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HomeMy WebLinkAbout2093DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36.56 -1 -12 BOX 18 Fir, I I of r3 �T .1 1 -(r i 16 j it f .� .. 0 . . i I r r i r IN 02093 - -7°- : � r ^ -'_; • . _,F`.". - 7 7 PUTNAM COUNTY DEPARTMENT OF,HEALTB Rev. 3/86 DIvisioa,of Environmental HealtL Se vices, Ca mel; N ?.10512 • ._' �p i D I P C H Permit N x.r CATE OF',CONSTRUCTION CQMpIIANCI FOR,SEWAGE DISPOSAL SYSTEM; �,bTT --. ... own o Located NPR -1G` Blockr 3 e vat Ta: P „ _ Owner /.applicant Name :`O1 -ali4 •EE�T1.}'!S Formerly Subdivision Name ,Sabdv: Lot N z Malang Aaareae , ivd FAt R�tEi_L? 1�SPJ:� Zip 1 QS o �i Dade Permit lasued ` j h .oral -tN. .�EF�Z94.s Addiesa R �lY Separate. Sewerage System built by 1. �oneteHag of j04c C? Gallon Septtc Tank snd - 504 L, F, Water supply :. Pubue Supply From Address: or X private Supply DrWed.by ('11 LL hi2C IJ_ 1 f3 f� Address i)..�15 to � ra•`l �g Type . Has Erosion Coutrol Been Completed? : N Ball.. TyP4 t7. 'ao� e[Sr�jv Nd _ Number of Bedrooms Has Garbage Grinder Been Installed? . Other. Requirements . I certify that'.the syetem(s) as_.listed seiving'.the ;above premiaea were.conatructe& essentially as shown an the plans.of the completed work ( copies of oohich are attached), and in :accordance .with -the standard s rules and regulations, in.accoidance with the filed plan,.and the permit issued by the Putnam County Departme /nt Of Health / ` o ! %� Cprtiflee} Qy P.E. R.A. Oats tj.► 4M EN!6�lM�r.ERaNG j •: // Vol Address CA7 _ Z L.icena N0 `P t , Any person occupying premises served by the abovo'iystein(s) shail promptly take such aoi0n:ss may be necessary to.secure the correction of any unsanitary conditions resulting from„ such usgga Approval of the sephrate saweraye system shall become null and void'as soon as a pubi(t�sanitory sewer becomes available grid the a ro`vil of the',private water supply shalPDecome null an q -volq .vfhen �a public watei supply becoinaa availabN Such ..approvals are sub)eet.to odiflcation or ehiir�9e when, .in the )udgment'ot the Commisiinar of M Ith, such ievoeation, modification or change Is necessary.' // /may9� �t --=�— Oat BYE U ./ Title .� M3 PUT'NAM COUN'T'Y DEPART OF HEALTH JIVISIOi�i OF.� 'T_.-O TAL HEALTH SERVICES Owner or Purchaser of Building 1> Building Constructed by N&N--C-f L,6,Q -OE Location - Street 1?71 �3- � dL Section Block Lot 36.56 I Subdivision Name Municipality Subdivision Lot # Building Type GUARANTEE OF SUBSURFACE SEWAGE DISPOSAL 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 guarantee to the owner, his successors, 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 - approval of the . "Certifidate`of` Constituct ori"ComplianceP'­ for the - seswage''disposal systan; 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 occupant of the building utilizing the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environinental Health Services 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 system. Dated this Iq day of �_ 19 7--:3 'Signature Title eral Contractor (Owner) - Signature Corporation Name (if Corp.) Address rev. 9/85 mk Corporation Name (if Corp.) ��ti -r� * v * WJ✓LL VVPIrLL' 11VLY LttoiVAl DEPARTMENT OF HEALTH Division- Of- Environmental- Health - Services• PUTNAM COUNTY DEPARTMENT OF HEALTH Office Use Only WELL, LOCATION STREET ADDRESS: TOWNMILLACILICHT TAX GRID NUMBER: Lot 1, Jasper Road, Patterson, New York -31-3— WELL OWNER NAME. ADDRESS :.. Bertam Construction CO., 14 Donnelly Dr.., New Fairfield, CT MMOBIVATE PUBLIC USE OF WELL 1 - primary 2 - secondary XgXSESIDENTIAL 0 PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP O ABANDONED O BUSINESS ❑ FARM ❑ TEST /OBSERVATION O OTHER (specify) ❑ INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY ❑ MOUNT OF USE YIELD SOUGHT 5 gpm. /N0. PEOPLE SERVED 2 --4 / EST. OF DAILY USAGE gal. REASON FOR DRILLING .[]REPLACE EXISTING SUPPLY ❑TEST /OBSERVATION ❑ADDITIONAL SUPPLY Xg3NEW SUPPLY (NEW DWELLING) ❑ DEEPEN EXISTING WELL DEPTH DATA WELL DEPTH 285. ft. STATIC WATER LEVEL 50 it. DATE MEASURED 11/24/92 DRILLING EQUIPMENT ❑ ROTARY X$X COMPRESSED AIR PERCUSSION ❑ DUG O WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE O SCREENED ❑ OPEN END CASING XM OPEN HOLE IN BEDROCK O OTHER TOTAL LENGTH 50 tL MATERIALS:. X STEEL O PLASTIC 0 OTHER CASING DETAILS LENGTH BELOW GRADE ft. JOINTS: p WELDED.. THREADED O OTHER DIAMETER in. SEAL.yWEMENT GROUT O BENTONITE 0OTHER WEIGHT PER FOOT lb./It. I DRIVE SHOE.)g YES ONO LINER: D YES ONO SCREEN DETAILS - DIAMETER (in) 'SLOT SIZE LENGTH (It) DEPTH TO SCREEN (It) DEVELOPED? FIRST o YES a NO HOURS SECOND :• GRAVEL PACK O NO GRAVEL DIAMETER SIZE: OF PACK in. TOP DEPTH ft. BOTTOM . DEPTH It. WELL YIELD TEST It detailed pumping METHOD: O PUMPED t tests were done is in- COMPRESSED AIR ' , formation attached? O BAILED ❑ OTHER ; D YES D NO 1PIELL LOG 11 more detailed formation descriptions or sieve analyses are available, please attach. DEPTH FROM SURFACE.. Water Bear. Ing well Dia- �eter FORMATION DESCRIPTION Cade tt. tt. WELL DEPTH It. DURATION hr. min. ORAWOOWN It. YIELD gpm. $Uf1aCe & 11. cobbles. 285. 6 - 200 35. MCLEAR TEMP. O CLOUDY HARDNESS O COLORED ANALYZED? )OWES ONO NALYSIS ATTACHED? YES O No STORAGE TANK: TYPE CAPACITY. GA NFORMATION [MAKER CAPACITY DEPTH VOLTAGE HP WELL DRILLER NAME ADDRESS putncm .Ave a MILL..DRILLI Wres Brewster, NY 1 o.7 ELLIS A. TARLTON LABORATORY DIVISION OF ELLIS A. TARLTON, ENGINEERS, INC. PHICAL PHYSICAL 34 PLEASANT STREET DANBURY, CONN. 06813 -2328 BIOLOGICAL P.O. BOX 2328 203 - 748 -7903 WATER - WASTEWATER METHODOLOGY APHA - EPA - ASTM ...N.r- ...::, ..s� -.f -e rs,.� -s-r ...alt. i.. .. WOR`T"OF- FAL-TER[OLOGICAL AND `CI41;-MI'C AL=A- X"iNATiOW- 1OF!'�-VATER NAME AND �M111 Drilling URCE Of SAMPLE , Inc. . ADDRESS OF Water Supply, PERSON TO pp y RECEIVE Putnam Ave Bertrum Const. Corp. REPORT Lot 1 Jasper Road Brewster, NY 10509 Patterson, NY JDATE OF COLLECTION Nov. 27, 19 9 2 DATA COLLECTED BY Mill Drilling Hydrogen Ion COLOR TURBIDITY ODOR CORROSION INDEX DISSOLVED SOLIDS Concentration LAN G EL I ER (PM) RYZNAR NTU Mg /L Alkalinity as CaCO3 Fluoride (F) Bicarbonate Nitrite Mg /L Mg /L Mg /L Alkalinity as CaCO 3 Chlorine Residual CONSTIOTUENTS Nitrate Mg /L Carbonate Mg /L .00 Mg /L AS Total Hardness Conductivity NITROGEN (N) as CaCO3 Ammonia Mg /L Mg /L Micromohos/cm Mg /L Iron as Fe Mg /L Mg /L Chlorides as CL Mg /L Manganese as Mn Mg /L Mg /L Detergent as MBAS Mg /L Sulfate as SO4 Mg /L Mg /L The arithmetic mean of all standard samples examined per month using the membrane filter technique shall not exceed MEMBRANE FILTER TEST one ` cdfdrfy - per 900m1.- Coliform colonies--per— standard sample shall not .exceed 3150ml, 4/100m1:- -7/200m1:- or -13/500m1 -- -. -- Coliform Colonies /100ML in: (a) Two consecutive - samples; (b) More than one standard sample when legs than 20 are examined per month; of (d) - - - More than live per cent of the samples when 20 or more are examined per month. AT THE TIME THE SAMPLE WAS SUBMITTED: 0 1. The results of the analysis of this sample were satisfactory and met requirements for a potable water. D2. The results of the analysis of this sample were satisfactory for a potable water but certain of the chemical or physical constituents were high. These are as follows: El3. This sample was not satisfactory since it did not meet the bacterial requirements for potable water. The presence of organisms of the coliform group In a sample of potable water is undersirable and, while not necessarily Indicating the presence of any disease - producing organisms, does Indicate that such contamination might survive to the same extent. The presence of organisms of the coliform group may also Indicate that the treatment was not adequate at the time the sample was collected. 4. This sample was unsatisfactory as a potable water because certain chemical or physical constituents were above acceptable limits. These are as follows: COMMENTS The bacterial analysis showed no organisms of the coliform group at the time the sample was collected which indicated the water potable. Certified............................................................ ..............................6 ... ............ 9111"69 T a" [7M . Y,110 Lot j seed= 0* Dq"h V L-1 J Numbo W Bedimeeiiii DnIV Flow G P D PCHD Nefficida6 lm R*qWmd Wbm FM Is campleftid i6 Sepinde Seliamijip Sysisma 'amm te0de Tm* -ad ou ly Wetter S140*11" 0 Smp-p -10eii Add- Addrien above. di County. ismi sub" pate M so" •of wm be I County Date APPROVED FOR CONSTRUCTION' This 8PPr0 revocable for cause or may be anuinoisd aor46odil "Quit" a now -fter emit. Approved for dispose I Rev. 5,A 10/88 Data ion* of the proposed systsim(s); 1) that the $*"rjite.saw di al t� and in:accordantj With the standards. rules- 'I 0 of ca;imitrue6bri'dompliancil" latisfactOry to t�oCiDminisftnw pf.1-lealth will the.ownar, his jua;osaaojs, heirs or ass" by, the builder. that ;midl builder will during,theperlod . of twq•(2) years Wrinwillately following theallisto of the Inu- systsiwoa� any ratipairs therawtoi 2) that the drilled wail described above idance, with tiie. itandiii4s, 'rules and reiguls"ns- -3f the Putnam P.E.a".A. �—Llcenss No -A ss, date I nless construction of the building has been undertaken and is by I the Commissioner , of Health. Any change or alteration of construction arid/or private waiter supply only. Title Cpl DEPARTMENT OF HEALTH Division of Environmental Health Services * : ;. 110 OLD ROUTE SIX CENTER, CARMEL, N.Y. 10512 (914) 225 -0310 APPLICATION TO CONSTRUCT A WATER WELL��� PCHD PERMIT #� WELL LOCATION Street Address Town/Village/City Tax Grid. Name bailing Address N i iV --y". Number Aprivate ® Public WELL OWNER USE OF WELL 1 - primary 2 - secondary S RESIDENTIAL ® PUBLIC SUPPLY Q AIR /COND /HEAT PUMP ® BUSINESS O FARM O TEST /OBSERVATION ® INDUSTRIAL U INSTITUTIONAL O STAND -BY ® ABANDONED O OTHER (specify, AMOUNT OF USE YIELD SOUGHT_ gpm /# PEOPLE SERVED 4 /EST. OF DAILY USAGE 3 ®0 gal O REPLACE EXISTING SUPPLY O TEST/ OBSERVATION 12- ADDITIONAL SUPPLY ZJNEW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL J REASON FOR DRILLING DETAILED REASON FOR DRILLING 1 WELL TYPE RILLED ®DRIVEN ®DUG ®GRAVEL. ® OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name (/^AX0t_A/ Address : �ttiAl/ IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NO NAM OF PUBLIC WATER SUPPLY: N�� TOWN /VIL /CITY. DISTANCE TO PROPERTY'FROM NEAREST WATER MAIN: -4-;//Iq _ y LOCATION SKETM & SOURCES OF CONTAMINATION PROVIDED 00N SEPARATE SHEET (d te) gna ure) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part .5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. Date of Issue: L %��G 19 / �- Date of Expiration 19 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller a PUTNAM OOUNrY DEPARTMENT OF HEALTH DIVISION OF ENVIRUMTIAL HEALTH SERVICES DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. tc,c> F�Ig-(�IeCa CCJ ,.r tamer Address Located at (Street) ,'P.SP(f ('D.tJ/at�L'r� Sec. Block �_ Lot (indicate nearest cross street) Municipality {���� Watershed G(?(:::) +0 SOIL PERCOLATION TEST DATA REQUIRED TO BE SUBMITTED WI'T'H APPLICATIONS Date of Pre - Soaking °I Z°t a Z Date of Percolation Test HOLE NUeER CLOCK TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Fran Water Level No. Time Ground Surface In Inches Soil Rate Start -Stop Min. Start Stop Drop In Min /In Drop Inches Inches Inches 2 3 4 5 ;. NOTES: 1. Tests 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. 1q�.c�G> --q�� x�r1u -�. �4'� Zoo" 2�� is T�u•� /�►� 2q.�o - Iv�.c� ��r��iJ. Z`{ Z � �Z I ��Z �O M y-- 7�►..7 3 io:m - l o � 3n `�o r-tr�• Zq 2� 4 Q �4 �� t4 4 ZA 5 AP - � � .... is go- g 3 e 8 M�►�. L��' . �� .�,, _ _ .. ` �o L-,3/tom 2 '24 m,P . ,, V 2? , 3 !2> /, ►-� • 3 \o� ©Z - ro_3z r1v-� 04 27" �© MAN /ice_ 4 10 -3Z - it 07" M\ r, 1 2 3 4 5 ;. NOTES: 1. Tests 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 DESCRIPTION DEPTH HOLE N0. HOLE NO. ..�..�.,.�.�.......... �. -HOLE N0. G.L. 1' 2' 3' 4' 5' 6' 7' 8' 9' 10' 12' 13' 14' INDICATE AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP OLE OBSERVATIONS MADE BY: DATE: OF WITH IN TE - -- - DESIGN Soil Rate Used 2i- 3o Min /1" Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity gals. Type �. Absorption Area Provided By tDc-7,� L.F. x 24" width trench Other - i �' U +,oa A.i 1U . 1 _ r l LL, E'� Name 14 % b-'< Q- - .Address SEAL Soil Rate Approved sq.ft/gal. Checked by Date PC -1 pUTNAM COUNTY D E PARTMENT O F H EAL TH a.._.- ._•, -. -- APPCTCATIOV -FOR' APPROVAL- % -'OF' PLANS' FOR-* MTEWAT-ER--DISPOSAL SYSTEM =­ 1. Name and Address of Applicant: ­�,-,VAOJ e:?C-,-P7WU I,-\ (c>o f/NogF1b,© C)(ft\-/1?_ k _�bHN e-16-94 CLJ,NM 2. Name of Project: k.SC0>S LOTg 1 3. Location T /V /C• ?A,T•1 rs-oI-4 4. Project Engineer: 19S+re: EN6,►NEk1Gi.L6, a aF -;5-%4 M Y.C. 5. Address: ItA- t. r_C11_VTF_ C*V- ir_L_ IN-( 105%-& License Number: Phone: L-2-v ,2- 2-00 6. Type of Project: Private /Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 7. Is this project subject to State Environmental Quality Review (SEAR) ?. Type Status (Check One) Type I.. Exempt Type II. Unlisted .2!�­_ 8. Is a. Draft Environmental Impact Statement (DEIS) required? 9. Has DEIS been completed and found acceptable by Lead Agency? ........... I Jlj�. 10. Name of Lead Agency - t-_J &, —1-L-Is- , this .projept__in• an area-under- control of local planning, zoning, or other officials', ordinances? *....... ......... ........ . :.::.:'Fc 12. If so, have plans been submitted to such authorities? .................. Ny 13. Has preliminary approval been granted by such authorities? Date Granted:i� 14. Type of Sewage Disposal System Discharge...... Surface Water,�Ground Waters 15. If surface water discharge, what is the stream class designation ?........ r—►IA 16. Waters index number (surface) ........... ............................... f") / Ja 17. Is project located near a public water supply system? .................. NO 18. If yes, name of water supply `I J& Distance to water supply 19. Is project site near a public sewage collection or disposal system ?..... NU 20. Nam of sewage system N% Distance to sewage system 21. Date observed: ojKNoA-,st-J 23. Name of Health Inspector: y�Klucw��U 24. Project design flow (gallons per day) ...... ............................... &� 2. .'Is S`` tatePoTTiitani-Dischar§e 'Efiimination System (SPDES)'Permit ;required ?::� 26. Has SPDES Application been submitted to local DEC Office? ............... 27. Is any portion of this project located within a designated Town or State wetland ?..... ........................... ............................... 28. Wetland ID Number ........................ ............................... 29. Is Wetland Permit required? .............. ............................... NO Has application been made to Town or Local DEC Office? .................. N� 30. Does project require a DEC Stream Disturbance Permit? ................... A-O 31. Is or was project site used for agricultural activity involving application of pesticides to orchards.or other crops, solid or hazardous waste disposal, landfilling, sludge application or industrial activity? ........ YES or NO 1�-b 32. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potential known source of contamination? ..............YES or NO NO DESCRIBE: 33. Is there a local master plan or file with the Town or Village? ........... uN K� i\,D 34. Are community water, sewer facilities planned to be developed.within 15 years? UN 'Lb N 35. Are any sewage disposal ar "eas in excess of -15% slope? .......................... 36. Tax Map ID Number ......................... ............................... 37. Approved Plans.are to be returned to: Applicant 22!EL Engineer If the application is signed by a person other than the applicant shown in Item 1, the application must be accompanied by a Letter of Authorization. Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this i form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A Misdemeanor pursuant to Section 210.45 of the Penal Law. SIGNATURES & OFFICIAL TITLES: RAILING ADDRESS: 29-12 4�L 01 CPA &I (OU 90) Q§ D Utp I �ZWAIV Z, �0 VA DESIGN DATA SHEET-SUBSUFACESS%7 AM DISPOSAL SYS7EM YILE %'\ I Owner �Hrj e-:(-,PV—UtA Address Located at (Street) ' �D � 0At-:e--N- 1 4J Sec. Block Lot (indicate nearest cross street) Municipality Watershed Date of Pre- Soaking -7114 lb-7 Date of Percolation Test POLE RMER C= TIME PERCOLATION PERCOLATION Run Elapse No. Time Start-Stop Min. Depth to Water Fran Ground Surface Start stop Inches Inches Water Level In Inches Soil Rate Drop In Min/in Drop Inches 2 ,3 4 5 FA 1 NJ 2 3 4 5 2 3 4 5 7 s"'t's, 'to be repeated at same depth until approxuately 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 DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTHt: .HOLE N0 G.L. 2' 3' 4' 5' 6' 7' 8' 9' 10' 11' 12' 13' 14! .... . INDICATE LEVEL AT WHICH GROUNMTER IS RMNTERED INDICATE LEVEL TO WHICH WATER LEVEL, RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: LLy-.14 :J -- iJ ,�'1� DATE: (o q DESICG1 Soil Rate Used,2� Min /1" Drop: S.D. Usable Area Provided No. of Bedrooms Septic Tank Capacity l� gals. Type. Absorption Area Provided By L.P. x 24" width trench i Other CX A Q Ao%' Fli-L. AAA riEYI mac, u Name 7_>�1 PG, Signature Address E549 in"46 CO SEAL `;` j - SStC THIS SPACE FOR USE BY HEALTH DEPARTMENT ONLY: Soil Rate Approved sq.ft /gal. Checked by Date C7 =7 ----------- C.L rc Plans - ----------- ==,-= TE Z7— 77— zs- Z tal C-a NNCt=-!E CZ* azrc fz E 3=5 W/ n Neca ic t 0. f I INC 20' etc. IN to 2C C C' - E�- 100 tc 13, =- L: IL Z: -ESS, UNDER THE DIRECTION NEER, IS A VIOLATION OF HE EDUCATION LAW. (1) 3 AS BOIL } ` S { 3 rY•s-. S .f y N0 � r A F - B T REM,'A S _ TO w . PUTNA Xr J n v RECORD' q E NzT # N0 � r A F - B T REM,'A S _ TO w . PUTNA Xr J n v # L r. s O 5 �' •� yA •3 ,s } E , 'Y Y RULES ANI DEPARTME r:r DEPARTME 2 F'i4LL FA`CILI TOTAL = LEA -:TOTAL, LEI a Y ' J _ TI -F TN-AT THE SEWA TED AS INDiCA ED Ot �S INSPECTED BY ` -IRS W4311'AND -HEr Fl €LDS R.EQUI`f2E FIELDS P_ROVID'E - S Q _ TO w . PUTNA Xr J n v Y RULES ANI DEPARTME r:r DEPARTME 2 F'i4LL FA`CILI TOTAL = LEA -:TOTAL, LEI a Y ' J _ TI -F TN-AT THE SEWA TED AS INDiCA ED Ot �S INSPECTED BY ` -IRS W4311'AND -HEr Fl €LDS R.EQUI`f2E FIELDS P_ROVID'E