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SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
Albeiro Jimenez
PO Box 249
Patterson, New York 12563
Dear Mr. Jimenez:
DEPARTMENT OF HEALTH
I Geneva Road, Brewster, New York 10509
April 13, 2006
ROBERT J. BONDI
County Executive
ROBERT MORRIS, PE
Director of Environmental Health
Re: Addition — Jimenez
No Increase in Number of Bedrooms
294 Route 292
(T) Patterson, TM# 3.4-48
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 April 12, 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.
2. The area of the existing sewage disposal system and its expansion area, must be
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. This Department recommends you contact your local Building Department to ensure
setbacks and other current codes can be met.
5. This 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 Patterson.
If you have any questions, please contact me at (845) 278 -6130, ext. 2261.
Sincerely,
cz-
Gene D. Reed
Senior Engineering Aide
GDR:cj
cc: Building Inspector, (T) Patterson
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
PUTNAM COUNTY DEPARTMENT OF HEALTH
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3 BEDROOMS
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ALL SUBSEQUENT REVISION/ALTERATIONS TO THESE HOUSE
PLANS MUST BE SUBMITTED TO THE PCDOH FOR APPROVAL
1
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REAL PROPERTY CONSULTANTS
Dwelling
Albeiro Jimenez
„ SIGNATURE d TITLE
z,� I DATE
PLANS
294 Route 292
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CARMEL, NEW YORK 10512
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REAL PROPERTY CONSULTANTS
Dwelling
Albeiro Jimenez
498 HORSEPOUND ROAD
PLANS
294 Route 292
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CARMEL, NEW YORK 10512
Patterson, New York
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68 —48 - i0 E 171.32
28. _
N/9 -56 -43 E
r. ROUTE 292
Certified To
Michael Ryon
Peoples 'Westchester Savings Bank,
its successors and /or assigns
Chicago Title Ins. Co.
for policy No. 85 - 10- 492245
SURVEY PREPARED ,. FOR
MICHAEL RYAN
S1 TTATE IN
TOWN OF PAT TERSON
COUNTY OF PUTNAM STATE OF NEW YORK
SCALE I° = 50' JULY 14, 1,986
JAMES K. DEVINE
LAND SURVEYOR
4 CHAS. COLMAN BLVD.
PAWLING, NEW YORK
12564
75073 -bl
"Guarantees or Certifications Indicated hereon signify
that this survey was prepared in accordance with the
UNAUTHORIZED ALTI'N,TION OR ADDITION TO
existing Code Of Practice for Land Surveys adopted by
THIS SURVEY NAP IS A VIOLATION OF SECTION
the New York State Association Of Professional Land
7209 (9 OF TIIE OUX 10RILtl' MEOLIOATION
cum Yom. Said Parents" Or Certifications Shall run
�• - ii�%5s:
'nly to the person for whom the Whey 4 prepared.
� of 16I slash fat h1��fAa lad
nd on his behalf to the tide cmnpmly, governmental
~ IbIR an be ammo
:;ency and lending Institution listed beredn, and tc
b�� coM
.c assignees of the IelMing Instltutfon. Gu"Mees of
: ertifications are not transferable to additional insti.
tudons or subsequent owners."
'
SHERyLITA AMLER, MD, MS, FAAP
Commissioner of Health
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
ROBERT J. BONDI
County Executive
DEPARTMENT 'OF HEALTH
1 Geneva Road, Brewster, New York 10509
D
a 6b
ADDITION APPLICATION RESIDENTIAL ONLY
STREET 6 9.2 TOWN TAX MAP # -3r
NA "PHONE PCHD# -161-6
"MAILING v
ADDRESS X G)
DESCRIPTION OF
ADDITION ,�_47
NUMBER OF EXISTING BEDROOMS -3 PROPOSED # OF BEDROOMS O
(FROM CERT. OF OCCUPANCY OR CERTIFICATION FROM BUIL,DING.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,
Brewster, NY 10509, Phone: (845) 278 -6130.
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
�...
0
SHERLITA AMLER, MD, MS, FAAP
Commissioner of Health.
LORETTA MOLINARI, RN, MSN
Associate Commissioner of Health
DEPARTMENT OF HEALTH
Geneva Road, Brewster, New York 10509
Town Legal Bedroom Count
ROBERT J. BONDI
i
County Executive
Re: (Owner's Name)
T ap #:
Address:
Town: p
Year Built: %O
According to records maintained by the Town, the above noted dwelling,
is in compliance with Town Code.
is not in compliance with Town Cole.
The Legal Bedroom Count is:
This information has been obtained from:
Certificate of Occupancy:
Building Insfector Date
Environmental Health {845) 278 -6130 Fax (845) 278 -7921
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
N/F RYA N
As built distooces
ex�s�'nc�
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4
5
7
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Mar 31 06 U3:Ulp
To:
BU1LUINU Utri
U195LbUUUb
NOTICE TO INTERESTED PARTIES
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.. P. c
Please take notice that the undersigned has made application under the
"Freshwater Wetlands, Watercourses and Water Bodies Ordinance",
Chapter 144, of the Code of theTown of Putnam Valley, said* notice to
interested parties is required under Chapter 144-6 F of said Code.
TM 19.-2-17
Name PHTT.T.TPC
Address No # Route 301
DesCriptiOn Of pro]eCt r,oposed singles fam; l a rPri r pm-S, Cnn+. ++ thin
100'' buffer tore
blacktop) . Presently . bef re' . he Planning Board. A p, ��� fDate:
7
Name o p ent
S' re
00 .o 4d go
rY
r 'R v. 3i PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services, Carmel, N.Y. 10512
Engineer Must Provide P -12 ^83
P.C.H.D. Penmit # CEROF CONSTRUCTION COMPLIANCE FOR SEWAGE DISPOSAL SYSTEM Patterson
�ted at Route 292
.;Owner /applicant Name Michael Ryan Formerly
Mpg A.], Lakeview Drive #8 zip 10541
Town or V e
T" Map 1 Block Lot 19
Subdivision Name N/A Subdv. Lot # N/A
Date Permit Issued 11/29/84
ae Mahopac, NY
Separate Sewerage System built by M & H Custom Homes, Inc. Address East Branch Road, Patterson
Consisting of Gallon Septic Tank and 300 LF x 21 wide trench
Water Supply. Public Supply From Address
or: X Private Supply Drilled by Boyd Artesian Wel dr.. RD 5 Route 52 Carmel
Building Type 1 Family Res . Has Erosion Control Been Completed? Yes
Number of Bedrooms 3 Has Garbage Grinder Been Installed? No
Other Requirements
.';I certify that the system(s) as listed serving the above premises were constructed essentially as shown on the plans of the completed-work.( copies
of which are attached), and in accordance with the standards, rules and regulations, in accordance with the fided plan, and the permit issued by the
,Putnam County De_ pnrtme t of Health. v
Oats y'1F �A(�wJ(`� Certified by P. 11 R.A.
—�
Addre Cashin Associates P.C. Rt 2 Carmel NY 10512Icense No:2600. &I,
ss
Any person occupying premises served by the above systems) shall promptly take such action as may be necessary to secure the correction of any unsanitary
conditions resulting from such usage. Approval of the separate sewerage system shall become hull•and void as soon as a pubt': sanitary rawer ,becomes
available and the approval of the private water supply shall become null and void when a public supply becomes available. Such approvals are
subieet to modifiutfon, or change when, in the judgment of the Commissioner .6 Health, ch r ton, modiflut ►on or change Is necessary.
.Date ��r, / _ / 6 l y Title = LAS
Owner or Purc4aser of Building.
Building Constructed by
Location - Street
Municipality
Building Type
Pu � e�'Soo
Section
Block
z
Lot
19
Subdivision Name
Subdv. Lot #
GUARANTEE 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 guarantee to the owner, his success -
ors, 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 system.
The undersigned further agrees to accept as conclusive the determin-
ation of the Director of the Division of Environmental Health Services
of.the'Putnam County Department of Health as to whether or not the fail-
ure of the system to operate was caused by the willful or negligent act
of the occupant of the building utilizing the system.
Dated this day of 9--4 Signature
Title
Corporation Name if corp.
Address
p � L -1
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
�e
yf
PUTNAM COUNTY DEPARZMM OF HEALTH
DIVISION OF ENVIRONMENTAL HEALTH SERVICES
•c -�,9� 2 art/
Owner or Purchaser of Building
Building Constructed by
2,
Location - Street
//-9,Ted f o i✓
Municipality
Building Type
Section Block Lot
Subdivision Name
Subdivision Lot #
/7
GUARM= 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 inmed.iately following the date of approval of the
"Certificate of Construction Compliance" for 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 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 q_ day. of flldei L 19 E 7
2n"d-ri�y— 2 4-:�
General Contract (Owner) - Signature
�%
Corporation Name (if Corp.)
1 /-0 A c 7 � �.
Address D
d`9fJ// C> !,j C N-X �oJ- (j/
rev. 9/85
mk
Signature /Y�c
Title D C., 67e
Corporation Name (if Corp.)
Address
GENERAL BACTERIA _' .
"
A,
Standard Plate
Count. per .1 -.O. ml.
(Agar plate @
35 °C)
MEMBRANE FILTRATION
TECHNIQUE (MFT)
Total Coliform
ner 100. ml_
Fecal Coliform
per 100 ml
Fecal Streptococcus
per 100 ml
MOST
PROBABLE NUMBER
TECHNIQUE (MPN)
Total Coliform:
MPN Index ner 100 ml
Fecal Coliform:
MPN Index per 100 ml
OTHER ANALYSES
THESE RESULTS INDICATE THAT THE WATER SAMPLE WA (WAS NOT) (NOT APPLICABLE).
OF A SATISFACTORY SANITARY QUALITY ACCORDING TO,THE.NEW:YORK STATE DRINKING
WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION.
Albert H. Padovani, M.T. (ASCP), Director
LEGEND
RDS = Recommend Disinfect -
ing Water Source
< = less than
TNTC = Too Numerous Too.
Count
WALL ; COMPLETION REPORT PUTNAM COUNTY DEPARTMENT OF 1HEA1
Division of Environinenal Health Swvlm
COUNTY OFFICE BUILDING • CARMEL, NEW YC
nTs—rip—or, _1s`t0-y9'6IRM-PrAM1VWe9 druek-and suti_mhted to County Health Departritent together with laboratory report of
analysis of water Semple indicating wow Is of Satisfactory bacterial quality before certificate of construction compliance is Issued.
REPORT MUST BE SUBMITTED WITHIN 30 DAYS OF WELL COMPLETION
OWN ER!
NAME Hal Barr tt
M & H Custom Romes
ADDRESS
Deacon Smith Hill Rd. Holmes, N.Y...'l:
LOCATION
or WELL
(No• I strool—) own (Lot JVI
Rt. 292 Patterson
PROPOSED
use of
WELL
BUSINESS
FK1DOM1S"C ❑ ESTABL13NMEW TEST Will
PUBLIC All
SUPPLY ❑ INDUSTRIAL ❑ CONDITIONING ❑ (speciOTHER fy)
DRILLING
saUIPMENT
COMPRESSED CABLE OTHER
❑ NOTARY All PERCUSSION ❑ PERCUSSION ❑ (Specify)
CASING
DETAILS
LENGTH (feel)
41
VIAMETEI(Inch")
WEIGHT PER 11001 -
19 FLI THREADED 13 vwaftDr7
M%'E SMCt--
LXJm NO
ff" CA31NO WWUIZU'r
L&J YES NO
Yino
TEST
HOUR P A
EIIII ❑ PUMPED COMPRESSED AIR* 6
YIELD (G.PW
15
WATER
LEVEL
MEASURE FROM LAND SURFACE—STATIC(Spectly
28
DURING YIELD TEST It"t)
205
Dopih of Complaw well
In lost below Land surfow 205
SCREEN
DETAILS
MAKE
LENGTH OPEN TO loulpek P
SLOT gill
DIAMETER rem
IP GRAVEL
PACKM
Dle"ter of won I
gravel pack (Ine"Int I
OR VEL SIZE (IRI FROM ff"fl TO
I I
01"" PROM LAND WWACI
FORMATION DESCRIPTION
skomb OMNI fteaft" of wall with d1fraft". to of Meet
two permanent londmarks.
FEET to 1911T
0
25
Overburden
003 Ar-16slati WWI _C,_d7,F,j.
R. D. 5 -Route 52
25
205
Grey gneiss & quartz.
It yield was tested at different depths during drilling. 110 below
FEET
GALLONS PER MINUTE
DATE WILL COMPLETED
6-5-86'..
EPORT IWELL DRILLER (Signature)
9117—Te .. .
. v
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..:'P�.�'•ei� .�?�- 5..'" "'._.'s:.�'_+���"'�- '�'*�'`�' r'- �, :.N �L' "�" -a. -• . .-a �K�..s� �c.r.5-"'��,�> •�.w,y, � -�,,-}gig
i.•:... . ��ti'r� .�. �. � .-J•.w .t. W M ..F,•'!?T T a 'V .rY.. e�_ .+.� rr[.
PUTNAM COUNTY DEPARUIERT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES `.
INDIVIDUAL WATER SUPPLY SUBSURFACE SEWAGE DISPOSAL SYSTEMS .
FIELLI INSPECTION REPORT
r1L tti °`n DATE:
T21'
INSP. BY:
(Name Owner) (Street Location)
INITIAL SITE INSPECTION YES NO CIONA�TS
Wetlands on /or proximate to property........
Property.lines or corners found....... •'•� _ _
Can estimate house location... ... _....... ...
Will driveway need cut ............................
Must trees be removed - note these...:.............
Deep holes representative of entire SDS area......
Additional deep holes needed ................... ..
Sufficient SDS area available considering driveway
cut, house location, separation distances,ete...
Adjacent wells /septics............................
Artac-, to nrnnosed we-11 location for drillina.....
D. H. 1 Lot
Depth to G.W.
Depth to rock
Soil Descri tior
0 ft.
3 ft.
6 ft.
9 ft.1
12 ft.
-D.H. 2 Lot
Depth to G.W.
Depth to rock
- 0 ft.
u.n. -' Lu=Y rvl(--
G.W. - Groundwater.
D.H.'3 Lot
Depth to G.W..
Depth to rock
0 ft.
Soil Descri•
DATE:
FINAL SITE INSPECTION INSP.BY:
House SSDS located per approved plan ...........:.
Length of trench measured 3 b o '
Width of trench average I-
Slope of tile line and trench acceptable.........
Roan allowed for expansion trenches ..............
Over 100 ft. fran watercourse ....................
Natural soil not stripped or SDS area
unnecessarlygraded.............................
10 ft. maintained fran property line and
20 ft. fran house .. • ......
Distance well to SSDS (ft.) ....... S�.11........... .
Number of bedrooms checks .............. .........
Stones, brush, stumps, rubble, etc., greater
than 15 ft. fran nearest trench ................
15 ft. of peripheral soil horizontally
fromtrench ..... ......... .I...... :..............
Boxes properly set ...............................
Could surface runoff fran driveway, roads,.
ground surface, etc., channel near SDS area....
Does lot drainage. appear OK in area of SDS.......
YES NO CCMMEN'TS
-Cj ?Z.
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.
Owner {_
"_y qEL_ lk>,JAN
Address "kc VAZLJ 7`Qa.
P-P 1*8 e M
A90 i o 541
Located
at (Street �7-g. 919:L
�'
Sec: Block 2 Lot-t9
Indicate neares cross street)
Municipality
Watershed
L° CzoTo eJ
1
SOIL
PERCOLATION TEST DATA
REQUIRED TO BE SUBMITTED WITH APPLICATIONS
2
i i o8 -
-tz:z6
l 8--
Tole
Number
CLOCK TIME
PERCOLATIONT
PERCOLATION
Run
Eiapse.
Depth to Water
water LFve
1 :. 18y a
No.
Time
From Ground Surface.in
Inches
Soil Rate
Start -Stop Min:
Start - Stop ...Drop-in.
_
Min. /in drop
l
9
Inches Inches
Inches
1
f1:49- p.: o4 15
19"
���
SZ!
3
12: z I -) z: 39
_ n
�2 y
3
6 t
4 ti j a i "- l a" <9 I g,,.,.�
1-1, as
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.
5
1:01 —
1 :.2
1
tt: 55-
IA: 07
1
2
i i o8 -
-tz:z6
l 8--
5
1. �o -
1 :31
1 :. 18y a
�., -7A
l
2
_
l
9
-�
5
DEPT, O� 1JEAL T H
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. HOLE NO..
G.L.
6"
12-11 =. -
1811 ,
2411
3611 _
4211
4811 LOAD
54
.6611 .. ... .... .. ....... .
INDICATE LEVEL AT WHICH GROUND WATER IS ENCOUNTERED
INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED 4_. tq.._ga
TESTS MADE BYCT> Date 5 -31- 83
DESIGN
Soil Rate Used (,-i Min/l "Drop: S.D. Usable vided �� r
S �U A L E�y4i` c
No. of Bedrooms Septic Tank Capacity �-o-a �° `�. C Ayy e AsowR L_
Absorption Area Pro ded By., o-o L.F -x24" W tre c
er
ame astciw Assoc-;AT-m igna u
Address. FA — 5 S 0 Vo• 2
C ICvN EL.. T COS { 2� F rHE S7 i''y •
THIS .SPACE FOR USE BY HEALTH DEPARTMENT ONLY:
Soil Rate Approved Sq. Ft /Cal Checked by Date
As bwlt distances
2
3.
4
5
6
7,:.8.
9
I0
A
25"
48y2`
541,
61"
44y;
51
57
:93�
97"
100'
B
3d
31/2
36�z
43
73
76"
N/f RYA N .
'48'
55'
c
>
ibw
200.00,
Y
z' AREA= 1..351 ^ acres
QO
W
LKII,
stpnewn II we /
z
.
N/ f RYAN
-
N / -'F CASE Y
_ ro'gcp
'
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VA
., ?IN
9
�_�+
ell
lit � �
5 10
1 •. � 7
boX
N
�, •
S.
W
V: � � p (ryP.�
M � � exl5fin
Pasea -
tn
100. •-
d; �1,.`
f
Ax
.
.- NO3-,48-30E r
.¢� - _171.32. ♦
,j
RourE 292
s ..
.S•
i ..
As bwlt distances
2
3.
4
5
6
7,:.8.
9
I0
A
25"
48y2`
541,
61"
44y;
51
57
:93�
97"
100'
B
3d
31/2
36�z
43
73
76"
79"
'48'
55'
S7%