HomeMy WebLinkAbout1000-101.-1-16.1
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11416rC420
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COVENANTS AND RESTRICTIONS
WHEREAS, East Coast Properties, a partnership having its
principal place of business at 142-21 Northern Boulevard, Flushing,
New York, is the owner of the following described property:
All that certain plot, piece or parcel of land, with the
buildings and improvements thereon erected, situate, lying and
being at cutchogue, in the Town of Southold, County of Suffolk and
State of New York, being more particularly bounded and described
as follows:
BEGINNING at a point on the westerly line of Alvah's Lane at
the southeast corner of the premises herein described and the
northeast corner of land of Bates;
RUNNING THENCE south 61 degrees 19 minutes 20 seconds west
along lands of Bates and Adams, 478.61 feet to land of Klasfeld;
RUNNING THENCE along said land north 33 degrees 03 minutes 20
~, seconds north 974.08 feet to land of Grigonis;
RUNNING THENCE along said land north 56 degrees 32 minutes 10
seconds east 470.00 feet to the westerly line of Alvah's Lane;
RUNNING THENCE south 33 degrees 27 minutes 50 seconds east
along said line, 1013.98 feet to the point or place of BEGINNING
and;
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WHEREAS, it is the desire and intention of the owner to sell
the property described above and to impose on it mutual, beneficial
restrictions under a general plan or scheme of improvement for the
benefit of all the lands in the tract and the future owners of
those land;
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NOW, therefore, the owner hereby declares that all of the
property described above is held and shall be held, conveyed,
hypothecated or encumbered, leased, rented, used, occupied, and
~-13q}- improved subject to the fOllowing limitations, restrictions,
/.?';;;;,.,. conditions, and covenants, all of which are declared and agreed to
/" .".-:. be in furtherance of a plan for the subdivision, improvement, and
!,:; G' ;[}-: sale of the land~ and are esta~lished and agreed. upo~ . for the
, ~ ,: purpose of enhanclng and protectlng the value, deslrablllty, and
.' attractiveness of the lands and every part thereof. All of the
/ LJ;' limitations, restrictions, conditions, and covenants shall run with
- the land and shall be binding on all parties having or acquiring
any right, title, or interest in the described lands or any part
thereof.
1. The one hundred (100) foot front scenic easement as
designated of the major subdivision map, shall be landscaped in
some manner. There shall be no structures of any kind located
within this area, including fences, gazebos, statuary, etc. with
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11416PG421
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the exception of the driveway access areas as shown on the map.
2. The one hundred (100) foot rear scenic easement, as
designated on the major sUbdivision map, shall be left undisturbed.
3. These covenants and restrictions can be modified only at
the request of the then owner of the premises with the approval of
a majority plus one of the Planning Board of the Town of Southold
after a public hearing. Adjoining property owners shall be
entitled to notice of such hearing but their consent to such
modification shall not be required.
~ IN WITNESS WHEREOF we have hereunto set our hand and seal this
J tj day of \JA~v"l ' 1992. (.
~~ h</a-/t~
Zoe Karatzas fJAltiXIetf.
d/ / ,/4:/
_-~~~~ L~t?
C~ichael Maleas ~~qr~ei
State of New York
County of Suffolk
On the),/ day of :Jl\tJV/IIZv , 1992, before me personally came
Andreas Kalapodis, to be known, who, being by me duly sworn, did
depose and say that he is a member of the co-partnership of East
Coast Properties, the firm described in and which executed the
foregoing instrument and acknowledged to me that he executed the
foregoing instr~:;;'~::d in b..alJl:'J~~ co-pnrtnership.
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11416PL422
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state of New York
County of Suffolk
On the J'l day of J "":>LV\ rr, , 1992, before me personally
came Stavroula Papathanasopoulos, to be known, who, being by me
duly sworn, did depose and say that she is a member of the co-
partnership of East Coast Properties, the firm described in and
which executed the foregoing instrument and acknowledged to me that
she executed the foregoing instrument for,an in behalf of said co-
partnership. l-~ ~'l- ~_
GEORGE N ICfSSAAfS _ ~. (-C ~
NotMy Public, Staff! of N@WYOI'II:
, No. 414914811
(ommiu,*, EXJlIles ~mm 19, 1992
state of New York
County of Suffolk
On the ;)q day of ..JAtJV/H'f 1992, before me personally came
Zoe Karatzas, to me known, who being by me duly sworn, did depose
and say that she is a member of the co-partnership of East Coast
Properties, the firm described in and which executed the foregoing
instrument and acknowledged to me that she executed the foregoing
instrument for an in behalf of said c parfJership.
G[ORGE N KESSAR1S (/L...-
Notary Public, State 01 N~ York
No. 41-4974817
Commini," bpireJ November 19, 1992
State of New York
County of Suffolk
On the J1 day of ,JANUIV'y , 1992, before me personally
came Michael Maleas, to me known, who being by me duly sworn, did
depose and say that he is a member of the co-partnership of East
Coast Properties, the firm described in and which executed the
foregoing instrument and acknowledged to me that he executed the
foregoing instrument for and in behalfE;~ ~f ~id co-partnership.
GEORGE N K[SSARIS __
Notary Public,. Stal. of Noew York
No. 414974811
(ommi~si&n bp4res November 19, 1992
State of New York
County of Suffolk
On the :;) "1 day of J A NV At Y , 1992, before me personally
came Kostas Mylonas, to me known, who being by me duly sworn, did
depose and say that he is a member of the co-partnership of East
Coast Properties, the firm described in and which executed the
foregoing instrument and acknowledged to me that he executed the
foregoing instrument for and in behalf of said co-partnership.
~~
GEORGE N KE!iSARIS
Notary Public. State of New YOlk
No..,,4<J74817
(ommi~si.., bpre! No~mbel 19, 1092
,:~' li3G2PG402 (
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PlASOUTHOLO TOWN
NNING BOARD
PRIVATE WELL COVENANTS
DECLARATION OF COVENANTS AND RESTRICTIONS
THIS DECLARATION made by East Coast Properties this i ( day
of June, 1991, a partnership having its principal place of business
at 194-21 Northern Boulevard, Flushing, New York hereinafter
referred to as the DECLARANT, as the owner of premises described
in Schedule "A" annexed hereto (hereinafter referred to as the
PREMISES) desires to restrict the use and enjoyment of said
PREMISES and has for such purposes determined to impose on said
PREMISES covenants and restrictions and does hereby declare that
said PREMISES shall be held and shall be conveyed subject to the
following covenants and restrictions:
1. WHEREAS, DECLARANT has made application to the Suffolk
County Department of Health Services (hereinafter referred to as
the DEPARTMENT) for a permit to construct and/or approval of plans
for a single family residence, a subdivision or development or
other construction project on the PREMISES; and
2. WHEREAS, the PREMISES are to be served by an individual
on-site private well; and
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WHEREAS, the test wells sampled for the PREMISES indicated
a groundwater supply that had contamination in excess of the
minimum drinking water standard and/or guidelines of the State of
New York and contained excess of the following:
Nitrates and Iron, and
'() A complete list of analysis results is attached hereto as
. .'0f/SChedUle C, and each chemical parameter which exceeds 60% of the
" ,'_acceptable level is indicated with an asterisk; and
. i5'
WHEREAS, the County of Suffolk Department of Ileal th
Services has agreed to issue a permit only if there be a record
covenant that the necessary water conditioning equipment be
installed so as to meet the quality standards for drinking water;
it is DECLARED and Covenanted by DECLARANTS, their heirs or
successors and assigns forever, that no residence upon the above
described property will be occupied prior to the installation of
the necessary water conditioning equipment so that the water, when
,J conditioned, meets the said minimum quality standards for drinking
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11362PC403
water of the state of New York and evidence of the same is
furnished to the Suffolk County Department of Health Services for
their written approval.
3. The DECLARANT, its successors and/or assigns shall set
forth these covenants, agreements and declarations in any and all
leases to occupants, tenants and/or lessees of the above described
property and shall, by their terms, subject same to the covenants
and restrictions contained herein, Failure of the DECLARANT, its
successors and/or assigns to so condition the leases shall not
invalidate their automatic subjugation to the covenants and
restrictions.
4. All of the covenants and restrictions contained herein
shall be construed to be in addition to and not in derogation or
limitation upon any provisions of local, state, and federal laws,
ordinances, and/or regulations in effect at the time of execution
of this agreement; or at the time such laws, ordinances, and/or
regulations may thereafter be revised, amended, or promulgated.
5. This document is made subject to the provisions of all
laws required by law or by their provisions to be incorporated
herein and they are deemed to be incorporated herein and made a
part hereof, as though fully set forth.
6. The aforementioned Restrictive Covenants shall be
enforceable by the County of Suffolk, State of New York, by
injunctive relief of said agencies or the County of Suffolk to
enforce the same shall not be deemed to affect the validity of this
covenant nor to impose any liability whatsoever upon the county of
Suffolk or any officer or employee thereof.
7. These covenants and restrictions shall run with the land
and shall be binding upon the DECLARANT, its successors and
assigns, and upon all persons or entities claiming under them, and
may be terminated, revoked or amended only with the written consent
of the DEPARTMENT.
8.
contained
covenants,
herein.
The declarations set forth in the WHEREAS clauses
herein shall be deemed and construed to be promises,
and restrictions as if fully repeated and set forth
9. If any section, subsection, paragraph, clause, phrase or
provision of these covenants and restrictions shall, by a Court of
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1136ZPL404
competent jurisdiction, be adjudged illegal, unlawful, invalid, or
held to be unconstitutional, the same shall not affect the validity
of these covenants as a whole, or any other part or provision
hereof other than the part so adjudged to be illegal, unlawful,
invalid, or unconstitutional.
10. Local Law #32-1980 the DECLARANT represents and
warrants that he has not offered or given any gratuity to any
official, employee, or agent of Suffolk County, New York State, or
of any political party, with the purpose or intent of securing
favorable treatment with respect to the performance of an
agreement, and that such person has read and is familiar with the
provisions of Local Law #32-1980. u;.') ,)
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NDREAS KALAPODIS I
( /;,C /c f'(/cz"r/ ~:(
~~ROULA PAPATH~rASOPOULOS
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GOOGE H kESS""" ZOE KARA
\ C':l NoUrr NIle, Stale of Ml!w York
\ J ' No.41"'914111
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. 11362PG405
SCHEDULE A
DESCRIPTION OF PROPERTY
DECLARANT: East Coast Properties
All that certain plot, piece or parcel of land, with the
buildings and improvements thereon erected, situate, lying and
being at Cutchogue, in the Town of Southold, County of Suffolk and
State of New York, being more particularly bounded and described
as follows:
BEGINNING at a point on the westerly line of Alvah's Lane at
the southeast corner of the premises herein described and the
northeast corner of land of Bates;
RUNNING THENCE south 61 degrees 19 minutes 20 seconds west
along lands of Bates and Adams, 478.61 feet to land of Klasfeld;
RUNNING THENCE along said land north 33 degrees 03 minutes 20
seconds north 974.08 feet to land of Grigonis;
RUNNING THENCE along said land north 56 degrees 32 minutes 10
seconds east 470.00 feet to the westerly line of Alvah's Lane;
RUNNING THENCE south 33 degrees 27 minutes 50 seconds east
along said line, 1013.98 feet to the point or place of BEGINNING
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1136~PG406
SCHEDULE C
See attached test report.
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11362PG407
STATE OF NEW YORK
COUNTY OF SUFFOLK
On the l cf day of .hJ,J\C ,1991, before me personally came ANDREAS
KALAPODIS, to me known, who, being by me duly sworn, did depose and
say that he is a member of the co-partnership of East Coast
Properties, the firm described in and which executed the foregoing
instrument and acknowledged to me that he executed the foregoing
instrument for and in behalf of said co-partnership.
GEORGE N KESSAAIS
HotIrJ F\Mc. Stlte of tffw York
.....U..91.t817
Corminien bp'''' ~mbl':f 19. 1 ~
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STATE OF NEW YORK
COUNTY OF SUFFOLK
On the 2) day of JL'IIJ( , 1991, before me personally came
I STAVROULA PAPATHANASOPOULOS, to me known, who, being by me duly
sworn, did depose and say that she is a member of the co-
partnership of East Coast Properties the firm described in and
which executed the foregoing instrument and acknowledged to me that
she executed the foregoing instrument for and in behalf of said co-
partnership. .~ f I
GEORGE N I(ESSARts I {
No"" IW<. St.., 01 H,w y~. >... i . . ..\d'. '
. No."'-4914817 '" .\!_
(orrms.,*, b~'~1 No~mbl!r 19, 1997
Notary bll.c
STATE OF NEW YORK
COUNTY OF SUFFOLK
/ On the 2) day ofJu {J( , 1991, before me personally came ZOE
KARATZAS, to me known, who, being by me duly sworn, did depose and
say that she is a member of the co-partnership of East Coast
Properties the firm described in and which executed the foregoing
instrument and acknowledged to me that she executed the foregoing
instrument for and in behalf of said co-pa tnership.
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Nolar (ifOllGf N KCSSMIS
,......... SYle of New York
COl'I'IrrIuiM '~''''914817
E:o:pfttNOvtmb@/I9,t997
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11362PC408
STATE OF NEW YORK
COUNTY OF SUFFOLK
On the l'( day of jVf.X, , 1991, before me personally carne MICHAEL
MALEAS, to me known, who, being by me duly sworn, did depose and
say that he is a member of the co-partnership of East Coast
Properties the firm described in and which executed the foregoing
instrument and acknowledged to me that he executed the foregoing
instrument for and in behalf of said co~ artnership.
GEORGE N KESSAAIS 1
NobfJ P\IIIc. Stile .1 New Vorl:
fib. 4''''914817
~bpirt'INoYotmOO' 19"Nvtar
STATE OF NEW YORK
COUNTY OF SUFFOLK
On the lS day of J'U/Jc. , 1991, before me personally carne KOSTAS
MYLONAS, to me known, who, being by me duly sworn, did depose and
say that he is a member of the co-partnership of East Coast
Properties the firm described in and which executed the foregoing
instrument and acknowledged to me that he executed the foregoing
instrument for and in behalf of said co-p~"rtnershiP.
GEORGE N KESSARIS ) II \ I
..u"""",-SU".'N,wV.,k , t ~ '~J< '
No. 41..4974817
"'""""...."p"'.....m"""9.1991 Notary Ii blic
\::~~'...;'-~.~~}136{.m~~
. . ~ .... RETURN TO: SU'-'-OLIt COUNTY DEPARTM!:NT 0,-
. HEALTH SERVICES, BUREAU 0'- DRINItING KATER
/l 225 RABRO DRIVE, HAUPPAUG~, N.Y. 11788
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TEST KE:LL KATER ANALYSIS
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Rec'd by SCDHS
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-,-q-J\pp't
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Fee of $400.00/well received on
u*
TEST WELL '31- ":;7'f
3* Health Dep't Ref. Number
;;15 t CvrHT IreI'
2* Name
4* Hou.e ol1~OX Number
tr.1 U41 (f Lo.
9* Street yare,/
Lu IC.-Itw' L~ .
8* Village tf Zip Code
;:1 'r-Y/ Y (
23* Home Telephone Business *
12 <:,-
31 * Well Depth
5"
44* Water Filter
~3
33* epth to Water
Installed
TAX MAP NUMBER - From the tax bill
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14*
13*
16*
17*
/QltV
District
Sect ion
Block No.
Lot No.
I
.jtJ.Ll'1... .jLL~
Mailing Address - If Different
~ocation:
Reviewer N1J;nt. :'7. &--'
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Directions to tIle Sanitarian:
: ~_~, Locate test well on subdivision map
or tax map.
i.?....J Total depth ~.:!tatic water level
checked? _ Yes No
.3. Run time, sample tap and GPM noted?
4. If an existing hose is sampled be
sure to test the raw water only.
-*- ***
111** ***
This section for officia~ use only
20* SUPP~Ty~e pi~v
'W"e ('" t'r--
46it Well Drill'er
Ncom
Carom
57* Field Tests
C12
pH
Electrolysis Check - Amperage
// - / .~ / ,')
51* Sample Date
'.. ~-
-
54* Sample Tap Kit Bath OT Other
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47* Elap.ed Run Time 24* GPM
50*51* Resample Date
50*54* Re.ample Tap
7* Township
TEH_
TSI
Code
THU_
TSM_
TBA_
TIS
TSH
TBR
TRI~
TOS
Samples Collected:
Part Chem___.~
Cd & Pb J. ~ -
MBAS
Pesticide~~.-___
Bac't
VQC's
4 vials :~-~
2 vials
lar'Je
Remarks:
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.~ Real Properly Tax Service Agency"',,,"'" -
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11362PL41~ C
1190002 118V (l 1 19~U
Lab No. Date Received in Lab
Field No. dV0~ Public Water
Date: /,-/-70 Private Water J-
Time: A/Yl Other
Col. By: ;'?-r.::"Jr.! Date Completed
(Name not initials) Examined By (,NIl<' .-A--
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
PUBLIC HEALTH LABORATORY
CHEMICAL EXAMINATION OF WATER
Point of Collection
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District
tEA Ii: "" 0"> tV ,""
Name
Location
/'.i ~ ~ '~......
Remarks:
".,., " -
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(1) Resulls Reported as Micrograms Per Liter.
Partial 0:
Complete 0
Metals Only 0
75 Spec. Cond. ~ 67 84 T. Alkalinily Imgll CaC031 81" MBAS Imgll} Co ..-
mhoslem '.- 0
73 pH b.1. 82 T. Hardness Imgll CaC031 88 Total Hyd P Imglll
78 Nitr~es t 7~ 83 Ca Hardness Imgll CaC031 90 Fluoride Imgll FJ
Nitrates Imoll NI
76 Free Ammonia {mgll Nl .( J J 1- Mg Ha,dness Imgll CaC031 77 Nilriles Imgll NI
80 Chlorides Imgll CII 7 ~
87 SuKales Imgll S041 8 H _ ....120 Arsenic 11) I
.
100 1'00 Imgll Fel ..- 0. 7 12 12~ Selenium 111
. .
101 Manganese Imgll Mnl " r@ Cadmium ::::: 11
(1) .
102 Copper Imgll Cui ~ ~ b II 0 Q Lead 111 .,::. >- 13
- -
106 Sodium Imgll Nal l3 1-; .2 126 Silver 11)
103 Zipc Imgll Znl iL ~ ~ if 104 Chromium 11)
124 Mercury 111
121 Barium Imgll Bal i
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Director
HI.,n_
Lab No. TO- /
Field No.
Date
Time
Col. By A'.-(;; .,.Jf<
11:JG2PC413
(C'd at Lab
.blic Water
Private Well
Other
Exam. By
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DIVJ:SJ:ON
surroLK COUNTY DI:Ii'ARTMIaIT or Hl:ALTH SI:RVJ:CI:S
Ii'l1IlLJ:C Hl:ALTH LABORATORY
or Ml:DJ:CAL LEGAL J:HVl:STJ:GATJ:ONS , rORl:NsJ:c
TRACI: ORGANJ:C ANALYSJ:S or KATI:R
SCJ:I:NCI:S
NYS Hell' S-
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R<7- -S 7-r'
Sample
Tap:
Raw~ Treated____
Name
&).;./
C,.. 'r) ,-:--r
No. , Street
Village
Number of 'ample vial. .ubmitted
.~.,~ ,.)
I' .
Hell____ Tank____
Kit____ Bth____
Other
Q
/t.'''r' Ikc-
OT ____
DBt
Comnound
Doh
".-:7. /fl .,~ ,L /J
(//7i.H(J/',/r
310 trichloroethene ......
303 chlorodibromomethane .
293 1,2 dibromoethane .... ~'o"-
420 2 bromo 1 chloropropan
301 bromoform ............
306 vinyl chloride .......
305 methylene chloride ...
323 1,1 dichloroethane ...
309 trans 1,2 dichl'ethene
300 chloroform ...........
324 1,2 dichloroethane ...
321 1,1,1 trichloroethane
304 carbon tetrachloride .
294 1 bromo 2 chloroethane
405 1,2 dichloropropane ..
311 tetrachloroethene ....
308 cis 1,2 dichloroethene
320 freon 113 ............
292 dibromomethane .......
307 1,1 dichloroethene ...
302 bromodichloromethane .
4062,3 dichloropropene ..
407 cis dichloropropene ..
408 trans dichloropropene
322 1,1,2 trichloroethane
409
295
433
450
451
452
1112 tetrachlo'ethane
a-tetrachloroethane ..
1,2,3 trichloropropane
2,2 dichloropropane ..
1,3 dichloropropane ..
2 chlo'ethylvinylether
.
Doh
t/
DBt
Comoound
250 benzene ....................
251 toluene ....................
258 chlorobenzene ..............
259 ethylbenzene ...............
254 o-xylene ...................
252 m-xylene ...................
253 p-xylene ...................
255 total xylene ...............
266 2-chlorotoluene (0) ........
267 m-chlorotoluene ............
268 4-chlorotoluene (p) ........
265 total chlorotoluene ........
419 1,3,5 trimethylbenzene .....
418 1.2.4 trimethylbenzene .....
415 m,p-diohlorobenlene ........
412 1,2 dichlorobenzene (0)
432 p-diethylbenzene ...........
435 1,2,4,5 tetramethylbenzene .
437 1,2,4 tr1ch~orobenzene .....
438 1,2,3 trichlorobenzene .....
600 ethenylbenzene (.tyrene)
601 1 methylethylbenzene(cumene)
602 n-propylbenzene ............
603 tert-butylbenzene ..........
604 .ec-butylbenzene ...........
605 i.opropyltoluene (p-cymene)
606 n-butylbenzene .............
607 hexachlorobutadiene ........
608 1,2 dibromo 3-chloropropane
Re::uH for c....f'h '''(r' .
1;,../-, p A.- 'J .), rlc CC/r-':-:'(','_ld
.. ....d l,bo1'u I::; <0 '"r.-.. "X' t
. ....Ji-'f~..J c;. Ct1p
Wllerc HOled.
..:::::--:::>.2-
,
11362P&41t
r
,
Lab No. TO- ~~?O.;(
F. 1 (~-'"
~c d No. //_ _ ""'
Dilte L' / CJ)
'r ilne q/Y>
'".' "" j'.""",,),\-
Rcc'c\ at Lab
I'ublic Water y
Private Well
Ot.her.----,- --_
0,-.":..-; It',. ;y)_eJJ 5,_h___JJ..:J ~.....:....{lf?_._
II-I-~o
,,,~
SUf'FOLK COUNTY DEPARTMENT OF lIEALTll SERVICES
Nilme
-
/ Iv
PUBLIC HEALTH Ll\AORJ\TOR.Y
OF MEDICAL LEGAL INVESTIGATIONS r.. FOR.ENSIC SCIENCES
ORGANOllJ\LIDE PESTICIDE ANALYSIS OF WJ\TER
Ci:<-7 r- "7 (' .' . . ,., , ..
o / - ---7 /' y: bl !-r .(.or, ~T .1,{ fIr.
"L 'A ,r L/1 t' -n.' '--. ..
~. , ,!/ ,.. r .; ,-y . , / /i ( ,.,. f'T. ,/ "
// ' I
I~ 1'/';; /"Ib..;("~
DIVISION
Address
Sample Tap Kit ---- Bth ---- OT Other
4 Vials ~ 2 Vials ---- Large----
#
Compound
ppb
ff
Compound
ppb
Ih <("~
a p a-BHC..............
b t <0.)
e a-nHC...............
., . " t. \j.r _ _ ~_
c:. I I t..,('~,.:..... _l ___ - .
.: r" 'J
~j'J I.:.:..CI::"'_II_\'r\(J .'~i. -- - ~
, .
~. ,
-
gamma-BHC............. .
" c,. ',,:;
1 ,n.:;
de ta-BHC..............
Heptachlor ............
Heptilchlor epoxide..... .:. b. ~I
'ld . -<: o. j
1\ r~n.................
~,o. ~'~
-
'. < (). .,.'
D~eldr~n. . . . . . . . . . . . . .
" (l. J
4 , 4 ODE................
4,4 DDD................ <.0. ~
4 , 4 DDT................ <. 0.1
Endr;n ,0, .J
..... ..................................
Endrin aldcnycll'!........ ""o.J
Chlordane.............. ,\
f\LI\('-~\L(Ji'!' _ _ " _ _ _ co,)
n\~l\-\O)l'/C.IIL(J,..:.. <0.C"
(~O)L_bIJJ~_~()()L__ ('
ri~'ldl f.rl~--
(Sl)Date ~J-J-~,"""
Time ~~ '
C"l. By /i1 -' .. .' i .. .
11362PL415
'''1,...,,, l' ( ','
( ._'. __,J,_JU _ ~ " I"
rtf~c'd ill _____~ '. _ __"'" JV
Public Walcr:
Priv.lte Water ,""(
Ot ht~ r i I
D.lt.e C~~l-~t~d.i].jj Z'f(fl?l~V~lJ
~Ul""0L1'l: ("Of:P.lTY np;pJI..ftTN''!:tr!" O!l" ~.!:J\..!.."'!':! 3~!'.7:tC!:.';
rJrv rSION 0\'" ~}I;~rr.;lJ. L~:-.a_i.. :m."Zc;T:r..4T~O:,3 ;. r")j~":'iC::O.,: 'C:;l-1~~?:1
PUBLIC HEALTH LABORATORY
PESTrCID~ ANALYSIS or HAT~R
(11 Well' S- i];i~
(Slm) Station'
i-e~T \jJ-e l~
(2) f'ir:':l't
r= ~ r 1 _II?"" ,\()
CG..s!._~:oc-<-s' , v_\
(3) La:5t Name
(4) Street'
(9) Street
f) L vi ii.t.L .:.
_'-"
(8) Community
(' . / / T (' i I (I; '::' ,; ;-
----_.~---
(54) Sample Tap L(,,'t ~.\(\ ~,:c-
(R/T)~Raw ____Treated
(20) _C,?mm ____Ncom LPriv
_Surf kTW
1]1) Well Depth /~ '
Mailing Addre33
Remat"k..$
(14) Di.trict
./0/')(1
(1]) Section
I() I
I
0./
(16) Block
(17) Lot
COMPOUND
HB
(4]0)
(';')0) ~j)'1'llrJ
(':)'j i) \'-1 t. H" D(....b
<'I
~I
.-!:/
~I
</
(428) Oxamyl ............. ..: /
(429) Carbaryl........... L /
J. J" I
(5541 1-Na,~hol ..........
"-1
Methomyl ........... __
..(1
<\
(4251
Aldicarb Sulfoxide
(22])
Aldicarb
..-.........
(426) Aldicarb Sulfone ...
(224) Carbofuran ..........
(427) 3-Uydroxycarbofuren