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HomeMy WebLinkAbout0637DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 23. -2 -69 BOX 7 rs L I�� I L IL r 00637 r' r., PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CERTIFICATE OF CONSTRUCTION OMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCHD CONSTRUCTION PERMIT #­ 4:-2y - Located at A0k1D&-iPZ5'Ab2 /41 IZO14 -D Town or Village Dove, by Owner/Applicant Name C7&054,- (O15TXyG7-1,01V Tax Map Block 2- Lot —�- Formerly C %'&)s PAM Subdivision Name Subd. Lot # Z%/ Mailing Address P 0 6 6 X J S V M D 06 A-W Date Construction Permit Issued by PCHD Zip 105q-7 Separate Sewerage System built by Address "W i: Consisting of 12-50 Gallon Septic Tank and ��� 2�TZgmLe i 3 Z�r' 90,6 aLz­ � 410:s-Z� Yes Other Requirements: Water Supply: Public Supply From, Address or: X Private Supply Drilled by 70 P,L - /SH- Address AXA1 dk jC . NY Building Type 4)OOJ) /��, Has erosion control been completed? Number of Bedrooms J Has garbage grinder been installed? _ ND I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulatio s of a Pu County De artment of Health. Date: Certified by P.E. & R.A. .(Design Professional) Address 33.T SUS /T-144-A) �2I&W Y, ZSb3 License # 532%7 Any person occupying premises served by the above system(s) 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 sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revocat catiolu or change is necessary. By: ��� ��� Title: 0MC Date: 3 LV White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CC -97 ` ~ ' YML ' ENVIRONMENTAL SERVICES ' ` . 321 Kear Street Yorktown Heights, N.Y. 10598 ' (914) 245-28A0 Albert H~ F\aduyani , Qrector LAB to 93"015741 CLIENT #: 8641 NON,STAT PROC PAGE ' 1 - ~~~~~~~~~~~~~~~~~~~~~=~~~~~=~~~~~~~=~�� WALLACE, DOUGLAS /�c DATE/TIME TAKEN�� 02 �/98 10:�3VA P.O. BOX 154 DATE/TIME-RECD: 02/26/98 12130P MOHEGAN LAKE, NY 10547 REPORT DATE: 03/12/98 , . PHONQ (914)-734"1187 ' 'SAMPLING SITE: LOT #4 LITTLE P � HILL ESTAT�� SAMPLE TYPE. . : POTABLE ` ^ � �ATTE�S[}N N � , M. ,�"' '.'` ` � PR�SERV =�'. ` ` ~, - �� ' � '�.`'�,_-�� ~NO�� � . COL ' D BY: DOUGLAS WALLACE L TEMPERATURE~'.: < 4C NOTES... : KITCHEN TAP ' CQLIFORM METH: -------------- 7-Y -~~~~~~~~~-~~~~~~~�~ IF DATE FLAG` PROCEDURE ` ` ` RESULT NORMAL ~ RANGE METHOD � FUTNAM CNTY PROFILE ' ' 02/06/9S MF T. COLIFORM 4SENT /100 ML APSENT 1008 02/26/98 LEAD (IMS> <1 pPb 0-15 ppb ' 12S45 -. 62/26/98 NITRATE WITROG 0.47 MG/L 0_ 9139 /26/98 NITRITE NTTROG <801 MG/L N/A � 9146 ' 02/26/98 IRON (Fe) <0.060 MG/L 0-0.3 mg/l, 2037 /26/98 MANGANESE ��n) 0.320 MG/L 0-0.S[mg/I � 2837 _ 02/26/98 SODIUM (Na) 24.6 ' MG/L N/A 08/26/98 H . 7.2 UNITS 6 .5-t�.5 90*3 / , 02/26/98 MARDNESS,TOTAL 140 MGlL N/A / 02/26/98 ALKALINITY (AS 1O6 MG/L N/A _ 02/26/98 TURBIDITY (TUR <1 NTU 075 NTU ` -. COMM�WTS: ` '^ BACT THESE RESULTS INDICATE THAT THE WATE7jjj;jj3 WAS NOT) OF A ` SATISFACTORY SANITARY QUALITY .ACCOR0 THE NEW YORK STATE .� ~ AND EPA, FEDERAL DRINKING WA 'ER STANDARDS, `FQR THE PARAMETERS � TESTEDv AT THE TIME OF COLLECTION. ' - Pb/Cu LEAD limits for public schools are set at 15 ppb. ' ' ~ EPA Lead & Copper Rule for Public Systems requires that no more than 10% of their distribotipn points have a LEAD value of more . than 15 ppb and a COPPER value of 1'3 mg/L, else water treatment must be undeitaken to reduce the waters corrosive ' potential. Fe/Mn If both iron and Manganese are l uxm present, their e r tot � value . combined shaIl wt exceed 0,5 mg/L., _ Na No limits for Sodium are Proscr ibed . S `ggested guidelines state that for people on a pndium' reatf icted diet, the water should. ' contain no more than 20 mg/L of Sodium. For those on a Moderately restricted diet, a maximum of 270 mg/L of Sodium ' ' is suggested~ ' � | ` YNL ENVIRONMENTAL SERVICES ��1 Kear Str�e� Yorktown Heights, N.Y. 100% ' (914) 245-2800 � Albert H. Padovanij Director - ' LAB #x 93~015741 CLIENT #: 8641 NON STAT PRdO PAGE 2 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ - WALLACE, DOUGLAS DATE/TIME TAKE@: 02/26/98 10:30A P.O. BOX 154 DATE/TIME REC'D: 02/26/98 12:30P MOHEGAN LAKE, NY 10547 REPORT DATEx 0302/98 PHONE: (914)-734-1187 ` SAMPLING SITE: LOT 44 LITTLE POND HILL ESTATES SAMPLE TYPE..t POTABLE � ` pATTERgON� ~ ~ COL'D ON DOUGLAS WALLACE , TEMPERATURE..: < 4C NOTES...z KITCHEN TAP ' ` COLIFORM METH: MF ~~~~~~~~~°°~~~~~°~°~~~~~~ ~~~=~~~~~~~~~~~°~~~~~~~~~~~~�~~~~~~~~~~ ATE FLAG PROCEDURE RESULT. NORMAL - .RANGE METHOD ` . � � � SUBMITTED BY A i Ibb � *vrlil P a d o v a A i m r A S C P Direc�or � ELAP# 10323 PUTNAM COUNTY DEPARTMENT OF HEAL'T'H DIVISION OF ENVIRONMENTAL, HEALTH SERVICES WELL COMPLE'T'ION REPORT 1101- Well Location Street Address�Ilztj L�` '� Town/Village: _ /�, •• N Tax Grid # Map, Block Lot(s) Well Owner: Name: Address:/ Use of Well: -- prima 2- secondary Residential Business Industrial Public Supply Air cond/heat pump Irrigation Farm Test/monitoring Other(specify) Institutional Standby Drilling Equipment Rotary Cable percussion—'_1 Compressed air percussion Other (specify) Well Type Screened Open end casing--!!t,,L Open hole in bedrock _ Other Casing Details Total length ft. Length below grade Diameter in. Weight per foot �lb /ft. Materialg!'-� Steel — Plastic _ Other Joints: _ WeldecT-I Threaded _ Other Seams_ Cement grout — Bentonite _ Other Drive shoe. Yes _ No Liner:_ Yes _ No Screen Details. Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First _Yes No Hours Second Well Yield Test Depth Data _Bailed _ PumpeZti 3 Compressed Air Measure from land surface - static Zspecify ft) During yi ld test(ft) Hour Yield /9 gpm s Depth of completed we Il in feet Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface A I Alv e cod • it .I11 i -c o '• aidl~ �law If yield was tested at different depths during drilling, list: Date Well ComT;,—TPunam /: �/ Feet Gallons Per Minute Pump /Storage Tank Information Pump Type Capacity Depth Model Voltage HP Tank Type Volume County Certification No. Date f Report W Dri ler (signature) / / �� -- f I NOTE: Enact location of well with distances to at least two permanent landmarks to oe provided un a Scpaia­ S„-C-131al Well Driller's#ne rfs '� ! Signature: a-,-Z' Address: L�7' AV6_ �- Date: / Wftz White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM Owner 61 Purchaser of Build4ng Occ4 /as Ma11GcP /l -2VoIAse BuildidgQQConstructed by / / alch 90C Location - Street Building Type a3 �y Tax Map Block Lot Pe, 41evs 6 h TownNillage Subdivision Name Lo f y Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is 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 "Certificate of Construction Compliance" for the sewage treatment 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 Public Health Director 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: Monsh `3 Day lL_ Year / % General rontr or (Owner) - Signature ce Corporation Name (if corporation) Address: ,0. AO X l 90 A er. 0 State �i C �U(� V Zip 1� Signature---y 1 � ( 6014 s1 'I rOC_ Corporation Name (if corporation) Address: ,V, b 5. State pZip,5-� FormGS -97 }: f k . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES C NSTIt1U TION PERMIT FOR SEWAGE TREATMENT SYSTEM PE # Located at �� /1 �(`'S��(3Gti(��E'✓,'! ���'1�,CJ Town or Village Subdivision name I/ f 641,10 IhI (,Subd. Lot # Tax Map Block 2-- Lot Date Subdivision Approved / , • % rruJ Renewal Revision Owner/Applicant ant Name tit 0,1 ( J ' e of Previous Approval Mailing Address Amount of Fee Enclosed ml,-tl A Zip f6�- Building Type �(� C) >7 I'U lil 041 Lot Area �) No. of Bedrooms Design Flow GPD 0Z) Fall Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL. IS COMPLETED Separate Sewerage System to consist of 2--S--Q gallon septic tank and Other Requirements: a To be constructed by C/ Address Water Supp.11: Public Supply From Address or: Private Supply Drilled by Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs thereto. Signed: Address R.A. Date eU 2- License # -�-3 2- APPROVED FOR CONSTRUCTION: This approval expit`es two years from the date issued unless construction of the sewage treatment system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires anew permit. Approve r di are of domestic sanitary sewage only. Byt-` Title: ��C �� Date: 1 al White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design rofes ' Fo Form CP -97 p�+v�.. -.�m!� •.�'- ,.wry e.+,«- - ,;;•,.,..- --- ?G.+.>- .«'ten..,.,.._... ,.�sr oa`x- 'p,�nRCC:r,r- ssv.�...u- m^*�s-° .- �-^�^- 'U `�° ,�p�4pq ' ^ . •r .' ®1ffi®TMPAHffi 12 pVyM6q 03 s ® 6 A'` OF m SWAM- K � V � Name t ' a T.= Owm/Aff A 66 - 3-30.. a /r9� Date Subdivision. Approved' �,� Fee. Enclosed. Amrnmt Qgat _ Ana _ valtt � Mambw Homes G P A Iro �a9 WD H+9ll Bo comiliew � p� Saramb �W�a �. 1 @�{WtlaT Z Ton Was? i " . .•..ICF"S- .... - r .. .. '. -v 'W ` 4' of ..: Ylfif�$ 1 ropraant ":that Y em wholly and compliptely r6sp6nfib16,4(w tha dasiq l and k►celUOn tq"i AwV$y lnt l') that the` saparate.'sewage 6ispowl. stem aiwv0 dascriQlo<o will t►o txrlstructd as shown on Elie aDprov®d amandmen4 th®ro t�, ie std rdance vvifh thQ stdiridards, ►ulei a ragu Olif nam ,.. County DopartrricOlt o0 HE^®Itil, 011 that on eOmplatiof� tliavaOP a "Corti4iento bo .submittm0 to the .Depagtn ant, algid o t rktt®n ®uaia ntoa will 00 !urnishod 00 stsuctcon: Crompllbi •, s4tistaetory to the l:ommia8lon®r ti4 Health Wi11 hid &ieeOSSgf ;.'h ®i►tl or a ipns ®y'tho ®udder flat Said, OSUildor will plat ®. in goad op rating eoaiislition any part oP'said ego disposal system tAa perio6 of tWO (2) yiaars I ilrrladietoly follDVUillg tlta;Aato of �th0 I�tl- ans0 of the appro ial,of'tho eertifitifto of Construction :compliance oP tho sy 81�tor onyx repairs thia�a$oa 2) thaat the'drilld woll,desoiibod e6ove a n oN:40W' ©pprovod plan an® thaVfakl; wall mill bo (natal,' r nco 'with; Elie u a ns ot: 'tho ,Putnam cows iw .• ", 1, 70 � x,� ..'oP Omtm� /J7 �S9A�N II {{S/// L... VV." •Addraffi �. _ an40 i40 '. _'. APPROVED FOR COfdSTBiUCT10We This app!or!,!uR�rRS'Z77,-77 oays Pvom tale date issul , , nl rr� 1o#njw.rudion of the building .hai been undertaken and is �! m� revocable for cause or may. Do anandod or modified whan eonsid6ved n�as s s' cor: Pm ner of Health. Any change or alteration of Construction requires now parmit. A uad —t %0► . ®ig9pOOa1 04 oElit i' 61taiy eawag , a�oi . ator supply only. /88 'to By Q _ Title y -t. PUTNAM COUNTY DEPARTMENT - Off' HEALTH DIVISION OF ENVIRONMENTAL HEALTH..SE,RN7'ICES LETTER OF AUTHORIZATION RE: Property of Z)Q U!5 L-A-S' GV4-L1,-A-C4--' (�9OU-54-- C0A)S77V,'Uc770N Located at VIS-rA TN 124r7r=7,'SdPJ /-)Tax Map 4i Block Subdivision of L-177-L& 100AI-D 14-IL 1 Subdivision Lot Filed Man = Date Filed Gentlerntn: 7-6 HIV I h i s 11 e r rL ez 1 S rc) au h or i ze adul - 1, --OG wastewatler z�a=,-'-ntt to se-..-e the al0ove-no-u-d ac--omlanc-- hes=ndard;z,ral-, or -t-gulatiorns as prommi2 C, P-1th -,`the Pu-ma-mn Publi. I or otr r1z;-qar': oarers On T %az:men- I La 'a 11.cu-nr, Heal and all cons-,r-,ction i5al.d. ent anid;or --vat-r ot A--ticlit- 1 5 a�-,d'o- '' o and the Putna-m Count: Sanitary Ccxle. I LA ounters wee - A e d: ?r - 2--7 5:3 -7 -7 Mailinz Address dUj'14~ Ll /0,47 S c-1 /V State, /'Q Y zip, '14,56 3 7H4 �ftl State /V Z'- 106i.--), y- - Lid t q/c/— ,F7 , 7d LA 97 -�j t"Al 06 411 - - - - - ._ .- -- - - - . _ -. - -- - .,- - - --- I - v A -1 -k-L DIVISION OF ENWIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSLW--kCE SENV-kGE TREATMENT SYSTEINI Owner DOU(t+�!� j d 2 A�j &e & address (7'P-OUS-i--- CONS)-9LJC77-014 Tax . Man AJY 10 911-v- Located g7 (Street) C Block. -Z Lot (af P—g (indicate nearest cross street) AO#40 llylunicipalir� Ph -i-7E X56AI r7) Dramage Basil? ������ SOIL PERCOLATION TEST DATA Date ot"Pre-soakina Date of Percolati()r, Test L_- 1 V' AfV Deuth to Water 'Water GV V, rrom Ground L Ye e I I Percoladoz Time e Ela Ti=a Surface (Inches) Drou In Rate 1. , F01e N 0. -Run No. 4, t a r-, S top n." -`--rarT Stop en Incises Mia;lnch 4 A 4 4D� 1A I Z 1 V' AfV 5 s ame d e p i � un :L: i n-, e: e q 11 P- ;--,,,'on ra-es are oin-'rlc` atezl: h r. Al ..St j n f'-, 7 CAI) is 0, submined for review. 2. Depth rncasuremen?-s to be Made from tor, of-hoie. For. DD:97 'Al GV V, OY V. i I t i �I � t � I 4 5 s ame d e p i � un :L: i n-, e: e q 11 P- ;--,,,'on ra-es are oin-'rlc` atezl: h r. Al ..St j n f'-, 7 CAI) is 0, submined for review. 2. Depth rncasuremen?-s to be Made from tor, of-hoie. For. DD:97 TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED I TEST HOLES DEPTH 1 T Wei 2.01 4.0' 4.5' . v 5.01 J.G C1 , _ �J1 7 tit IO.G' HOLE NO.. HOLE NO. HOLE N10. indicate level at which ground,vater is encountered ©N� indicate level at which mottlins is observed No IVY Indicate level to which water i°Ye:: ses a°�er being encounters; eeo, hole observations made cv: i -j- Date JO/187 ''�esiar. P:otessional Narre: .J-71L PA, Address: Cv S#A-i,9 -c/ ,QoAO ! NEW �! 1 ! �'� ,rte .Q,ti•� , Signature: Design Professional's Seas`✓. ` �nS; t,�(,_�x,,�55�} .if ... : ': �..` - ..�7e•�+'•1 v ,r._.. ''!•;. 7.1? .+•s�8�"A. AIRK "ftN A=%_ . PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner Q j' W- � �5T Address u Ste. � • mac/. —.� Located at (Street) i// L OWPO 0 Tax Map L3 Block 2 Lot 4 STS 4d � (indicate nearest cross street) ,tom L�o7` Municipality _/.� - /7i% �T ,� Drainage Basin IyP/ lel'��.._. SOIL PERCOLATION TEST DATA Hole No. Run No. Time Start - Stop Ela se Time Min.) De th to Water From Ground Surface (Inches) Start Stop Water Level Drop In Inches Percolation Rate Min/Inch 1 3 b 3 Z- 2 � ?ia 3 � 'Z 7—. 3 2Qd Z�� V Z-2— Z- 4 ° d �,2 ZZ_ •Z 6 5 1 o I 30 Z.3 2 Z 3 Z. 3 U' (2,3f b Z 1 2.,6 4 Zt 2 -J 5 1 2 3 (✓� �,, 4 5 NOTES: 1. Tests to be repeated at same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s 1 min for 1 -30 min/inch, s 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD -97 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' TEST PTT DATA DESCRIPTION OF SOILS ENCOUNTERED LET TEST HOLES HOE XO. _�_ HOLE NO. ' v r��, /� HOLE NO. Indicate level at which groundwater is encountered Indicate level at which mottling is observed Indicate level to which water level rises after being encountered Deep hole observations made by: Date 2io` Desig Professional Name: Addr Signature: Design Professional's Seal CO w: �t 2 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT #` WELL LOCATION Street Address o illage City Tax Grid Number WELL OWNER Name Mailing Address QWrivate v O Public USE OF WELL G- fiSIDENTIAL 0 PUBLIC SUPPLY 0 AIR /COND /HEAT PUMP O ABANDONED 0- primary D BUSINESS 0 FARM 0 TEST /OBSERVATION 0 OTHER (specify, 2- secondary. D INDUSTRIAL b INSTITUTIONAL 0 STAND -BY O AMOUNT OF USE YIELD SOUGHT gpm /# PEOPLE. SERVED /EST. OF DAILY USAGE &pODgal REASON FOR 0 REPLACE EXISTING SUPPLY 0 TEST /OBSERVATION Q ADDITIONAL SUPPLY DRILLING m-NtW §UPPU DWELLING D DEEPEN EXISTING WELL DETAILED REASON FOR DRILLING WELL TYPE j FRILLED ODRIVEN []DUG OGRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES C, NO IF WELL.IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. A. WATER WELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES ciid0 NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH ,& SOURCES OF CONTAMINATION PROVIDED ` L7 �N SEPARATE SHEET E3 93 - (date) 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 otherwisercontaminate surface or groundwater. Date of Issue: Date of Expiration 19- -7� Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller APPENDIX 3 PUTNAM COUNTY DEPARTMENT OF HEALTH - DIVISION OF ENVIRONMENTAL HEALTH SERVICES INDIVIDUAL WATER SUPPLY & SUBSURFACE SEWAGE DISPOSAL SYSTEMS 4 . / REVIEW SHEET for CONSTRUCTIVIP ltm / fE OF OWNER �/ �, /SIR.EET LOCH ON L 5 9::;; DATE ZZ TAX MAP # 2 31 DQeVMENTS. PERMIT APPLICATION amZSESCHARGE (OK) PC -1 DEEP HOLES LOCATED WELL PERMIT P RESENTATIVE OF PRIMARY AND EXPANSION ENGINEERS AUTHORIZATION � ®/` -AREA; SHOWN; GRAVITY FLOW, SUFF.SIZE DESIGN DATA SHEET(DDS) m ID PIT & D BOX SHOWN &DETAILED Sg - NO.OF BEDROOMS DEEP HOLE LOG - nRO & SSDS'S W/I\i 1200 FT. OF PROPOSED SYSTEM CONSISTENT PERC RESULTS (3) ,� PERC HOLE DEPTH" METES &BOUNDS CORPORATE RESOLUTION OUSE SETBACK NECESSARY (TIGHT LOT) ! PLANS THREE SETS �-' OUSE SEWER - I/4"/FT. 4"0; TYPE PIPE HOUSE PLANS - T"R%®S�TS © NO BENDS; MAX. BENDS 45 W /CLEANOUI' VARIANCE REQUEST _ ; FILL SYSTEMS CLA✓YARRIER GENERAL Ca10 FT>HORIZONTAL: SLOPE 3:1 TO GRADE LEGAL SUBDIVISION � L SPECS SUBDIVISION APPROV CHECKED_ �_ GAUGES PERC RATE � '° FILL REQUIRED +.� ,� ESL PROFILE & DIMENSIONS CURTAIN DRAIN REQUIRED S 4A WES VOLUME TRENCH EX- APPROVAL SSDS ADJ.. LOTS M CH PROVIDED WETLAND (TOWN/DEC PERMIT R & D) �' ~ 60 FT MAX DATA ON DDS PLANS &PERMIT SAID` ED CAI i EL TO CONTOURS PRE- 1969 -NEIGHBOR NO CATION � 100% EXPANSION PROVIDED LETTER BMA SEPARATION DISTANCES SPECIFIED ON PLAN 100 YR. FLOOD ELEVATION FIE IUIRED DETAILS ON PLANS p,I DRIVEWAY, LARGE TREES, TOP OF FILL SEWAGE SYSTEM PLAN - (NO 0' - FOUNDATION WALLS uMb SSDS HYDRAUL OFILE GRAVITY FLOW 0 TO WELL, 200' IN D.L.O.D., 150' PITS D/ J BOX NCH(GALLEY l p_ ETAILS TO STREAM WATERCOURSE LAKE (INC.EXPAN) SEPTIC TANK - SIZE DETAIL ' y- `" O CATCH BASIN, 35' STORMDRAItiT, PIPED WATER WELL DETAII, SERVICE I.L�1E IF OVER 10' TO WATER LINE (FITS -20') CONSTRUCTION NOTES (GRINDER RATE) DRAINAGE COURSE DESIGN DATA: PERC AND DEEP RESULTS 20 . RESERVOIR, ETC.m 150 FT. GALLEY SYSTEMS TWO -FOOT CONTOURS EXISTING & PROPOSF,j�� SEPTIC TANKS DRIVEWAY &SLOPES CUT 10' M FOUNDATION; 50' TO WELL FOOTING /GUTTER/CURTAIN DRAINS WELLS 01,1,5, WELL TO Pi IMENTS: DESIGN DATA SHEEr-SUBSUFACE SEWAGE DISPOSAL SYSTEK FILE NO. Owner Located at ( Street) V sec °Z 3 Block Z Lot (indicate nearest cross street) Municipality Watershed SOIL PERCOLATION TEST DATA REWMED TO BE SUBMITTED WITH APPLICATIONS Date of Pre- Soaking 4 -t s Eb G Date of Percolation Test 4 - j c:; - e) 6 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 Inches 1 jo,4,, - ii!ob ZI Z4 Z1- `3 I 1 2 1 3 I l' 74 -1' 1 51 1 4 3 9 5 t, 1101.5M--Wo 7,1 Z4 °L:t 1' 2 2 -zl ZIA ti, 3 4- - Z 4 I I tg-Fo - L1.: V 5 - 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. rev. 9/85 TEST PIT DATA REQUIRED. TO BE SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES DEPTH HOLE NO. d HOLE NO. HOLE NO. G.L. Qi iG ,, d 3' ►4p e 4' Ia@ 4' 5' 6' 7' 8' 9' 10' 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS ENCOUNTERED INDICATE LEVEL TO WHICH DATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: i�AAjj d+G DATE: 3 17t5- ZOIPW DESIGN Soil Rate Used C°-(C7 Min /1" Drop: S.D. Usable Area Provided x-SWOO LA No. of Bedrooms Septic Tank Capacity Z ��_ gals. Type �tP Absorption Area Provided By L.F. x 24" width trench°'' Q Name T. MICHAEL DALY, P.E. Signature Address P. 0. BOX 243 SEAL ,. .11jI0 Jrri"D lvit uou Di nrm Aa L1:r.CtuV-L .W111 V1xu1a Soil Rate Approved sq <ft /gal. Checked by Date PC-1 PUT NAM C O UN TY D E PART M ENT O F HEALTH APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: Ap I x_ — "30 MAKOE N� ,'t o 125-1.0 2. Name of Project: zy 3. LocatioOTV /C: 4. Project Engineer: 1 o 5. Address: 1�50X 3 License Number: 46A68 Phone: _0 `. 6. Typeeof Project: V 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 (SEQR)? Type Status (Check One) Type I.. Exempt Type II. Unlisted ✓ 8. Is a Draft Environmental Impact Statement (DEIS) required? ............. 1 0 9. Has DEIS been completed and found acceptable by Lead Agency? ........... 0. Name of Lead Agency 1. Is this project in an area under the control of local planning, zoning; or other officials, ordinances? .......... ..............................0 y�--"D �tT 2. If so, have plans been submitted to such authorities? .................. 0 3. Has preliminary approval been granted by such authorities? Date Granted: 4. Type of Sewage Disposal System Discharge. �i?.!'? ��k'# Surface Water Ground Waters 5. If surface water discharge, what is the stream class designation ?........ 5. Waters index number (surface) ........... ............................... T. Is project located near a public water supply system? .................. K� 0 3. If yes, name of water supply Distance to water supply - 3. Is project site near a public sewage collection or disposal system ?..... ). Name of sewage system Distance to sewage system I. Date observed: 23. Name of Health Inspector: 1. Project design flow (gallons per day) .............. �?�Q................ z. . 25. Is State Pollutant Discharge Elimination System (SPDES) Permit required ?.. b 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? .................................. ............................... 1� 28. Wetland ID Number ........................ ............................... 29. Is Wetland Permit required? .............. ............................... Has application been made to Town or Local DEC Office? .................. vj 30. Does project require a DEC Stream Disturbance Permit? ................... Al C) 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 32. Is project located within 1,000 feet of existence of abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or ,1 any other potential known source of contamination? ..............YES or NO W DESCRIBE: 33. Is there a local master plan or file with the Town or Village? ........... 34. Are community water, sewer facilities planned to be developed within 15 years? 35. Are any sewage disposal areas in excess of 15% slope? ..:....................., 36. Tax Map ID Number ......................... ............................... 37. Approved Plans are to be returned to: .......:........ Applicant 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 orr this form is true to the best of my knowledge and belief. False statements made herein are punishable as a Class A Misdemeanor pursuan o Section 210.45 of the Penal Law. 1 SIGNATURES & OFFICIAL TITLES: MAILING ADDRESS: PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Date l _/1 Ct' Re: Property of 11 ��� �� 7 6 ac— F- Ar IL :1>610,5 Located at ! bo ! 0 X16; (T) f7 7V-1 0 0 � ection Block Lot G,! Subdivision of �Ii �. POP, 1-17 Mt¢ ``- Yr'' Subdv. Lot # Filed Map # ��/!(o Dat'e.< Gentlemen • T: MICHAEL DALY, P.E. :CONSULTING ENGINEER P. 0. BOX 243 , This letter is to authorize SRN P. OX 24 a duly licensed professional engineer V or (Indicate to apply for a 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 the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health JAw, and the Putnam County Sani- tary Code. Very truly yours, / Signed Countersign Owner of Property P.E., R.A. , # �, D , 60.x 0 Address T. MICHAEL DALY, P.E. Address CONSULTING ENGINEER P. 0. BOX 243 N. Y. 10587 Telephone 9L M 641 Town Teleplfone DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New.York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT. A. WATER WELL PCHD PERMIT -K. r, WELL LOCATION Stireet Address o illage City Tax Grid Number 2 ° Z _609 WELL OWNER Name. Mailing Address rivate Q O Public USE OF WELL 0- primary 2- secondary RESIDENTIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED ® BUSINESS O FARM O TEST /OBSERVATION O OTHER (specify, 0 INDUSTRIAL O INSTITUTIONAL O STAND -BY O AMOUNT OF USE YIELD SOUGHT gpm /# 0 REPLACE EXISTING SUPPLY W UPPLY NEW DWELLING)* PEOPLE SERVED e3 /EST. OF DAILY USAGE 43,00 al O TEST/ OBSERVATION Gl ADDITIONAL SUPPLY ® DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE RILLED ®DRIVEN []DUG GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING ?. YES NO IF WELL IS LOCATED .IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: J_jj -r..4_r '1-6&,10 Lot No. $ WATER.WELL CONTRACTOR: Name -I °,t,' Address: t, IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES NAME Ot ;. PUBLIC WATER SUPPLY: TOWN /VIL /CITY DISTANCE TO PROPERTYIFROM NEAREST WATER MAIN: LOCATION SKETCH �& ;SOURCES OF CONTAMINATION PROVIDED SEPARATE SHEET (date) n 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: f C,,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 PUT NAM COUNTY D E PART M E NT OF HEAL-7H � APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER DISPOSAL SYSTEM 1. Name and Address of Applicant: D D (--o e&.5 810x '3 /� y )OSI D 2. Name of Project: �C 7 "( 3. Location T /V /C: PATrE'UbAl Ci A. Project Engineer: i�� ;`iL''�bi1�� --'� 5. Address: (a� L� License Number: Phone: 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)? Tvoe Status (Check One) Type I.. Exempt Type II. Unlisted 8. Is a Draft Environmental Impact Statement (DEIS) required? ............. 9. Has DEIS been completed and found acceptable by Lead Agency? ........... N A 10. Name of Lead Agency 11. Is this project in an area under the control of local planning, zoning, or other officials, ordinances? ......... ............................... 12. If so, have plans been submitted to such authorities? .................. 13. Has preliminary approval been granted by such authorities? Date Granted: 14. Type of Sewage Disposal System Discharge...... Surface Water ,Ground Waters 15. If surface water discharge, what is the stream class designation ?........ 16. Waters index number (surface) ........... ............................... 17. Is project located near a public water supply system? 18. If yes, name of water supply Distance to water supply�i -� 19. Is project site near a public sewage collection or disposal system ?..... 20. Name of sewage system Distance to sewage system l�t T�iu! � GAF 21. Date test holes observed: vc �: ' ` 22. Name of Health Lnspector: /t / 66-�-M`6 90® 23. Project design flow (gallons per day) ....... ............................... 11/93 2. 24. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?.. 25. Has SPDES Application been submitted to local DEC Office? ............... 26. Is any portion of this project located within a designated Town or State wetland? .................................. ............................... !y 27. Wetland ID Number ........................ ............................... - - a 28. Is Wetland Permit required? .............. ............................... J Has application been made to Town or Local DEC Office? .................. 29. Does project require a DEC Stream Disturbance Permit? .................... (J 30. 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 31. 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 DESCRIBE: 32. Is there a local master plan or file with the Town or Village? ........... � 33. Are community water, sewer facilities planned to be developed within 15 years? 34. Are any sewage disposal areas in excess of 15% slope? ........................ 1\i 35. Tax Map ID Number ......................... ............................... 36. Approved Plans are to be returned to: ................ Applicant 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 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:-'` MAILING ADDRESS: DESIGN DATA SHEET- SUBSUFACE SEWAGE DISPOSAL SYSTEM FILE NO. Owner ��l�J %� N /2/%���� Address ,C L�//,9:�1��72�7� Located at (Street) Pola 5 Sec. �14 Block - Lot (indicate nearest cross street) municipality � t-t� ( Watershed Y4, • ■ • �1• �• ■' Y:`. • • Y• • 8• i• �• ■ i Hsi• ... M. •, Date of Pre- Soaking Date of Percolation Test HOLE NUMBER C =TIME PERCOLATION PERCOLATION Run Elapse Depth to Water Frcm Water Level No. Time Ground Surface In Inches Soil Rate Start-Stop Min. Start Stop Drop In Mi.n /In Drop Inches Inches Inches 1 2 4 .Sid 5 '6y. 7 W' I�y' t/ 9146— 2 3 3 4 5 NOTES: 1. 2. rev.. 9/85 Tests to be repeated' are.obtained at each for review. Depth measurements to at same depth. until approximately equal soil rates percolation test hole. All data to'be submitted be made from top of hole. TEST PIT DAM M• 1 P X11 TO : t, WITH APPLICATIM DESCRIPTION • OILS* •• Y�1' �I IN TEST HOLES DEPTH HOLE NO. HOIE NO. :•1 • G.L. 2' 31 51 i. /) � Ll 6' 7' 8' 9' 10' 11' 12' 13' 14' INDICATE LEVEL AT WHICH GROUNDWATER IS IIQOOUNTERID INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING DEEP HOLE OBSERVATIONS MADE BY: ? BATE: ll Soil Rate Used O Min/1" Drop: l�v S.D. Usable Area Provided 50 F7 No. of Bedroans _ Septic Tank Capacity 12-450 gals. Type C01 V Absorption Area Provided By �N L.F. x 24" width trench i W �� �L � C Q OE ESSIOryq� Other Name / U /(/�CL� �! Signa Address SE G XP;nA94 ,ill V /l_ 061 THIS SPACE FOR USE BY HEALTH DEPAR'TMM ONLY: Soil Rate Approved sq.ft/gal. Checked by ^w. 40V Tf OF NEW Date PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES Re: Property of� Located at (T) �%�"���✓ Subdivision of Subdv. Lot # Gentlemen: Date Filed Map #. Date This letter is to authorize) a duly licensed professional engineer L.I . �i (Indicate) to apply for a 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 the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and the Putnam County Sani- tary Code. Counter 'igned: P. E. AZ-:W. , # C., b 4Y R p 4 Address Telephone Very truly yours, Signed@ Owner of Property Address A/ Town le s 61 Telephone DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New York 10509 (914) 278 -6130 APPLICATION TO CONSTRUCT A WATER WELL PCHD PERMIT WELL LOCATION Street Address Town V;Ll age City �� Tax Grid Number, V D6 ��° WELL OWNER Name _ % (.() Mailing Address ® ' tV&l j �fl y��U XPrivate O Public USE OF WELL 1 - primary 2- secondary ;RESIDENTIAL 0 BUSINESS 0 INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION U INSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify O AMOUNT OF USE YIELD SOUGHT _4r gpm /# PEOPLE SERVED S /EST. OF DAILY USAGE 1660 aal 0 REPLACE EXISTING SUPPLY O TEST/ OBSERVATION Gl ADDITIONAL SUPPLY NEW SUPPLY NEW DWELLING 0 DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING - ---- WELL TYPE �URILLED 13DRIVEN ODUG EI GRAVEL 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name ,AZ>g Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES _K__NO NAME OF PUBLIC WATER SUPPLY: TOWN: /W1. % T -Y, DISTANCE TO PROPERTY FROM NEAREST WATER MAIN: LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED �; -,•'. NON SEPARATE SHEET ! •• ' (date) `,.(,signature). f` :,•� A :� f 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 thirt, (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 man as not to degrade or otherw' con surface or-groundwater. Date of Issue: 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 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road Brewster, New York 10509 Tel. (914) 278-6.130 Fax (914) 278-7921 March 25, 1998 John Karell, Jr. P.O. Box 644 Carmel NY 10512 Re: Proposed SSTS: Grouse Construction Vista Dolores Road Lot #4 (T) Patterson Dear Mr, Karell: BRUCE R. FOLEY Public Health Director Review of plans and other supporting documents submitted at this time relative to the above captioned project has been completed. Comments are offered as follows: 1. There is no record of a final inspection being requested or conducted by a representative of this Department. 2. Title block is to be note property owner and tax map number. 3. As -built measurements is to note the distances to the well from two fixed points. Upon receipt of a submission, revised to reflect the above, this application will be considered further. Very truly yours, Robert Morris, PE Public Health Engineer RM:tn v "This is to certify that AS —BUILT M the sewage treatment system was constructed as indicated on this plan and that MEASUREMENTS • the system was inspected by me before it was covered over. The system was constructed in accordance with all standard rules and regulations of the Putnam County Department of Health and the New York State Department of Health.,, , .. - .. OPOO I ll'-NT 3.5�r pag %11.1 -- /.. P� _`x l000lo I 6a5o j So 14 Putnam County Department of Health q •� 40 5 a $ 13 Division of Environmental Health Servioee qO - y^ 40 --' 1y Approved ae noted for conformanos with 3 y0 11 2able Rules and Regulations of the nam ty Health Departm'� 0 O O �11PIV i Signature & Title Dat® �• � S A / 1 • P,� I soft � a Ll Pt � /L,14 �cnaet'.S 11 1` Idly �t 7W* 23-2-69 : 1; 301 T>O L O P—E ' SLED R+�Pi 2•ZIb��VI•T� F pONOif�1LL R.S, J0rd&A1A*"*W5WRV&Y ley No p, $ REMARKS I 2C% 1 LT s to z : -75 3 3 (07 4 7/ g S81x 5 7 I3 6ux 6 �Q i ,1 00 1 1 60X �yNi9�+1;t�o 9 sy In3 �i 10 6 !0 g! ; a /D Z 90 ! ' 13 //:5 101 1 . 14 //e 1d$, 15 66 . 3 f LX_ 9&0 333 LX_ F940Y• 5S9 A020e,i5 Y ow -ry • 4Aoun' -e"Azs arm ,m.,� VOL aArf LiMLti POND /fit« I-VT 414 VI4TA DaNk,i ' P���SONm -;`-., I =3a . J0111VKAMUAP.E P . O . B O X 649.' CARME4 N.Y.10512 o _rrccrra. I I I