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CROIX COUNTY ZONING DEPART A r AS BUILT SANITARY REPORT Owner v a M6 r n t 5 x'9 'ti Propert Address - i r�4 couNr�r City /State Zn' °'INCiUF► \ Legal ription: Lot Block Subdivision/CSM # LV t /a /a, Sec. /� , T N -R_�j W, Town of 51 PIN # Q /0 - -acts SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer lJ 1. 5¢- Size ST/PC 16Z� Setback from: House .9.3 Well �— P/L Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line 7 / Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system re- s Width , _ Length 5 Number of Trenches I F Setback from: House _.�� Well N k P/L 9.:Z Vent to fresh air intake 76 ELEVATIONS Description of benchmark SW Co r �'� S" Elevation- Description of alternate benchmark Elevation Building Sewer ST/HT Inlet .7 z ' ST Outlet /J Z PC Inlet Y PC Bottom Header/Manifold C Top of ST/PC Manhole Cover Distribution Lines O 1641 O ( ) Bottom of System (1) q' 75 (�) �� 95 ( ) Final Grade O t t-? O� �' ( ) Date of installation / / ermit number 3�??�O State plan number Plumber's signature L L — . � License number a z 0 5 3 7 Date la l 9 Inspector Complete plot plan NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. a j6, PLAN VIEW r1 I V V O a INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit N -: ST CRO EX Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 338942 Permit Holder's Name: ❑ City ❑ Village X) Town of: State Plan ID No.: GREENWOOD ENTERPRISES STAR PRAIRIE CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.: l 00 00 5 a 51a kol 038-11055-20— TANK INFORMATION ELEVATION DATA A 990019 1 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic r p�- p Berichmark 12_13 2,(0 (OQ Dosing q Aeration Bldg. Sewer HoIdjP9 01 06 Inlet &, 0 0 rT7 TANK SETBACK INFORMATION &(t Outlet 03� Z Q TANK TO P / L WELL BLDG. Air i to ntake ROAD D et ir Septic ( f�q NA NA D om Dosing NA Header/ Man. - 3 /o/. Aeratio NA Dist. Pipe T /1, ( O PI 74D.-Ty -�� Holding Bot. System *t / . PUMP/ SIPHON INFORMATION Final Grade 1 0-3 1 �aZ. Manufacturer Demand .17 1 0 46 4 f /. d Model Number GPM TDH I Lift L oss Iction S m TDH Ft Forcemain I ength Did. Dist. To well I F SOIL ABSO PTION SYSTEM BE TRENC Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DI r , 2 Z DIMENSION SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING Manu cturer: SETBACK r *C/ INFORMATION Type O 00 / /I AJA O R UNIT del � {um er: S stem: e /`1' k DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Si x Hole Spacing Vent To Air Intake � Length Dia - Length _54 , ia. '�-4 Spacing Yv /T J J 1 4 7 0 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons resent, etc.) LOCATION: STAR PRAIRIE 13.31.181�pNW,SW 2133 CTY RD "CC" / n��t iw Or 411// of 'PiHI( 101 pmehtah prilm a / ---30t &;(,A;y seer (J) 411 5� "404 Cover ",-7 Plan revision required? [:]Yes O'No q �I Use other side for additional information. SBD -6710 (R.3/97) Date Inspector - nature Cert No- Safety and Buildings Division N*Wonsin SANITARY PERMIT APPLICATION 201 W Washin Avenue Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. ST • See reverse side for instructions for completing this application State San it Permit Num�berr Personal information you provide may be used for secondary purposes p Check if revisi pre 0 p"ication [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Pro erty Owner Name Property Location 'o-,e N'42A S %,0 1/4, S T , N, R YE (or Propert y O ner's M it gAd re T— Lot Number Block 6 I ` r i y, St to p Code Phone Number SubdivisipRName r CSM Number I. TYPE OF BUILDING: (check one) ❑State Owned It Nearest Road Village Public Pg 1 or 2 Family Dwelling - No. of bedrooms LI Town OF Ill BUILDING BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 3(, «, P3 A E] `�-' 1 Apartment/ Condo 3 `' 05s_ 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office / factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. -, New 2 ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System ________ System_____________ Tank Only______________ Existing System ________ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 p# Vepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 VSeepage Trench 22 ❑ In Ground Pressure :;) 3 , X • �� 42 ❑ Pit Privy 13 ❑ Seepage Pit // 43 [] Vault Privy 14 ❑ System -In -Fill k; I 4 y r r a c3� 7 VI. ABSORPTION SYSTEM INFORMATION: U . 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System EI 7. Final Grade Required (sq. ft.) Proposed �sed (sq. ft.) (Gals/da /sq. ft.) (Min. /inch) S � Elevation td 9`. ? X 9�{+'FL /01 Feet VII TANK in g all ons Capacit Total # of Prefab. Site Fiber- Exper. INFORMATION New Existn Gallons Tanks Manufacturer r s Name Concrete st un Steel glass Plastic App T nks Tanks eptic Ta 1 6& — , --Id �Q�p ❑ ❑ ❑ El 1:1 Lift Pump Tank /Siphon Chamber ❑ 1 ❑ 1 ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: t) P ber's Signa re: No Stamps) MP /MPRSW No.: Business Phone Number: s.3 s c S? Plumber's Address (Street, Cit , State Zip Code): A' V � I V —2 W IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing A en gn ture (No Stamps) A� roved surcharge Fee) p' pp ❑ Owner Given Initial � �60. 2 Adverse Determination IO l X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: 4 I SBD- 6398 IRA 1/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber 1 INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2_ Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3151. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc,), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than,8 1/2 x 11 inches must be submitted to the county. The must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction Foss; pump performance curve; pump model and pump manufacturer D) cross section of the soil absorption system if required by the county; E) soil test data ors a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. - 'Ian PI 57- c M; �c Cj t �anW o oc� r►`ehP h `�eS �nc.. Nth A $an�RMwwk• Sw 10� S r.+��c / `L D � :3? 31.E �� w s `1 I, v 3.f3� b :-I0000/ , 8f p Z cn •7 Ji S ,If t •Wisconsiri -D of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Difision of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # �]( g �_ �- dimensioned, north arrow, and location and distance to nearest road. 038 - 1D'3 APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION R rED BY DBE I PROPERTY OWNER: PROPERTY LOCATION l � Greenwood s GOVT. LOT NW 1/4 SW 1/4,S 13 T 31 N,R 18 k (or) W PROPERTY OWNERS MAILING ADDRESS LOT # I BLOCK # I SUBD. NAME OR CSM # 1416 Third St. 5 na NorthGate CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE []TOWN NEAREST ROAD Hudson WI. 54016 (715 386 -3674 Stair Prairie 1 214th Ave. (x] New Construction Use [ :4 Residential / Number of bedrooms 4 ( ] Addition to existing building (] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd /ft •8 trench, gpd /ft Absorption area required 858 bed, ft 750 trench, jt2 Maximum design loading rate • 7 bed, gpd /ft • trench, gpd /ft Recommended infiltration surface elevation(s) 99.75 -98 98. %.32 It (as referred to site plan benchmark) Additional design / site considerations t g 3 Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ? S E] U K7 S ❑ U 7KIS ❑ U ®S ❑ U ®S ❑ U 1 0 5 M U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Baincbry Bed Trerx ..., 1 0- 1 1 r 2 10 -24 10 r 4/4 none sicl lcsbk mfr Ground 3 24 -84 7.5 r 4 elev. 1Q3�3• Depth to limiting factor + Remarks: Boring # 1 0-14 2 14 -84 7.5 r 4/4 none ms 0SQ ml na na .7i .8 Ground elev. 3 ...... , 1 P��E V _ Depth to limiting N , factor i +841 ST CR k IAiG OFF+CE Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 it I 1 L� Address: 1554 200th. Ave,,oNew Richmond WI 54017 Signature: Date: 10 - - CST Number: m02298 1 _ PROPERTYOWNER Greenwood Enterpris .DESCRIPTION REPORT Page of 3 ' PARCEL I.D. # 038- 1055 -20 �. Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bour>dary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0-12 10yr 2Z2,.— none 1 2msbk mfr gw if .5 .6 2 12 - 10 r 4/4 none sicl 2msbk mfr gw if .4 .5 Ground 3 44 -84 7.5 r 4/6 none cos oscj ml na na .7 .8 elev. 10 Depth to limiting factor Remarks: Boring # 1 - 1 2msbk mfr Cfw if .5 .6 2 11 -15 10 r 4 4 none sicl lcsbk mfr if .2 .3 Ground 3 15 -90 7.5 r 4/4 none cos 0sq ml na na .7 .8 elev, 100.4¢ Depth to - limiting factor Remarks: Boring # 1 0 -24 10 r 2/2 none 1 lcsbk mfr Aw if .4' .5 5 2 24 - 46 10yr 4/3 none sicl 2msbk mfr gw if .4 Ground 3 46 -50 10 r 4/3 c2d7.5 r 5/6 sicl lmsbk mfr gw na .2 elev. 10 0.65 ft. I- none ms 0scl ml na na .7 . 8 Depth to limiting factor +90" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) l STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Greenwood Enterprises, INc. New Richmond, WI 54017 MPRSW -3254 NW-4J-4 S13- T31N -R18W (715) 246 -6200 town of Star Prdrie lot #5- NorthGate This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. N 1 =40' BM.= top ofSW lot stake @ el. 100 Alt. BM.= top of tel. ped C el. 101.85 p4 , r 0 a f 0� Gary L. Steel 10 -27 -98 t ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer -Q q ` S `Q Mailing Address I'y 1 to h���� Property Address o� ec�� , A✓� P Y (Verification required frorUanning Department for new construction) XT City /State 1 L 4 4 arcel Identification Number (93 t� a LEGAL DESCRIPTION Property Location i� W '/4, '/4, Sec. l�, T_:jj N -RI-5 W, Town of � ' Subdivision �j 0 , Lot # S Certified Survey Map # 35 63 . Volume , Page # s �� Warranty Deed # 12 7 , Volume I �5 , Page # Spec house (r yes ❑ no Lot lines identifiable yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance' consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification . stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 da f the th4ye date. G96ENWCUD aN r " (Ne . ay GNATURE LICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of ;GNATURE roperty described above, by virtue of a warranty deed recorded in Register of Deeds Office. -�2 E5.V c.� c�A anf T I ry c .�.' OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1 -1982 a W ORANTY DEED 58777 :. ALL _ ,i9ph(; 4 7 4 F Deed made between Walter H. Kraemer, a CROIX CO„ Wl ing s le _pe RO Nd ktr Assord EP 2 4 1998 Grantor, # y� and Greenwood Enterprises, Inc , a Wisconsin corporation � ot� of Deod� Grantee, Witnesseth That the said Grantor, for a valuable consideration - - -- - -- - -- — - -- -- RETURN TO conveys to Grantee the following described real estate in -, St Croix LAWSON, MARSHALL, McDONALD County, State of Wisconsin: 3880 Laverne Ave. No. Lake El mo, MN 55042 See attached Exhibit "A ". C3$ -)055 - 10 O - 1 095 r 95 Tax Parcel N o: C) , TRANSFER $ s oa This is not homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And — _ — warrants that the title is good, indefeasible in tee simple and free and clear of encumbrances except and will warrant and defend the same. Dated this day of R 1 9 — — (SEAL) (SEAL) Walter H. Kraemer _(SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF DOktW=$AWINNESOTA WASHINGTON ss. County. authenticated this-----day of_ -- , 19 � Personally came before me this day of Yk the above named Walter H. Kraemer, a single person j TITLE: MEMBER STATE BAR OF WISCONSIN (If not _ to me known to be the person who excuted the authorized by § 706.06, Wis. Stats.) foregoing instrument and acknowledge the s me. THIS INSTRUMENT WAS DRAFTED BY LAWSON, MARSHALL, McDONALD & GAL0141T Lake Elmo, MN 55042 JOHN MCDONA Telepho (651) 777 6960 s� A10R�1yIP� nnesota (Signatures may be authenticated or acknowledged. Bot " mmisslp,n I � are not necessary.) &VAI SStonEX 1;'gS1/31 t. (If not, state expiration Names of persons signing in any capacity should be typed or printed below their signatures. SB1 NTF 0020 WARRANTY DEED STATE BAR OF WISCONSIN Nelco Forms, P.O. Box 10208, Green Bay, WI 54307 -0208 I, FORM No. 1 -1982 J j - 1 VOL 1.3 ) Dac[ 4,75 EXHIBIT "A" A parcel of land being all of the NVE1A of the SW 1/4 and all of the NW 1/4 of the SE1 /4 and all of the NW 114 of the SW 1/4 except the North 470' of the West 463' of said NW 1/4 of the SW 1/4, all being in Section 13, T3 IN, RI 8W, Town of Star Prairie, St. Croix County, Wisconsin. I J J wooer uj-r S 0 Nar-tk N A C C 9 c Ewca E o o �� =� ° - a c T- M 0 > � c ` x co ui • .n E Q N x 0) M � 0 3 -0 c co N co N rj V C°7 T N c' 0 +� N U O cd O a) c ILI o L E 4 C U Em U O 4- = _ N n JO -0 0 cd (n 00 cz c�E�c U x M CO LL N N U N� � x $y > C2 C _ 3: L H O JJO2 v1 65 U) > s �s / 9$ N ^U 0 m V my m m � CO � a Q U C p H— , z m N co _ ' oLL „s 0 N rn y O � UJ a tD L c N o �-- ' m n w W oN s o U 0 c1 a . co m '0 cc W � O O r t0 co U t0 t ..ice c ; N t 10 co $� m J YI :1� 6 035 , 03 S By 07' 7• POINT OF BEGINNING E A 26 E 3l 6 2 _ 1 `R W 1/4 CORNER SECTION 13, 68.00' 7882' /// T31N, R12V 50• r,6O' BARN t SILO FOUNDATIONS TO 14 82' ; 250 00' BE REMOVED I m -J ? o H i 7 o I' J� /J o rm in I If o w ` oc 72.330 sq. — o i 1660 x. m co 2 — ���� q 3 L J Z 6 1 n 00' 90.680 sq. R. `''fl S89'07'26'E 2.082 ac. / in • A � 0 >( � CD z _ QQ� v� Z ti 12 6. 7 X 1 n , ( pE z Ni 1 i -+ Y _ 16502' "p0 3A E z tLj o� 3 I82o _, .22 � 10 ^ , 256.26' — 1x682' -- -- 2 66 3A •' w y ^ M o S f � 89 . 07'26'E 421.28' _ C31f1N1 i a�8 - 16.92' ® A� 2� o N89'07'26'W 420 00' - - U I H Z gq I W C o r o i a 'COQ Q, O Q o .ol 3 P ' m o !" cn v c; I JQ-` � 0 �,•� � U z �' - -- 5, --�___ o �I ' � ^ 66,555 sq. R. 01 4 ti�~ a� (7 1.528 ac. ce > �, vot��`'� ch al } z nVi V� �{ 82 o O /�►O q �i Z P / Top ° 1 otxTO" , m z / g oo X b L4 ° a S89'07'26'E 480.01' 76.00' SF,2 4 60.01' 3 420.00' 489'07'26'W ti 60 �0 Li y 50, ° °D cu ° S SECTION aco o Z 0 s9 96,918 . R. �� ALU > z i 2.225 ac. O 2" X 36" R( Ej X33' 55', 3.65 Oft N > Ilf)I o \0 ��" .v� Q�/ • 1,25" IRON oj W, Q T 42' 1'_' U fIL 11 V, fVl 3 3 i. — 12' 1Q S Qj / 1-01 BUILDINC J cn ("I c`•1 t PONDING d o o / ALL OTHE Z I42' Z Z WIT