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00576
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PUTNAM COUNTY.DEPARTMENT OF HEALTH
Rev. 3 Dlvision.of Emv_iroumm�tal Healtb"Services, Carntel, N.Y 10512 „.
Engineer Mast provide
3 —$Z
CERTIFICATE OF, TRUCTION COMPLIANCE FOR SEWAGE DISPOSA]AYSTEM ice, .T. T iZSo :%
Totvu
Located at Co iZV W +%LL Hit-(, i2 D ... 'T'E 1 (c; 4 Tax Map Bloc Lot Z u
CoRNWAti -t. 414L �?RA,wHt -L P21Df,6 'r
Owner /applicamt Name �'� � &rM% ' -. 1'1`► G , Formerly Sabdlvisloii Name � � 5 Subdv. Lot NJ
Melling Address Z.Z 3 i< A j'o ►.y />, Ave- Zip 1 O� 3 �c Date Permit Issued
Separate Sewerage System built by A, Fc S E P r 1C_ Sys r f; Fr)-- ) N G • Address' ►PI o , ?Y2k ) 4 / t L2o��5 �i�16 i� /.�]+ i'o )'3
Consisting of f � ' O Gallon Septic Tank and 4 O D L , I'. A S So J3 rJty ti T f2 � M C. H
Water Supply: Public Supply From p Address
or•. Private Supply Drilled by. ,3T� t`tl� tiy�' Address 9® eVc.KSwRoc. lzp. ToM.KiJLY taV&, Jvy
Buildhig Type IZrge5 t D6N'T 1 L. Hue Eroelon Control'Been CompletedY
Number of Bedrooms Has Garbage Gripder Been InstauedY O
Other Requirements
I certify that the systems) as listed serving the above premises were constructed essentially as shown on t�la the completed work ( copies
of which are attached), and in accordance with the standards, rules and regu ations, in accordance with the d the permit issued by the
Putnam County Department Of.Health. - -
Date Certified by ... P.E. X R.A.
4
w
Add►eAddress 1 CUV ZS6 Ice se No.
Any. person occupying premises served by, the,SbOve,system(s) shall`, promptly take such action as may be necessary to,securs the correction 'of any unsanitary
conditions' resuiting' from such usage. Approval.of the separate awe ►'ago system shall *come null and void as soon as a pubs!_ unitary 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 r change when', in the Judgment, of .thhee Commiisi6gor of Health, such revocation, modification or change Is necessary.
oat
Title
n
WELL COMPLETION REPORT Office Use Only —�
DEPARTMENT OF HEALTH
Division Of Environmental Health Services
PUTNAM COUNTY DEPARTMENT OF HEALTH
STREET AOORESS: _-rOWNIVILLAG1101Y TAX GRID NUMBER: 0 j, 6 �8 )
WELL LOCATION ® ,e iftL ko
NAME: ADDRESS: BIVATE
WELL OWNER , . /�J'7iS Zz3 j�•✓�- yat,,,a� .�� it., Q PUBLIC
USE OF WELL ESIDENTIAL O PUBLIC SUPPLY ❑ AIR /COND. /HEAT PUMP p ABANDONED
1 - primary ❑ BUSINESS ❑ FARM ❑ TEST /OBSERVATION ❑ OTHER (specify)
2 - secondary ❑ INDUSTRIAL O INSTITUTIONAL ❑ STAND -BY p
MOUNT OF USE YIELD" SOUGHT gpm. /N0. PEOPLE SERVED �� / EST. OF DAILY USAGE '
gaf.
REASON FOR &<EW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O TEST / OBSERVATION
DRILLING ❑ REPLACE EXISTING SUPPLY ❑ DEEPEN EXISTING WELL
DEPTH DATA WELL DEPTH 60 ft. STATIC WATER LEVEL _Zs�k ft. DATE MEASURED IX-1,0
DRILLING OTARY PRESSED AIR PERCUSSION ❑ DUG
EQUIPMENT ❑ WELL POINT 0. CABLE PERCUSSION ❑ OTHER (specify):
WELL TYPE ❑ SCREENED, ❑ OPEN END CASING. OPEN HOLE IN BEDROCK ❑ OTHER
TOTAL LENGTH
CASING LENGTH.BELOW GRADE
DETAILS DIAMETER
WEIGHT PER FOOT
DIAMETER (in)
SCREEN
DETAILS FIRST
SECOND /
GRAVEL PACK 1 ❑ YES GRAVEL
O NO SIZE:
WELL YIELD TEST
MEWO: ❑ PUMPED
OMPRESSED AIR
O BAILED ❑ OTHER
WELL DEPTH DURATION
ft. I hr. min.
7"
If detailed pumping
tests Were done is in-
formation attached ?.
❑ YES ONO
DRAWDOWN YIELD
ft, gCm.
WATER ErCLEAR TEMP.
QUALITY ❑ CLOUDY HARDNESS
O COLORED ANALYZED? ❑ YES ❑ NO
ANALYSIS ATTACHED? O YES ❑ NO
PUMP INFORMATION
TYPE 55t6" CAPACITY
MAKER 624)"_2S' DEPTH "o
VOLTAGE ZZO HP
ft- MATERIALS: M-fTEEL
ft. JOINTS: ❑ WELDED
in. SEAL: ❑ CEMENT GROUT
7 Ib. /ft. I DRIVE SHOE S ❑ N
SLOT 512E LENGTH (ft)
DEPTH TO SCREE
D PLASTIC 0 OTHER
BREADED ❑ OTHER
NTONITE ❑ OTHER
0 LINER: O YES ❑ NO
N (f t) DEVELOPED?
❑ YES O NO
HOURS
DIAMETER 70P BOTTO61
OF PACK in. DEPTH ft. I DEPTH _
It more detailed formation descriptions or sieve analyses
WELL LOG
are available, please attach.
DEPTH FROM Water Well
SURFACE Bear- Dia' FORMATION DESCRIPTION
ft. It. in9 In*
Land i. � �����if✓�� �:l�jr dE-6C%
Surface
It.
G70E
fj
r
k
STORAGE TANK: TYPE_V7P-07_-
CAPACITY GAL.
WELL DRILLER NAME ' F�� g° C4C ,,, �S -AW4_% OAr �y
f.� �xk -Z 4o / %/ � /
ADDRESS SIGT
".des tea$ , f•
fj
r
k
COUNTY OF WESTCFIESTER
E-11 Rev,86 DEPARTMENT OF. LABORATORIES- AND RESEARCH S
VALHALLA NEW YORK 10595-, = dg
BACTEFi'IAL EX,44INATIO4 OF pRINKING:AND TREE WAxER , ,4
#�
Lab �Io W o '
LaD No;ENT Date Colld> -E ` ���' Time -
}
Time Set w Time Submitted
Tests (Circle) SPp �Cofifo '�f - C oliform•Membrane Fecal, Other � t ^• { / t Agency Coli'd for -
p
Coll d from Neme �_ rr r' 3!f } + i
Roll r
Addf @Sa a ri ai l�lt7:r' }y:ifT /.e� ``£ '
(si nq;l ICq, To. v,n/N�lt� _ 12jpC�3ICweIVV
.I 'fit f
Ideniihcation o1 Source _ _- -
Sampling Point within Premises 4 L, ';f c1 - Retrigerated�
'Chlonnated� Ves9 No a Flee mg /I Toral mg /I -pH -
RE §UL7S'OF EXAMINATION' OF` WATER
3
MPN /100 ml-, ' Standaid Plate Count �4
'Bacteria -per ml (48 hr )
C-pliforn Group
Membranb Method /100 ml.
Number Posihve Tulles Toial Coliform
Fecal_Coliform Other
These results indicete aainple was wea riot) of ~ Reported by Date
satisfactory sanitary quality wham a sample was
3 n ^
i
3
IV.
V.
VI.
APPENDIX C
FINAL SITE INSPECTION Date
/
InspkEed
CWNER
- �-S; 7 9M # OR . SUBDIVISION IOT 4
y.- -
C CMMEDiTS
SEWAGE DISPOSAL AREA
a. SDS area located as per approved plans
x
b. Fill section - Date of placement
2:1 barrier- LGTH WIC7I'H AVG.DPTH
c. Natural soil not stripped
d. Stone, brush, etc., greater than 15' fran SDS area.
e. 100 ft. from water course /wetlands.
SEVaGE DISPOSAL SYSTEM
a. Septic tank size - 1,000 :1,250
b. Septic tank installed level
c. 10' minimum from foundation
d. No 90° bends, cleanout within 10 ft. of 45° bend
e. DISTRIBUTION BOX
1. All outlets at same elevation - water tested
.2. Protected below frost
3. Minimum 2 ft. original soil between box and trenches
f. JUNCTION BOX - properly set
g. MKS
1. Length required - I.,--n : installed-:��
'
2. Distance to watercourse measured: ft.
3. Installed according to plan
4. Distance center to center
5. Slope of trench acceptable 1/16 - 1/32 " /foot.
6. 10 feat from property line - 20 feet - foundations
,
7. Depth of trench < 30 inches from surface
8. Roan allowed for expansion , 50%
9. Size of gravel 3/4 - 11" diameter
10. Depth of gravel in trench 12" minimum
11. Pi' ends capped"
h. PUMP OR DOSE SYSTEMS
1. Size of punip chamber
2. Overflow tank
3. Alarm, visual /audio
4. Pump easily accessible manhole to grade
5. First box baffled
6. Cycle witnessed by Health Department
estimated flow per cycle
HOUSE
a. House located per approved plans.
b. Number of bedrooms -< c-
WELL
a. Well located as per approved plans
b. Distance from SDS area measured c, ft. Sfi
c. Casing 18" above grade.
y
d. Surface drainage around well acceptable.
OVERALL WORKMASHIP
a. Boxes ro 1 outed
b. All pipes partially backfilled
c. All pipes flush with inside of box
d. Backf ill material contains stones < 4" in diameter
e. Curtain drain installed according to plan
f. Curtain drain outfall protected & dir.to exist. watercourse
g. Footing drains discharge_away fran SDS area
h. Surface water protection adequate
-
i. Errosion control provided on slopes greater than 15 %.
' 77� S 7 7 �
n- {' tk
P,UTNAM COUNTY DEPARTMENT OF HEALTH
Dlvision'of EnvireumenUl Health Seirylces Ct emel N Y.105 Engineer O provide Permit tY
oa CERTIFiC TE' F COMP CE
PWGtMg type • r ��••�•_j�,•• Lot Area .� • •• • `– rw section UNy I L' Depth Volamo'
Number Of Bedrooms Design Flow G P D �%� ` PCHD NotlOcatiouas Required When FM le rnmpletod ,
Separate Sewerage System to rnnset of ?- Gallon Septic Tank
To be constrtiMed by'' 7- .,C�',r%'�%i /i{%.D
Address
. i
Wat6r.S4,013 `` PaBilc:Supply From Address
onPrlvate Supply DrOled by
/� % � Address
Other Renuiremeats '
1 iepresent.�that 1 am wholly and completely respon sib 16 for the design and loutiOniof: the proposed systems) 1) that the% separate sewage disposal system
above described will be constructed as shown'on the approved amendment there ao and -in accordance with the standards ,rules an- regu # ions o e u nam
County Department oP..Heakfi ; -'antl that on completidA thereof a .Certificate -.,of ConttiuctiontCompliance satisfactory tome Commissioner of Hea_lihwill
be submitted -to the`, Department; and 'a: wntten.guarantea, -" be furnishetl.,the owner, h�ssuceessors;'AeHSor issigns by the Duildor, that-said,.builder- Will
puce n good operating'eondition any?part of said sewage ,tlispossl'system dunng,the.period'of two(2).yearsimmetlutelyiollowi4q itedate of tfie issu-
ance of the.apDroval o "i, the Certificate =,ot Cdnstruct�on Compliance_ of he or�gmal ystem or .any :repairs thereto;2) that the.drillad; wall tlescritrod above
will De located ai shoavn on the approved plan and that said well wJl be ins a etl in accordance with the it der rules antl ,requ aaTf'ons of the Putnam
County Department of Health c a'
Date,:: /, Signed
R.A.
Address
;.
APPROVED FOR CONSTRUCTION This aDprovai expires tw.o yeas 'from t date slued unless. construction ;of `the building has
"been undertaken and is
reyocaDle' /or,`cau .or, mq amended or = modified, whencoris�dare neces `?Dy Y om iss' i of eatth.: Any ' change or. alteration of construction
reQuires a new ermrt proved for disposal* of domestic' saint ry ge and a
87 Data BY Tula�V E:�1
ti
Cif
DEPARTMENT OF HEALTH
Division of Environmental Health Services
TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641
APPLICATION TO CONSTRUCT A WATER WELL
PCHD PERMIT #j P-3-3 �
WELL LOCATION
Street Address
?t:�i�/fiQ�
Tow Villlp�age� //City / Tax Grid Number
/•��v �/
WELL OWNER
Name
Mailing Address 7 Private
zsr�l�•� 0 Public
USE OF WELL
primary
2 - secondary
aRESIDENTIAL
® BUSINESS
O INDUSTRIAL
O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O ABANDONED
O FARM O TEST /OBSERVATION O OTHER (specify
O INSTITUTIONAL O STAND -BY El
AMOUNT OF USE
YIELD SOUGHT
gpm /# PEOPLE SERVED :3- ,_5_ /EST. OF DAILY USAGE gal
REASON FOR
DRILLING
KNEW SUPPLY O PROVIDE ADDITIONAL SUPPLY O TEST /OBSERVATION
❑REPLACE EXISTING SUPPLY ❑DEEPEN EXISTING WELL
DETAILED
REASON FOR
DRILLING
.S ��✓��C�=
WELL TYPE
DRILLED
1 344
DRIVEN
ODUG
®GRAVEL El OTHER
IS WELL SITE SUBJECT TO FLOODING? YES NO
IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: 4 /!/.lJG7
Lot No. 1112
WATER WELL CONTRACTOR: Name Address:
IS PUBLIC WATER SUPPLY AVAILABLE TO SITE :. YES A( NO
NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY
DISTANCE TO PROPERTY FROM NEAREST WATER MAIN:��
LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED
O ON REAR OF THIS APPLICATION SEPA TE HEET
(date) ( gnature
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 pro id d th Putn o n
Health Depa ent.
i
Date of Issue: 19
mit I'ss ng ffi cial
Date of Expiration 19
Permit is Non - Transferrable to copy: H.D. File
Yellow copy: Building Inspector
Pink Copy: Owner
287 orange copv: Well Driller
LF trench provided
required
60 ft. max.
P^ el. to
House Plans - Two sets
Well permit; PWS letter
Variance Request
GENERAL
Legal Subdivision
Subdivision Approval Checked.
Ex- approval SSDS Adj. Lots Checked
Wetland (Town /DEC Permit R & D)
Data On DDS Plans & Permit Same
REQUIRED DEPAIIS ON PLANS
Sewage System Plan - (north arrow)
Sewage System Hydraulic Profile - Gravity Flow
Fill Profile & Dimensions - Volume
D or J Box;Trench /Gallery; Pump'pit details.
Septic Tank - Size, i
'Yell Detail, Serv.ic i e i over
nstruction Notes
Design Data: perc d results
Two -Foot Contours Existing & Proposed
Driveway & Slopes Cut
Footing /Gutter,Curtain Drains (discharge OK)
Perc & Deep Holes Located
Representative of primary and expansion
Expansion Area;shown;gravity flow,suff. size
If Pumped Pit & D Box Shown &.Detailed
House - No. of Bedrooms
Wells &.SSDS's w /in 200 ft. of Proposed Systems;
Property Metes & Bounds
House Setback Necessary (Tight lot)
House Sewer - 1 /4 " /ft. 4 "0; Type pipe
No Bends; Max. Bends 45° w /cleanout i
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
10' to P.L.., Driveway, Large Trees,Top of file
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake (inc. expan
15' to-Drains- Curtain, Leader, Footing
351to catch basin,stormdrain,piped watercours
10' to Water Line (pits -201)
50' intermittent drainage course
Septic Tanks
10' from Foundation; 50' to well
15' Well to PL
d
` REVIEN SHEET - CONSTRUCTION PERMIT
}"
y
DATE
BY:
R4VIEWED
(Name of Owner)
Ica .NTS
(Stree Location)
YESJ-A I YES, - Dods
Lo
_ Permit Application
Corporate Resolution
Plans - Three sets
s/s
✓ Engineers Authorization
Design Data Sheet (DDS)
SUBDIVISION
Deep Hole Log
Perc g:
Consistent Perc Results
(3) Fill
Perc Hole Depth
cd
LF trench provided
required
60 ft. max.
P^ el. to
House Plans - Two sets
Well permit; PWS letter
Variance Request
GENERAL
Legal Subdivision
Subdivision Approval Checked.
Ex- approval SSDS Adj. Lots Checked
Wetland (Town /DEC Permit R & D)
Data On DDS Plans & Permit Same
REQUIRED DEPAIIS ON PLANS
Sewage System Plan - (north arrow)
Sewage System Hydraulic Profile - Gravity Flow
Fill Profile & Dimensions - Volume
D or J Box;Trench /Gallery; Pump'pit details.
Septic Tank - Size, i
'Yell Detail, Serv.ic i e i over
nstruction Notes
Design Data: perc d results
Two -Foot Contours Existing & Proposed
Driveway & Slopes Cut
Footing /Gutter,Curtain Drains (discharge OK)
Perc & Deep Holes Located
Representative of primary and expansion
Expansion Area;shown;gravity flow,suff. size
If Pumped Pit & D Box Shown &.Detailed
House - No. of Bedrooms
Wells &.SSDS's w /in 200 ft. of Proposed Systems;
Property Metes & Bounds
House Setback Necessary (Tight lot)
House Sewer - 1 /4 " /ft. 4 "0; Type pipe
No Bends; Max. Bends 45° w /cleanout i
SEPARATION DISTANCES SPECIFIED ON PLAN
Fields
10' to P.L.., Driveway, Large Trees,Top of file
20' to Foundation Walls
100' to Well; 200' in D.L.O.D, 150' pits
100' to Stream, Watercourse, Lake (inc. expan
15' to-Drains- Curtain, Leader, Footing
351to catch basin,stormdrain,piped watercours
10' to Water Line (pits -201)
50' intermittent drainage course
Septic Tanks
10' from Foundation; 50' to well
15' Well to PL
d
PUTNAM COUNTY DEPARTMENT OF HEALTH
Division of Environmental Health Services
AFFIDAVIT - CORPORATE OWNER APPLICATION
FUR PERMIT APPLICATION SUBMITTED TO
PUTNAM COUNTY HEALTH DEPARTMENT
TO: Commissioner of Health
In the matter of application for: CEIVED
Cornwall Hill Estates, Inc.
I, Kenneth Emerson '87 APP 22 P 2 :17
represent that I am an officer or employee of the corporation and am authorized
to act for Cornwall Hill Estates. Inc.
(Name of Corporation)
having offices at 223 Katonah Avenue
Katonah, N.Y. 10536
Whose officers are:
President: Edward H. Emerson, 223 Katonah Ave., Katonah, N.Y. 10536
(Name and Address)
Vice - President: Kenneth Emerson & Martin Diano, 223 Katonah Ave., Katonah,N.Y.
(Name and Address)
Secretary: Janet G. Mastropietro, 223 Katonah Ave., Katonah, N.Y. 10536
(Name and Address)
Treasurer: Lynne Diano, 223 Katonah Ave., Katonah, N.Y. 10536
(Name and Address)
and that I am and will be individually responsible for any and all acts of the
corporation with respect to the approval requested and all subsequent acts relating
thereto. /j y
Sworn to before me this % day Signed: /u•
of 1 19 V Title:
Notary Public
.LIONEL V,1EINSTEIN
Votary Public, State of New YDW
No. 60. 4199160
Qualified In Westcliwter CODA. ,
UbrAniss�h- Expires Morc:h 30,19
8/84
'Vice President
Cornorate Sea
I'U`'NAM COUN`!'Y DLPARTMENT OF ]U?AU`rIi
i1i V l:il UiV Ui , i;1V VIR01w,16111'AL HL.AiA'H SMiVICES
COUNTY OFFICE BUILDING, CARKEL, N. Y. 10512
DE31ON DATA SHWI'- SEPARATE SEWAGE DISPOSAL SYSTEM PILE NO.
AQSO , }�1.1�. -tO'S8
u�rtie.r �-O �, Addresa�{�j C'�i.�'t'(AA. , �, 'Z
�Located at (Street �'` �.� Sec . ('� B1 oc k Lot�earest cross areet:7
MwLicipality j"T�(Z Watershed �Q�"n��
SOIL PERCOLATION ` EZT DATA REQUIRED TO BE SUBMITTEb WITH APPLICATIONS
IIuT�
Nwnl -r
CLOCK
TIM13
PERCOLATION
PERCOLATION
WWI
Nu.
-Start
-Stop
kUapse
Time
Min.
Depth to Water
From Ground
Start
Inches
Surface
Stop
Inches
Water Level
in Inches
Drop in
Inches
Soil Rate
Min. /in drop
50
::_.. 2
1
4
5 .
t -0
' .1 L•.
NULun: 1) 'rests to be repeated at same depth until approximately equal soil
rites.are obtained at each percolation test hole.. All data to be submitted
for -niv 1"•w .
' % .I )th meas.urement:3 to he made; from top of hol e .
UL•'P`1'H
6
TEST PIT DATA REQUIRM TO BE SUBMI'711M WITH APPLICATION
i)E6Grurl'.1uN Of" SOiL; IN Th;61' BOLLS
HOLE NO. �_ ROLE NO.� HOLE NO.
G. L.
61' 7TQ eaQt�
12"
18"
2411
) It
36"
4 211
i� �of
'I-A 11
ll..•r 11
vlt
1 N1)1 CATER; LEVEL AT WHICH GROUND WATER IS .ENCOUNTERED .
I ND IC A`PE�E LEVI ;L TO WHICH WATER LEVEL 'RISES. AFTE13 BEING ENCOUNTERED
TESTS . NE )W BY R. to Date_ •:. L
DMIGN
Soil 'Rate Used MirVi "Drop: S.D. Usable Area Provided S°oa® �.F.
No, of- Bedrooms ii Septic Tank Capacity 9 ® ® o` Gerl�; N►1- �e
Absorption Area rov d� By g o L.F.x24" -` `c t1- rencT1.1
Nanx� ,v gna u e
z
Address Zx> t �E SI�I!
N.
U 04
%b.
THIS 'SPACE FOR USE: BYMAUM DEPARTMENT ONLY: ®
boll Bate Approved Sq. Ft /Cal. Checked by bate
R ECC,. 6
I ED
PUTN DEPT A F �-OUNTY
HEALTH
4
F7c- -7 -,�>U,77--1
. A ce, -
As E5U I L,-r
1--, 50,
r7
Spa
A5-I-,5UII -'(
t�IMENhION� GNA12`(
Nell
A
P>
1
22.5"
G7.5'
2
35.0'
Goo'
5
X9.5'
X3.5'
7
62.0'
35.d
8
GO.0'
3
82.0'
IOS.O'
10
90.0'
105.0'
I I
92.0'
101.5'
12
94.0'
90.5'
13
O1S.Q'
9G.0'
IA
G
V
16
co 1.5 "
90.0'
I..
A5 SUII,T
i
iNl� I� TD GG2TI�( THAI THE �GN/AG(i I%1�1�0�
5�l5TEM WAy INDIGA'itid ON
'fHly t7t,AN AND -(HAT <HC,- INSpE
0',( M5 13Et/o2t: l'( WAS GOV5�IZOW O\I>i1Z . THE s
W,q� GON�TiZUGTI:D tN A6609- t7ANGE WKH AV
STANDAtZD RULES ANA THE
r,V-fNA M GO U IJ'CY P VWA RTM E NT O F H C-,A vrH A N t
NSW YOIZV- OF HV--A,(H.
NOTE' HOUSt✓ �OG/�'ftON '�P�KEN Ft20M "BUR
P20PERL1'{ " OF LO'( I � P12>it�Al2En X012 KATOr
G�06E t�ATI:D I - �- 8�, pt2>ipA121:D 01Y 1?,UNN
A��OGtATES, IP�Nt� S��zJEYDt2S .