Loading...
HomeMy WebLinkAbout3166DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 72. -1 -22 BOX 26 03166 A�,ti�- - r, r ,ths �� In 1 a 16 t�� . ti r el-I ;9:1 03166 ... .. •'�ii�r Ll i•ft r41G` iri�`. is ,�f.�l�i,"f."i.��'�f''r}:'.�e�: � -. _- .4,.-. Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Donald and Elizabeth Broas 731 Sprout Brook Road Putnam Valley, New York 10579 I�TiT —41UT 9%:3= August 21, 2006 County Executive ROBERT MORRIS, PE Director of Environmental Health i Re: Addition Approval – Broad, A- 146 -06 No Increase in Number of Bedrooms 731 Sprout Brook Road (T) Putnam Valley, TM# 72. -1 -22 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 August 21, 2006. The addition is approved with the following conditions: 1. The total number of bedrooms must remain at three without prior approval by this Department. .. '3 r :�• �_. o v, ^7 0 �a�. rtn :+1.� ^.^, _ .ci ,�.4 m.�'�. r1 4,�. .�'..ns n � i + -t,-b- .. . - _ The Sp @ :� 2 ex;stl..b se .3�. 31 , e_ , ...Tl.-: i exp �._ ar a,.rra, ,. .c• maintained. 3. All plumbing fixtures must be updated with water saving devices, i.e., new low flush toilets, restrictors for shower heads and faucets, etc. 4. The approval is for the proposed changes only. This approval does not validate any construction shown as existing that has not obtained proper approvals. 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. Very truly yours, Mike Luke Public Health Sanitarian ML:cj cc: B.I. (T) Putnam Valley Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 F.Aw Intarvnntinn/Pracrhnnl (R451 97R -6014 Fax (R45) 97R-664R SHER�L+-ITA AMLER, MD, MS, FAAP -.. -. .. :�5�1:!i21;.' /u.fl. °•f:er C,�HC::I:�".. y . ". _ . LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 ROBERT J. BONDI ROBERT MORRIS, PE Director of Environmental Health May 18, 2006 Donald and Elizabeth Broas 731 Sprout Brook Road Putnam Valley, New York 10579 Re: Addition Broas, A- 146 -06 731 Sprout Brook Road (T) Putnam Valley, TM# 72. -I -22 Dear Mr. & Mrs. Broas: I have received and reviewed the plans for the proposed addition at the above mentioned residence. Based on the information submitted, the above mentioned addition cannot be approved for the following reasons: 1. The new laundry room is considered a potential bedroom. 2. The legal bedroom count for the dwelling is three. The potential bedroom count of your proposed addition is four. 3.: 7-he, addition of a_.potential bedroom requires this Department's approval of a revised septic system plan trom a professional engineer.' Please revise the proposed floor plan to reflect no more than three potential bedrooms, or have a professional engineer or registered architect design a sub - surface sewage treatment system meeting present code requirements. If you have any questions, please contact me at your convenience. ML:cj Sincerely, Michael Luke Public Health Sanitarian Environmental Health (845) 278 -6130 Fax(845)278-7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 0 4, SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health ROBERT J. BONDI County Executive Cr. 9,9- /031 �S31V DEPARTMENT ' OF HEALTH 1 Geneva Road, Brewster, New York 10509 ADDITION APPLICATION RESIDENTIAL ONLY STREET 731 SPROVT BROOK { AD TOWN Tv -rN&B VAU.,MTAX MAP# 7a • (-Z Z NAME DoMAtz ELIZABEM BRaAS PHONE $`f5' _M-3(01 R PCHD# 6 MAILING ADDRESS 731 Spcovt BP-oo y- ROAD � TvTj-3 N-j V Ar (,L6'1 , fly 105 7 ) DESCRIPTION OF ADDITION FP-CO ux c' oVn ek F- '-os-�A K� 4'0-MS it Z SAVV-'j 0. ,nau d NUMBER OF EXISTING BEDROOMS 3 PROPOSED # OF BEDROOMS 3 (FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUILDING INSPECTOR) "Any addition which is considered a bedroom requires formal approval of plans (Construction permit) prepared by a Professional Engineer or Registered Architect in accordance with applicable sections of the Putnam County Sanitary Code. Please submit this form and the following to Putnam County Health.Dept.,_ 1 "Geneva Rd, _ .._..':: : "r ",-. " .... ~'lix c �%3tci; 1'`�1•i"' iv5%iy; `i�liislre: "��u�+ j'G % o =b i � ii. :_.._ . __ .... _ ._ -..._ 1. Certified check or money order for $100.00. 2. Sketches of existing floor plan (drawn to scale, all living area including basement) 3. Two sets of proposed floor plan (drawn to scale - with name, street and tax map #) *Non - professional sketches are acceptable 4. Copy of survey showing well and septic locations to the best of your knowledge. Include date of installation if known. Label all wells and septic systems within 200 feet of the property line. Contact this office with any questions. 5. Copy of Certificate of Occupancy from Town or Certification from Building Dept. with legal bedroom count of dwelling. OFFICE USE COMMENTS 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 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI County Executive PUTNAM COUNTY DEPT. OF HEALTH 1 GENEVA ROAD BREWSTER, NY 10509 Residence TAX MAP# Z f 2 TOWN`` To Whom It May Concern: According to records. maintained by the Town, the above noted dwelling, IS ',�r CDE. iv COMPLIAy C L � E IS NOT IN COMPLIANCE WITH TOWN CODE LEGAL BEDROOM COUNT IS, This information has been obtained from: CERTIFICATE OF OCCUPANCY: OTHER: Z&'2 I ding Inspector Date CERTIFICATE OF OCCUPANCY Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Im Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 - . f__<__..,- .__ <!. -- M_­-I­ 1 /4A[\ 190 LAI A V /OAC\ — l /An Arue-us I I 200('0 A �t 4t rv% $�ez 731 SegevT Sezov- 9Zp Wiz.- 1-2; fv j S LAI -'T d*-a•W LKII fj _V _S 4AA 4@ LL -T'Z KJL� Wj- - 9 2-dan, %i - Zb 13 X28 r �l 1 i Hid MIJ f ts r � 1 t Xri j SEW - L .� * YO UT T KII Ic 22k, V4 22k -7� TI I'M 0 L o 7 2 00 "-.Li -I ( I , / {Y\ /� %� ,� ►3r�eM��i -7.3 S1o,.ov1 aro o {� -P,, ValILI -Tq,14 w p 7d - rota 4 ' j 3 �t i f f r 1 I F-V 561.,:WU 03 L agnfL -7.5-1 TA'V -7 1 -2Z r " Y 3x zy,s�,�� �►esi r -r�,z 751 selea Zoop r 9 I 1 t 4 n .r tT)v� it �T�+u/./stltS NALL k G, � ete d, I PUTNAM COUNTY DEPARTMENT OF HMT; HOUSE PLANS APPROVED FOR BEDROOM COUNT ONLY; 3 BEDROOMS f. `C3-t 1- m FL�2 731 i u flcK►..► da c I.I. •fl Nov 2 SrsRy� �r 9 6X►5T /Ni ADor'CYo✓) ' Nll r LrstoRy z ReLeagt ° EllsTr�j Kr T• li .i £ IJEw Mv0 cq e u 7z f3 7L i3 sa KITeW4 1 Ff a `; 34 ra J �7 b.X/ST /y S IL IS / X Z3 •�.l r!X /STI •/s � f �1wLL +i 3e 3� PUTNAM COUNTY DEPARTMENT OF HEALTH FI rt�sT F Loo(l- V HOUSE PLANS APPROVED FOR -731 5 PQo u'r 31e oo K TZwg,p BEDROOM COUNT ONLY; BEDROOMS �JTN A M V h U e/ I ' TAX MAW t Er " 1 V t ALF_.�.V 'iSEteet 0 ' •FG ee 1L; `'I!►0 v rTFo ./, t:,. IL " r { - V yc+v o r�wof. o N w N A4i4t I&S-TA {.a+M 9 a �,►rl l .� rL:L 1_.D!f 2 IKo,o SI . I0-t Ic yFF. '� ,. _ � _ __ _ °8 '' � X I Z� T _ Reteaaf � -- ♦ 8e_ EPLie�.fit r '�1a J y Ld1NK4 14F - 11 t cl Ct� 6V�ST►�q Jff- G 6►v� YAC6 V � y5 ep i �. D - S X9� b: Sy" Flm.it ro Lrw r. of Cl-S r S. - Slceodt� FLeoe.. 'j3t 3PRovT '�Iteolc Q,ap,p ;�, TAX �iAf # 7a - i -a a 4 r r t r •r PUTNAM `COUNTY r' 1 SERVICE CALLS INCLUDE TIME ON THE ROAD ;-P-7- term 3. _ �.. :°fc�i�3�ir.:Li r'ctiiSuTtt^'W�i�E'Y Owner or urc aser of Building Municipality Ralph Peterman Building Constructed by Cimarron Road Location - Street One Family Residence Building Type 58 action 1 Block 6.2 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 :Wade 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 system. The undersigned further agrees to accept as conclusive the de- termination of the Director of the Division of Environmmental Health Ser- vices of the Putnam County Department -..of -- ?i�ali:h ,a.'I . h ether o.r._.nQ.t -the. Tfe .lLti : >e -- o� -• }rie �syete -m 6= cper .to- -;ids �a.use� ' j�_t'ne wlllinul or negligent ' act of the occupant of the building utilizing the systA O wnaels Dated this 3 day of April 19 85 Signature Con'tracfol-s Add��ss Pkon-C, THREE (3) COPIES ARE REQUIRED WITH THREE (3) COPIES OF FINAL PLANS BEFORE CERTIFICATE OF COMPT�ETION 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 Heal . -. P.O. A0% 90 ~~~ K83[ S' [C8t � -^3~2^ 0 1 uEAR ST,vOnKTOWm HEIGHTS, N.Y. 10598 246-3203 Yorktown Heights, N.Y. 10598 ' []Xu1 BUTTONWOOD AvE,pEEKSKuL.m.v.105$O 737-8777 [] *95 MAIN ST, MT. K|sCO'm.v.1V54$ 666-3335 DATE TAKEN- DATE RECEIVED: - DATE REPORTED- cizn- y- REP EARED BY- COLLECTED LABORATORY REPORT []ACIDITY ................................................. OxLuw/muw —.--------_.-.----'—....-----'.'. [] ALKALINITY --.—'. ` ' O*wT/wmwv ............................................................... 2/8AoTEn/^`TOTAumL .............. /^................ [] *mxswIC ,,_~__^^,._^.,_.~-...------..^-...—^- [] SOD. s DAY .................................................. OuAn/um ___.____^______—,------.-..—..._. []anom/os -----.------'_,---'~--.. OusnvLuuw ............................................................... � [] CARBON DIOXIDE, FREE .............................. []BISMUTH '-.-------.--_---.-__.--_.—'.~~ []CHLORIDE .................................................. []BORON ----.---.—..--.....---.-------... [] Cxuon/ws .................................................. OcAow/mw ---..—.---.---.---------.---' []coo ........................................................... OoAu:/uw ---.----------..--.----.---' []COLOR ...................................................... O CHROMIUM <'pd ........................................................... []CYANIDE .................................................. [] CHROMIUM ow"pvale",> ................................................... [] DETERGENT, ANIONIC .................................. OcoaAcT -..--.------^--.--.--.--.--.' [] FLuomoc .................................................. [JCOPPER .................................... ----_------ [] HAnowcss .----.—.----.'—.-.---- []COLD -------'---------.----..--- []MPwcouponM COUNT/ 1oom/ ----'----'--' []mom _--^.—^---_-_---.—.--.—.—...—_-- [6TTcouponw COUNT/ 1ou"l ................. (D LEAD --...--------.-------------. � [] CONFIRMATORY TEST .................................. [] uT*/mm ----.—_.—.—_---.--_..--.-_--' �������y�:^����.^��.-��..����-��..�� {] /��omseuw.�,.�.^...'.��,-�,.�.....'�`�..�../ ' [] w/rnoosm. xusLoA*L .............................. [] *mwoAwsss ._-_-----.—....--.—.-_-.--...�.��� C] NITROGEN, NITRATE .................................. []MERCURY -_--'-------.-_--._-._--_---.-~, [] NITROGEN, ORGANIC .................................. [] NICKEL ........................................................................ []ODOR .................................................. []PALLADIUM ............................................................... []ou& GREASE ...................... -'r................... []POTASSIUM ............................................................... []»* .......................................................... []RHODIUM .--...,--..-.-.-'_.-----_--.----~. [] PHENOL ...................................................... []SELENIUM ........................................ [] PHOSPHATE *"`»p> ------'~-^^-~'----'--^. []s/ucow - --.--.---.---.--_--..-.-----'�.--. []pHotrxArsuo"uo"�u)--''-----,'--_---.- []SILVER .----.------.—'------�----_---'��.^-- [] PHOSPHATE nuwU ...................................... [] SODIUM ....................................................................... [] SOLIDS. SETTLEABLE. mill- .......................... []T/w ..-.--_..--------'------.--^-.---'------^ [] SOLIDS. SUSPENDED ........... ........................ []ZINC --.---------..---'-.---'---~...-.-^..'^,^ [] SOLIDS, DISSOLVED .................................. r] ..................................... o ............................................. []youoS.ToTA L .......................................... []................................................................................... [] SOLIDS. VOLATILE .--.'--------'...-'... []nsmAnns ,-....'-.--_--.'--'-~,.---'-.----'...'-.. []Spsop/cCONDUCTANCE ..--.--'-.~..�..- ' O..................... 15 []SULFATE .................................................. [] .............. ��.! ........ ............................................ []suLp/bi ................................................... []................................................................................... �[] SULFITE ................................................... [] ,.----'.._'.'^---'.^.-.'~_,'_'.~^^-^,.'..~'^.'...~.^^^~,,. CJSURFACTANTS........................................... [] .................................................................... -~'..~~_. []TunB/o/T� . ............................................... [].............. /_,__^^__^^,_~,,.'.,_.,,-^,.~~_ _- `�~^~, ' ESC DCSOl3S INDICATE THAT zx1u wAzuu - WAS OF A SATISFACTORY SAwI^anx gwmLI/x WHEN IRC S����C �&S ���I�Z3�D_ - � THESE RESULTS INDICATE THAT THE WATER DID MEET TIM- SATISFACTORY C83MICAL' QUALITY. OF NEW YORK STATE ADMINISTRATIVE RULES &'RECUlATIONS^ DRINK% C WPTER STANDARDS (PART 72) FOR THE PARAMETERS TESTED. . ' � :Town; 4=0001111111W ev Not f cation Reiltii!�.d--� �F,6pirate sewerage System an To be constructed,by vsi abov& described: will be constructedjj7 shown bin'the a pp-rove�,a mend miiift hdri. td and in accordanUt with thp� itpndarqs. rules and r� Putnam el' so - tisfktory to he nor of. Health will e submitted- to.,t-h�beparim'ent,.,,,a,n"-d- -a, -wr it ten, guarantee w I I'l ju'rn ished I th-o buildarjAhat 4aid builder will ..,ancd.iof"the,';60,iord�bl,.of ihe -Ce-rtifii:at6---,6f,.;,",b���t,-iliictio�: -,,the original, system 2) that -the d6icilbe-d! abo've. Debi Title = KI PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Re: Property of Ralph Peterman Located at Cimarron Road (T) 58 -1 -6;2 Section . i i?:r�V�e+ =Y .R.:4 �.�..y�- n ^��j ^T'. a«MC'[Yi �-._:�sr'S..rt .1 .. L.w H+- i•. - -'� Date February 11 A Block p►�-T� D. Subdivision of Velcol Inc,' Subdv. Lot # 1 Filed Map # Oentlemen- 1769 This letter is to authorize Joel Greenberg a duly licensed professional-engineer or registered architect XX (Indicate to apply fora Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations as promulagated by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise thle construction of said system or systems iri conformity wi'�tli -the' provisions . oI: 'Article -i4'5 6Y 147, Education La blic Health Law, and the Putnam County Sani- �Ea 4Ro �\Gj REN C E Ayl �� 4V ov Ir tary Code. 11.0 T �'do ot1oCounters ° n • P NE P.E., R. # 11056 Muscoot North RFD# 2, Box 488 _ Address Mahopac, NY 10541 628 -6613 Telephone Very truly yours, Signed Owner of Property Oscawana Lake Road RD# 2-, Box 243 Address Putnam Valley, NY .10579 Town 526 -3125 Telephone 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. OS,AiUAuA t- pka Rop V Qwner R4Lf1j4r Address #Z . 3 T U LL ./057 Located at ( Street e,1M AV_V-DN Z- P. Sec. 53 Block 1 Lot �Tndicate neares cross street O L d N 01 JUT 4 ik atershed 4 1a_ bt_>_a_ i P—% Us.-C, SOIL PERCOLATION TEST DATA REQUI TO BE SUBMITTED WITH APPLICATIONS 0C 1983 )qj1 iVJEIl�AA "11 C0+gWCK TIME �j'1� PERCOLATION PERCOLATION Of-At Tai K I apse 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 f7'r al 8 ;3o- ,fo 3o l (,0 17 17.5 16, 7 17.7 1-7.5- ° 1,70 1'? 39; A-0 - /0; 20 AD m"o I -7I ? �0 (-ri'` 1q 4 2 B: 20/ !7- le5 16, 17.7 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 SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO._ HOLE NO. PTh HOLE NO. r+� . Y... .- ... ryz i `.. '� _-c� � vaa��a� �v; +..v c3 :�C.o'. i-"'.°r'a✓r.Fni� w sS. - ..Y...f . c� v - .5....•xZY. t.: x : ®- !+t '.�'a � i 1 3:-af+r -': � :e 12" 2411 3011 3611 4211 4811 54 6011 6611 72 fl 7811 8411 INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED m 2�`d d` I. _ it INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED 2. �' TESTS MADE BY Jb °' Date -DE GIN Soil Rate Used Min,%1 "Drop: S. D.- Usable Area Provided Nos of Bedrooms Septic Tank Capacity / 00(C) Gals. e ..E S-- Absorption Area Provided =y L.,F.x2 `—`b"— it ch. Address Joel Greenberg- Architect Muscoot No. /RFD R2 /Bx 488 Mahopac, NY 10541 THIS SPACE FOR USE BY HEALTH DEPART14ENT ONLY: o Soil Rate Approved Sq. Ft /Gal. Checked by Date t4" a j � d 5,7" - : Mv Ce Q v i �►w G, 001 I5 4' okti d G N Z f f h k= I zzz 9az Owl t RnIIAM •• (WY DEPMDOIT • HEAL111 I DIVISION • ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET-SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner Address.";?�VZ-a*""*"/"-/—,//�e--,* Located at (Street) AICIIZ9 Sec. 7>- Block o,/ Lot (indicate nearest cross street) Municipality Watershed SOIL PERCOLATION TEST DATA RBWIRED TO BE SUBMITTED WITH APPLICATIONS Date of Pre-Soaking Date of Percolation Test HOLE NUMBER 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 Indies 211 7 2Zal 112- 2— 7 3/ J17 4 3; 2- 4 5 1 2 3 4 5 NOTES: 1. Tests to be repeated are obtained at each for review. 2. Depth measurements tc rev. 9/85 at same depth until approximately equal soil rates percolation test hole. All data to'be submitted be made fran top of hole. TEST PIT DATA REQUIRED TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOUS EMOUNTERED IN TEST HOLES, laVi`�,L,IJ: G.L. 1' 21 5CW4 31 'u 41 5° 6' 7' 8' 9' 10' 11° 12' 13' 140 INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED A`a,p`e- INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: �+ �/ 1l'�/1:� DATE: - DESIGN -- Soil Rate Used f 2- Min /1`° Drop: S.D. Usable Area Provided©�� . + W. I STA MMNMA..��� Septic Tank Capacity Absorption Area Provided By Other 3 A er'rh -IS 37-5-- Name Address I /ak1w, THIS SPACE FOR USE BY HEALTH Soil Rate Approved L.F. x 24" width trench gals. Type Signature ! of fw ONLY: sq.ft /gal. Checked by Date s Vii. C0 1, MAI Jns - v- T "tap > Q —j. - — . . . . . . . . . . . Alto ri so! reo E LkWv, - - - - - - - - - - TRY A v MAI Jns mo 1 Aq—..z lY: vo 07 A 42 IMMA now so, Q yu "jai 1 T "tap > Q —j. - — . . . . . . . . . . . Alto ri so! reo E LkWv, - - - - - - - - - - TRY A v