G.L. 611 . 12". 1811 24411- 3911 36" 42" 48" 5411 60" 66" 7211 78" 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED INDICATE LEVEL TO WHICH WALTER LEVEL RISES AFTER BEING ENCOUNTERED TESTS MADE BY Date Soil Rate Used ��Min/1 " DESIGN Drop: S.D. Usable Area Provided � � !S No. of Bedrooms Septicr Tank Capacity (CCO Gals. f �i Absorption Area Provided Bys'L.` O L. F. x24 "�3 P o� F7k GL w TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOIL ENCOUNTERED IN TEST -HOLES HOLE NO. { HOLE NO. HOLE.NO. ure Address THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved Sq. Ft /Gal. Checked by x'4'82°$..1�, Date � ,� . I :P. I , I I 1-1 ""':,�� . ,j .! . � ... . -, Y 3 , I � - � ,�- ;.. , \ . ,,` - i ... , : . .. %: '... .1. , —f t" '] , . . . K. � I . "", , 1'� ,� . ..... . � ,i� ,.) 1,�- % � , , , V I — . "-� ". ,�-';--� .. 1'��.-, - -. - I 11 ""Is, � , , , �1 : h I I . � . . i, �. 1`..11 - . . " . . � . . . I . . � . . . , . F� i - ,,—, , , * �: '. "'O, t, , ,,,� -, 1 i t' - .. ;� , :;,i�t- 1". 4, d, P. .,A � , , �*-,,t 0 . — . , -A,, .' , �,� . � v ! g. A 'il. � � , I , �: �,�-Y ki� '� ',��' I - . , ,� ,.,:R� �, '. , . - - ��' I .., . . , � � ., "a , � �d. � ' . � -1 — 1, I , .., � , . � �.. -,� .. % ,J;t.� -� ! ?' . . . .. - I , " ' " �, 1, :� �..:�-"-',, ,�j' -, � I .,. i . ,,, 4 4 ,!�; . � . � - . � � . �,��, . I . . I - . � . � - - . . ., ` , ; 1, k11 I , I � - .1 � , . '. -3t, �V to NA,r-%-Ls1:i \A61ki.0", , �.)�g' " - - . . .4;1, ,A �, '�, , * - -, * , e - - * N.�� I . , I X-) �- T ,-�,4i4A- L. , , - . . � � , � � , -1- 1 , -11-1�14 . I . . .. , . , I —�,AZI I I .il 4 , , � - , t ." , : -,,.Z , 1 .�, zf,j. , , � �c,-- jj {,� . . , e,45 �' - I . I 't ; . ?I.- k. 4, , � , .I.- . t t'. . � , 1. , . . , I . " , I.: t� . - . � 7 " :1f . - , -," .�VL.7� f-;i�(�-` t , , - I .. �i- ,,, " - . . , , � .� 1�� I - � 1 , ,;t ,� . .1 I " . 11 � 11.2, '; -, � :- , I I -1 � � :. � I � - , i�,Z�- ; w , , I 'i, - - , , . 1. ... 11 , - ", ,. , - . � - , I -, . I " ,., I '. - �� , . . I . . � , . . . - �, I 4, , ". , . .. ... , , ,�, -4 '. , I . . � ': ., : � : , . , ., , . ,.�'.. . �, � 11 , '.* '. -�.* '-- . , , � ': . -, I., '. .. .- I . , , lz� , , ­­ , . .. . I 1, � '. _ . . . . . .. , . �., - , ,� ", , ,� ", . � 7 �?'. * - - , ", � I , -. -,.- ; � .--" -- �- ,'--' , � , � ,1 I I - " � - . o), .,-, -, - ,,, , - ", - - , " , :j, � _4 1, . " t� � :, , � ,. ,-'. 11! 71" - It " . � , . , , �.. / , z . . t`�`- ,'," �11'11 1� -,, "�,--' op I "--I,,'.'- I - " .. � :-,; � , � . . . fo�,qz)oo -7. s , "t , I , . ; . , I -� . � - �,.��:; , t ,; ;" ,�..�.� , - : "' , . . , -� :, I 5 � - - � 4. . � � '. - k '4� � , ,, - - - . � - � ,,- . " , , - ,,, , � - , V- * o� �, 5."q -:, -•,r' .;M ' . , ,M� , -; � "t,44 f, , - lt� , , ". , .1 i , , " 0, �� . , . I 1- .. , tc;i . , , ;,eq , - - . I z , f� *,,,*,` , , & 41-q , _ ,,,,, � I ", , , - '-;"-: " � -,-..'� , : . , , . .. , . I ; 1 , , ` ,; ,-,- �� . , 7 � . �. . � .. - . . . . "I , � I7 . . � I I I . I �' � ,,�k:" -. 1 ,V�,��,,, j;,,- "' 4i, , , , " .� , , '. � -. .It, _ '-,:, . � , - 4 - . I I - �tx�� ;, , ", ",,- i , ` �,:,;!, � ,�'! " - , , . , � . , � '. . .�� .": ,- � -. I ,,�,�, - I-', , . ., . I . . r , , I I I - - ., I . "" -i- , , ;, �," , , , , , � " - ,j­. .�:, 4,1 I.- . - " - , , , , t's - , , .. 7, . . . I - I --1 ,.�, " ;, t 1� . . .1� -,p - , . 1, I I - , . I � �, . " �,,� p. I , F ",, :1 ,., i,!.,� i� ,. I." �-,-� y , , I , . ..., , " , . - , 1 * . . : . _ , , _ - - - - ,� ..,. . , -- - � � I . , . -, . , � .�kl It. ,��'- '.- ,-. -�- t �. .. , - - .. - - , , , .. .. I I �� . j ,'ttt�;.' ,.;:T, .1 . . - , i� �. � , . .V� , , , � . - " . , " I " ..� , ., .": , _ r,a ', 't . � . " I . ,i. ,4-1... , - t- , , ., I . � � t*-'�,,'�;'.,, t' �'�.it!. , . ,�1,, ,.-,'� .'.", ..J. ., , - . 1- I . : . � � ." . - .. I � . . . . I , . � . I ... i- 11 . jl"� 11"'. - �,. . . I . . , . . - ' - O 7�,4),'� . , .. . .. . , �" � �, -i�,:: � ... �` ,!. � � �.-,: �,,:. �-, - . !"', I I . � t %, . — - I I , . . I I : . , -, i , I � , I - ". 1� ., , , . � . t, Z 1 . . , :�� . I I . 1 '! .� ��—', � -1 -,. -: � I..' �- . � , . - � ft,`,�-'-� ,:�.- :, ' � - , . , �:._ , .� ' . , - � , � - - ,. . . I � . , � I I � I , I . � . .. . . '. .. . 4� � � � .14 '! I . . " - .-, . I , . . . . � I . . 4 , � . I . I "I. .. . " , , � . , ., � , � , . � , , " � � � I ,t : • -', ,, '� ', . -, �;,i . � � . , � - --.�:, " .. . ... . -...- I . - t - . . � . , � I . . . -1 ,�,',�` 1, , � , .,��.�-, "'.. �.. , .: .), , �­ ...... 1-, . � �1 I-', - . "� , - .. . ,. I ,WT- - - � - �,-,- ,*i - , . . I , - f � ,11--.. - , , :,' ,�-, . . � 1::11 i.- , , ,- �� ,.:1 , 46 ,,'� I '. ,,-.11,1�,.�-, �,l . , r" " . *� "n. � ; � " � ��,-,,;i,�, �7"-, -, 1. I , I ; , . I v�,- ` , - *�-:� :, �� itr- � , ip- ,��,,� , -," q . - , , l'! � ,w I : : . t.�,,� S�"­ ,'�,!"�,�jl,- � , " I ,, ��4� � .". - - � � I 14, I , . - " -.111.1 , � -1 -- - � It : , � ..., - , , " , .." 1, I " - ', , 11 � � , ,: a - : - 1�, -, I , , . � , . ,� � I I r�---'� , �- .1 i'j � 1 � " � �. , . s , _* _ :nor _ , . � , ,.! ,'k­,� �j� �l�L, . I _ '... � , ,! -��`,; : ::, t-� , * -, . ` , . : k," , 'I- I - - 6t,t � z ;X 14 , �:� * ;� � , 'L Q��L; '. , 11, I " . , ,,, a . ,;. �� �� -. . ,�,�, � 4 , , , ,-:,� 1_ I .-�� ,g . - - I - I ,q �:-,., "'. - � � , . ., , � � , , - , . . , , , .� - '�:'-;�� �'�,'��'i"�L -� ­ 't. -,%'� " - , , , 'r�'. � ,� .'�' � 'I. � . , , , , , V?��,�! isto , - , . � I . E ��, L I `1 t4 t,i, i-.'- x��;,- � - I . . � ",-- ,;,�,! �- , '-� I , 'P�� .. , - . . , *, � � I; .-'. -, . i', . ­-. �- !I", - , ". ... - - . , � ; , , ,�,�- " - — � - ,,, �,- -0 1 , � ", , �-% 11 - I.- '. � -11 - , q.�i.-:�. i�', ,� '.. %' , , . , , . ", , � � .- � , * , - , - , , , ': �" O , - - I � ;-" ��,.,;;"t­'. . ,:- ,.;� , . � 1, ; .. ,� , , t ,;;.. T.,:'. , �� -:�:-: , X�t::, " , , -� ..." ;6 I -T, , � �1' "'��" ',,':� �: :4 '.t' I'; � -"�'% :;` . � , ,�qi�'. , ; . , tj . ,�. , �,'�� ' -:. , I I . t, 7. , , , , , .. " - , 7�,;�,!,z� .t,t-'tt..1,:, , ..);"; %j'a" _ ..' 4 -. -- ..'N. ,; .. . Vvt,, ��,,�',-S--`-,!-- �" . � -it' '-��-- "" � � '� I , ��. 1, ­�' .,:*'��!�' "' I .t , '. 1� . ,�', F% . . . -, - ,� , . ,:,.-. � , .`41 . ";�., - 0, , , � - t, I --I�'; „r .�, - 'i - ” ., � I" � , - : �, -i""..�-'.. �� ,��, . ,�- ,-�., ',.'Jz� , �Q�-,i �11- � 4-A k- ,V-,,:1 J, �', 1�. , - - - - -.,., , ,',,�o ,t,t-.-�V,.4,--' ' ' . ,:,,.,�,"- �,-,- � ' , �f, . , " , - � , , . ", , .� . z .1r, v ,., "t " z, , . '. , . , '. " - 1. k'� - ' �- ' t- i ; `4 . !;�,--:� . -I " k . ", ',�,� � . ." , . . . . 1,1� . I"'.. . j .1 , .. " -, - 'il � 1�-` ��. , . . , 1, , ,,, � "I � ,': �*!,,, �- i, - .. , � - . . I I a I., , `." �� � � �, : ", � 1, �, � � '.." , , ,- '. * ",'. I .. . 1, ' - " I I .�� ,!��- ,;., �. �� " .. ;� - I ' ' ` �, . I,' ' ! ". - , - - ." � 1.� , ip I � 1. �4, � , �1,-" ; . : . " -, , Ii! ,, ,-; - " , �/ - - " ; " , , - , , p �` -; � "; �! " '%-' , � , " , � ,;� - - . .�- " , , !, :. - . , t." . � a . . tt- . ;� �, - i� I ��P, ., ,�.;- , "'], ..,��i:.,�� � ,". 7" ,'.'t, , , , , I , 111-1j-'17 �,Ul `..;t,�� , . ,.: '�-�, t "'e", 3', .�'4" 1'�-i , r , . - I 'I- t. ;� ��, ..." �,', -.- , , ,.,tt, -�1,11' ,P`��-, 1. , , , ", 1; , :" � V 1- ,. '.. t . , , * -t­., "r , - - - I . 1:� I "I , ", k.. � ,.-, , t", I . .1 - - I, ,., � , .,,,�l !, P, 4�;, � -!.,j�;- ,", , '.. . � .� ;.-� . V, , -, "; -�p - � , ,�:, . , , , ,-. , �,., ". -� - , - I I , 't I � ", , , : - K: X: .1 tz �,,t;, ♦, MN . ,;;� I- , �.:."'4., , A .., , *..:k , , .1; il .. " . . . , , � ',-� "it", "i... ,t�, � , , . ,A-k " 1, �," , ?v,�--t-.;, '.�',!, -,,,'� , , , I ( � "." ,,�,� :� I -., , . - . . � , ,� � I , , , , .�w - ;"% - .,;��,�� .- ,-:,.2. ' --� � , ' j , ' - � - ,M'--,,,W- , 1 .. 1, . , '. �; ! V1, - �' �`-""`-' , , , , - d, I` -' !" , - 7 , " ,:.��, :. i , ,1:t I �..�, . I I �� ---,-�,- � -.-rq !.�.��*�-i,'., ,,t-. ", - . _,,. ��,_, . , �� ,��.. , ... . " .1 1, I. - , 4 . , ..,�,!, " t ;�, ,,,,� d , � ,� : ;, , �,�.; - i `�,�,': Pty I , '. , � .. . -,��- 1�1 �k� �� , , ', kN4, , 6-t- 14W, �, ;,��`, C!,�i 2�� i 3 , , 1 ,,� ", . tz. o"", I �,-;- -�- 'ill' -* -V7,� ... " �.inl �k �, . I - I , � -t��, -�.n,� - - , �2 --,. �,"�,-.--' , , � ,'��,` :,:,. . tki, !j -�I: I � , .., , - . , , - it, ; ':�: ---:".--, , , , t,.- . ,x _�. _' ,'�, � - ,��' ,� % . 1, 1� . . I � ,,I -,,.i' 'W��' :J, -,,_;�', �j 1'e.". - . , - 1 1. , I � 1 7 �',,��,!�-!;��4,�� - . �: ,: ..,*, - �- � , .1 t;� 11A� � , "', , , - - ,,-.- .., " . , I � I li-k � I , , "J , -, -,;r- ',':�,,�,7-- - - - , Z' - �, ----�, � . ,� � I11--l-I . ,--' ��, !�,; .� k. ,-!.. . 1 . ... : .1 , I . -P11_,6 1­--� q� ��'- , ' !,�,�, , -- -, -, ; -, ,,, , , "' - , . :1 � ; • . ,�tltl ... -".11 ", " .., .�-- , .- , ,,� ,,, % ��: . . , . . "'' " 1, , t19 .- 51 a * ,� '. , - ...:,. �, �, � � � � - , ., , . "!," ,,!�w .. - . . . 1, :!,�' . .. I � , 't�. ,,;, - ,,, -, "' '*11";�,,, *. ,� iq'rl :� - 'i� I I - . . . �,i� I I -k i -�,7 ,�,",'.`,,`� .��` '. . .., , - ,Q ..- I ��, , . -W: 4""i,*�,��-,,,�,.��'.,�,--�i,,,'.�'- �� " 1,i"t-1 -.,1 - .� � . - . ,. .. - - q , i� ,%� - - -1 I -, - - , � - . I , . -1 . � , .. - , , , , -, . ," - 41 11 , k ., I . � `t: , -, ­', ., ,,^,, .1 .. .. I - �, I ^;. , .�, f'- I I �'. - is .Z� " _,_ z - 4�*,?,',; � , '��'w ,�;" r -��' '-:.1 , - k, ai.i-. � I "W', . . ,;,, , � , �, ��T - 0, r . ; '. . , . . -��i ,, , � , '�. ., 'toi ",i, ,�54 , � ". , . �','i , ,' ; , . V � �W_ . I I , � - -;��f to , �ij ,`; . - i-1 - - . " . 4�- � '� - - 4� - , Ai�,,, " , , �)*�, !'^ -%; t," t�ze -11.�... . , - 1-� n,� ,4 , ,• -r I-- � , . % 4 . tt� -,; � 6'r-11,;1,1N�. �1'11* , 2i� .-, - - -tit-A",�,"!�,%1, :'i�, ;, � , . lv� I �, , .--.-�., It'.. . iA i.i � 1, . 1, ,�, I - . ,- �l�f,�-,, ", I . � , � 11, ,, ,," - , ,, " , . " , ". , 1� lt,ill I . -1, " , � " ',*.* . . , I , -� � I . .. , - . - I , , I • . � , ,� L,'-`�� , - ., . � .. �, ,.v � �, , t,'t.,j�-,ii,,,�, .'-g ?�t-,, ,"j, -. �!s-,,'. ,,�'. I I � - , '.1 ,� �� ".4 �:..,. . ;, � . ; , I -4Z� Z7'6-8!E. �, " . .. 4 � -�. .. � , - Z, �. "�, � ;"":� ; , , .'' , ., .--�. __ .. - -1- " I ., . - - - .�, ,..i '. 11 -1 I . , -, 11 1, I -,' .� � - � , � , - . , :1 : �, i, , ; 1,' 1� .; "', 4'-�g. : J, 9.� " ' �� ' � - 1,.�', i� ".1 . ' � .� , , � , - - i ;: � I W,) , , , . ".. , - 11 , - - � z �, � � . , -'�' !j7't I , . .. . W, q. . '. - , 'i �, i - � ., It., - . 9-14, , I I - � " 11 --A.,"".. '.pi;i� L,.,. �� . , ,4',�- � 1"' � i't', : ' )' � - I ' J� ,� I ,�., -, .% � , ,'. s ' , 0%,,��,� , , ,, , -..-�- � ,*.�.,,, ,� � - � - 4�- 4 - , . .. . � - - � , "'. ! ., � , . .i. It , , , � ,�', - --, . ".. . tie-14-65 � , � � - � . I , . , , , . � . - . � J, �, , . , , . . . . , I "." ., - .1 1, - � I I . - , V 4,, 1 � "ii , � 4". 2a:) , .1 . . ,;, -, . , . �A �' I � , -11-'�: -�4. �;- � -, t; 1� � �'; 1�-,�;.p , " �'. - I , " . '�, r : . :., . 1� --1 , " - `,,, " . ,,� I �, I i " 1'� " , ,% -� .., ,�', " � , , I � . - 11 i ". : ; , -t- , - ­ 1A . . ��-, " 't '.,-, " ". �:'_., ,, - 1 , - , - ,'� ,`t . t'. %, .. . ,- 1` ,� I , , - -, � . , ,- , . - ,- - � , , . . . ., . '. ..., I ,,, �, - , . i ,�;;� , " ,,, �, ��. ,�' . �. . �11-1 . � 4 - � , � " �� , . , � .1 .�: .e.-fg , r� � , �- -1� , ,.� !�'�, " '1�1- I'� ": .1 � . . .:-,&� 'i : ,.., . , , - ,� I., I 1. :. , , � , 1, N 'Lt-", : 1: -� -w` 4.;.., � . - il. I 1. I -�. ..; . . �., �,� ", '. . -il", � ,;- I '. ,� , , nt j ,,,, ,,, � � 11�111 . I .. . � , � 1. - . 1� "' I - �� � " , ��.-. t. . ".... �� ,5�., " """, ,ix_. r� - -, ; i- �, . ,, , " i'� I , , 1p.". - D. '- It - ".1, I , , '. 4 ��', . �:.., 11 - " " " , - - - � �, '. . 1;1 -111k.wl , -i ,,.' � � 1- , ',S�, !�,--�, : "''t'," , " — I I - �1� - .> . ',�,., ., . ." - .;,,�, ,,��.-,',,-.,.���!,� "'.... , , �, --�t:t-: I 11 I t:` 1 4�,'�,, - - V " " ." :',',--- 1 I., lis. ,, 1! 1-,4 � ; � . � .. , , ,��--- -, ,,, - . , , , :, , � � , ,—..." , ,� ,, ." ,.. -� .. . - . I ... �, "! . . . - , ?�, , , � - , - � - �- ', " "I I -, *,t- ".. - ", ,,,,,� f, , ,�, , ., � ; -.;, . -�,;'. , . : I . , " . . 11, � , -�, , , 1'e, �-; 4' � 'I,: �.q" �' , -J,— , - '. �, % �,.. .". . . , _ � . I , � , , - "i � . , .1 . , ", .:t, - . '� �L ­ , , ,�, � e ., 4 ., .. . 1- � , k, -1 -` - .. , -r`,� � , " .. . , '! - .. , � .. i , ­ , - . -, , ." 1. I t,'�,- ':. , I ", � . . - W, ,, .� , . - - , , , ". . . .�' I , . �.'-� .-.'�Z,, . """.."', i L , . �;: : � . , �-,-, I ,;,,. ,.; . , ,�, I - * - ..�, , .".. . -'i, , �� ,� - ,%, - -, '. ". 7, ., �v .. �1. .%. . � " , , �rt"- -:*�,,-t�k -'. ' �-_ -� � : � - , -,�,, 'j " , . � , � , * I '. �4 %., '. , �4,.-,', . ,t::, � %�� ,- t, . � � �.', .. . - I 11" " �� . � , �, . " ." i " � -11 - 1� . - , �,`�� - ., - �.. , _ 4 'J� I . '. .�-,- „:' � �t� ,- - . i - _:._ ., `1",".1 , . , - .-I . _ � I . � .. . ,�, � � -f -�e,.- , , 11, . ,-�:” �, � ,,, ,- I. , . ;�? 4 , . li�;. - �� . �l, � , V,,, � ,,k,�: . � - � . . ,. � - I . � ., , � - � . , . I- �-' .• � , ', , , - . ; , * -.� - . ;� I 11". : � - . . . . . , - � - -.: � .. ,� � . " . ,.- " - , ! - . '. " .. ,- � - , � , . . ,�-, $,. .i , � I . "' I , -� . . I " , .1 1, , „,,�,f�� ”, - , I �f - - , .. , , 5,,� � , , , ,. -, - � , , , . � � , t 7 . I . . . . -�;� �j C - .,� , , � � ,., ,4, , "."',; �!:� " -, ." " - - , �'.' �,ii ;�, - . , Z�,;-. ", . � .11 I ,,, � ,,, , �. , ;, , . .., .. � :4. 1:��, . " * . � , , ,,, :11�, " �, - - ., . I L, I I -, �, ,� ". I . . - il ..�, � -,�, I 1, ,". 11 :� , 'O :- c , , - �, 5. , , -� ; - I I I . , . - � I - , -. , � I .-,. . �. ob "'' - :� ��6�, � -- �,ti % � . �. � =.; I . I , � , ?L . �. '. . 'It � . : '. 1� 1, � . .:: \ �� ,'- � . 11, . � � , I �. � - ,� .�.�, � . - ,. I I . " r PM 1T•,O�HE i E ­,WELL COMPLETION, REPOHV. Orviaion Cat. Evvironmentai Heatth',SorAA! � 3f7t J. h , Ct)IJN1v OFtrLCE kit!iGp {N(,. CARML, NEW this ; report is to. be completed by well dslller arils submitted ti,`County 1�ealth (�rparttnelittogether wlEh;laboratrr,y rr?pt�rt analysis of water sample indicating waterds of satlsiactury bacterial qua1 iy before certificate o{ constl uction ccimpGanco Is Issu �.. REPORT MUST BE SUBMITTED 1N9TMIN 30 17AY5 >CjF INEL1. COIVIPL> =� • 1 .1 � NAM ADDRESS I g ��, gWNER :_.l.�J ( (Town — W