Loading...
HomeMy WebLinkAbout038-1164-30-000 / y \ 2 \ � \ \ j & % �. / � 0 © % D 72 /p . ® EE ( � � \ cc 77 co 0 . z § 5 c� 2 2 '6 q Ear < z . � » � � ? \ z \ w % \ o E \ \ o § § \ a ■ ! E § z \ 2 \ t z \ \ § a \ ■ w 2 S [ { \ e _ \ ca- In } -� \ ) \ + ' d 0 \ § 2 < / \ z = z 0 .. z a I \ '0 \ Cg E c < ^ a � % \ §E CL % £ / ® ) e 7 \ \ § a co § k § 2 2 2 i & \ \ 2 ] q \ / \ / z _ \ o = LO § \ § o / c a. . < � o2 a 2 # z m m t \ \ = kCD _ k � \ a \ \ \ ) k 2 112 & ) \ \ 5 $ / ] & \ - \ \ \ \ \ ` -c 3 \ % V) R g \ ] z o z / / k A � ® � E § \ K C & J a 2 \ 0 & J VEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING LABOR&HUMAN RELATIONS DIVISION P.O.BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION MADISON,WI 53707 State Plan I.D.Number: SW-',, SE�,S30,T31N-R18W � CONVENTIONAL F-1 ALTERATIVE (Ifassigned) Town of Star Prairie 0 Holding Tank ❑ In-Ground Pressure ❑ Mound WAVVIE E ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Tam Martell Route 1, Sanerset, WI 54025 1 N- 3 d BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Calvin Powers Jr. 1563 St. Croix. 119454 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY I WELL: BUILDING:I VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: ❑YES ❑NO ❑YES ❑NO NEAREST-� DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: P PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING:I VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF) ❑YES ❑NO NEAREST--� SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire,construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID TRENCHES: MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FfLL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV.INLET: ELEV.END: PIPES: FEET FROM LINE: AIR INLET: NEAREST MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑YES ❑NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE I MANIFOLD MATERIAL: NO DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: ELEVATION AND ELEV: ELEV: DIA.: ELEV.: PIPES: DIA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS [:]YES ❑NO I ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM ❑YES ❑NO ❑YES ❑NO NEAREST No Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: SBD-6710(R.06/88) Zoning Administrator E�TQLHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05,Wis.Adm.Code COUNTY STATE SANITARY PERMIT# -Attach complete plans(to the county copy only)for the system,on paper not less than I I C/45 8%x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D.NUMBER I. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. PROPE OWNER PROPERTY LOCATION—qkd '/4, 6F , N, R (or)62 M PROP RTY OWNER'S MAILING ADDRESS LOT# BLOCK# C STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NU I M M ER .r 0 CITY II. TYPE OF BUILDING: (Check one) ❑State Owned ❑ VILLAGE NEAREST ROD ❑ Public ®1 or 2 Fam.Dwelling-#of bedrooms/—I PARCEL TAX NUMBER(S) 111. BUILDING USE: (If building type is public,check all that apply) e;7 7 1 ❑ ApUCondo 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/C r W 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ® Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. V1 New 2. El Replacement 3. El 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## — Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 ❑ Mound 30 El Specify Type 41 El HoldingTank 12 Im Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1.GALLONS PER DAY 2.ABSORP.AREA 3.ABSORP.AREA 4. LOADING RATE 5. PERC.RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED(sq.ft.) PROPOSED(sq.ft.) (Gal /d /sq.ft.) (Min./inch) ELEVATION Feet 1,0d, 9 Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Se tic Tank or Holdina Tank Lift Pump Tank/Siphon Chamber VIII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name(Print): 177�' Sig ature: No mps) MP/MPRSW No.: Business Phone Number: ��L 'j/ Plumb 's Address(Stre t,City,State ip Code): bC,11A&A4W 14) IX. COUNTY/DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee(includes Groundwater Date Issued IssUln Agent Signature(No Sta s) Initial Surcharge Fee) Approved ❑ Owner Given , Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-8398(formerly Plb-67)(R.11/88) DISTRIBUTION: Original to County,One Copy To:Safety&Buildings Division,Owner,Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the 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 & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. 11. Type of building being served. Check only one and complete ## of bedrooms if 1 or 2 Family Dwelling. Ill. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in 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 in ##1-7. VII. Tank information. Fill in the capacity of every new and/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% x 11 inches must be submitted to the county. The plans 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 loss; 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 on 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, ground- water contamination investigations and establishment of standards. SBD-6398(R.11/88) of � APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------------------- Owner of property Location of property _51d_1/4 _S.d'_1/4, Section 3D , T_,?� _N-R_Zd'-W Township _� �/,Ps r Mailing address Address of site Subdivision name [=1���?'(C '�J ,4,04--; 'dw Lot number 43 Previous owner of property Total size of parcel Date parcel was created Nov / 9 Vr Are all corners and lot lines identifiable? --Yes No Is this property being developed for resale (spec house)? Yes _ No Volume and Page Number as recorded with the Register of Deeds. ------------------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. ---------------------------------------------------------7--------------------- PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty de d recorded in the Office of the County Re a of Deeds as Document No. ���' ; and that I (We) presently,,,-'own a proposed site for the sewage disposal system (or I (we) have obtain an ,as_ .pnet, to run with the above described property, for the c `" of sa' system, and the same has been duly recorded in the Office o ister of Deeds, as Document No. ) . ignature of Owner Signature of Co-Owner (If Applicable) Date'o Signature Date of Signature -DOCUMENT NO. STATE BAR OF WISCONSIN FORM 2-1982 THISSPACI=RESERVED FORAECORDING DATA WARRANTY DEED Lester H . Martell a married man REGISTER'S OFFICE ST. CROIX CO:, WI Rec'd for Record conveys and warrants to Thomas W . and Mar o r i e N 0V 1 81988 Martell husband and wife at $4- 9:15 A. M Register of Deeds`r RETURN TO the following described real estate in St Croix County, State of Wisconsin: Lot 13, Crestview Addition , in the town of Star Tax Parcel No: Prairie , St Croix Co, Wisconsin . EXEMPT ' This is not homestead property. (is) (is not) II� Exception to Warranties: Easements and covenants of record 1 I Dated this 15 day of Octoper is gg i(SEAL) _11fs_ ' <e� (SEAL) 1 • Lester H . Martell (SEAL) (SEAL) R AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. St Croix—County- authenticated this day of 19 Personally came before me thi �—day of 0 c t O b e r '19 the above named Lester H. Martell TITLE: MEMBER STATE BAR OF WISCONSIN (If not, t kno be the person who executed the authorized by§706.06,Wis.Slats.) fore rument and ac the same. THI S RU T WAS DRAFTED `� '4 Denni s F1 i sr•hgtipr L�tTt� Y N M ti 8rC I r Notary Public St--S£9 E County,Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not neces ary.) date: 1 Sept 1990 80 Names of persons signing in any capacity should be typed or printed below their signatures. NTF 22 WARRANTY DEED STATE BAR OF WISCONSIN Nelco Forms,P.O.Box 1075,Green Bay,WI Form No.2—1982 54305.1075 t '3•"`'.`- 4-',i'G+r.3'n .... r.".'±'uxWM'MV.'Y.h+n+�.SYN t>..IMYtl.1fi sM4V t+1\y �. D7PNr.':q: .:YPb94xKSt •tMl?R# n^-. ;Cr .. STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ROUTE/BOX NUMBER 16 FIRE NO. CITY/STATEo5& ZIP PROPERTY LOCATION: 13jdL_1/4 _1/4, Section y? , T.2LN, R_J2__W, Town of St. Croix County, Subdivision � �s'J'` /L•"/ fft'�DL1% Lot No. Y"-? . 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 SEPTIC TANK PUMPER. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and ree to maintain the private sewage disposal system in accordance with the- st dards set forth, herein, as set by the Wisconsin Department of Natural e o rces. Certification form must be completed and returned to the St. onin ice within 30 days of the three year expiration date. SIGNED ' DATE Yi z 5t y�T St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 r (715) 386-4680 Sign, Date, and Return to above address DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS IN,DUSI-R�(, DIVISION LABOR HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 (H63.090)& Chapter 145.045) LOCATION: SECTION:T p TOWNSHIP/MUNICIPALITY: LOT NO.:BLK. O.: SUBDIVISION NAME: COUNTY:,* O ER'S BUYER'S NAME: MAI I G ADDRESS: USE DATES OBSERVATIONS MADE NO.7MS]C!0MME CIAL DESCRIPTION: I PROFILE DESCRIPTIONS: ER LAT ON TESTS: Residence ®New ❑Replace Il RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK:RECOMMENDED YSTEM:(optional) 9S ou ©S ❑u ®$ ❑u ❑S2qu ❑SO " - - If Percolation Tests are NOT re uire DESIGN RATE: 4 If any portion of the tested area is in the under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH HICKNESS,C L R, EXTU E, D DEPTH NUMBER DEPTH ELEVATION OBSERVED EST. IGHEST TO BEDROCK I OBS RVED( E AB RV.ON BACK.) B- -, rtr •S s / /.yAd ter S 414AW, - s B- +JId sF,�/' �I 9 '� . R7A�.S•�JI��''� B- rc�L B- B- — .� w PERCOLATION TESTS Yi TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IN644Fk AFTERSWELLING INTERVAL-MIN. P RIO 1 PERT 2 P PER INCH P_ Ald" —740 !S` / %P_ f P-_ P- P- _ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suijab a soil areas`Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. fsh a surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION A lee _ I { I E I { .� I I 4� � 3 ii � j l tt 1 __.._....... _._...... .-.-• -_L_—_ 111 .,.....-_. }.._... . .. ....�._ __..._..... ,._..._. _._ � ' � 3 I f t i r , a I,the undersigned,hereby certify that the soil tests reported on this form were made by me in a d wit the pro Cl�'rs a methods pecified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my kno a e f. 'e NAME rint TESTS WER OM 7E ADDR S. CERTIFICATIO NUM PHON NUMBER(opt nal): CS S ATURE: DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — INSTRUCTIONS FOR COMPLETING FORM 119 - SRD - 6395 To be a complete and accurate.soil test,your report must inr.lude; 1. Complete le<tal description; 2. The use section must clearly indicate whether this is a residence or commercial project; . MAXIMUM number of bedrooms or commercial use planned; 4, Is this a new or replacement system; 5 Complete the suitability rating boxes, A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; d. PLEASE usa� the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet:may be used if desired; 8. k%Iake sure your benchmark and vertical elevation refei'ence point are clearly shown,and are permanent; 9. Co replete all appropriate boxes as to dates, names,addresses, flood plain data, percolation test exemp- tion, if appropriate; 10. If file information (such as flood plain,elevation) does riot apply, place N_A, in the appropriate box; 11, Sign the form a}ad place your current address and your certification number; 12- Flake legilfle; copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st st'-w (over 10") FAR — Bedrock oh Cobble (3 - 10") SS Sandstone gt C i a°uO (under 3") L5 Limestone `s Sa�td HGW --- Ilklh Giom, �t fatt;r r;u Coors Sand Perc €' rc ll'ition Rati s F ar .Grid Bldg t3 , ldinq i;• — Lo ugly and l Lrs�<rt Hn - R -dv n S,ilt Ley _. (31Z y ("'!'w "ti),iol y Ye iac r jri Sa dv Clay Lo,,w (I - R'cd silty v Loam t ; ., �arrdy ,clay s — `> :v Clay f t f(vv, r:r�� . 7 a rsl w — iklb l' tt' .... 'I >tInc! o ._. {Jr"orYWWIf rt 4 Six q rrr r ' soil .r-"O res sur-tac.e V aue� apt; astir disposal ISM t;,nch Rla'K VRP elrrticalR ri=rara Font v� h TO THE OWNER: This soil test report is the first strap in securing a sanitary permit. -[he county or the Department may request v iific.at"on of this soil test in the field prior to permit issuance, A complete set of plans for the private -evva(W system ancia permit p{lie<ttEon must b{� suEfrnitted ua (he appropriate local autixority Ira order to ohlaira a permit. Fl e sanitary prFrrnit natant; be otatained nand ps>>ted t-)rior to the start o€ary conso"c;tifan. ------- ce- 1h I Ta� 77� ?low TI tnLvi I A I I , I C I I, I I 1� I , i i t ; � ; ,—�� � �__; j i 7-1- 5*7 , —J-4� I - - - - -- ---- - - - - -- -- - --- -- - - - -- - ---- i ! - - I - I � ' I I I ! _! - ...- -- -- - --- - -- - - - - - - - - -- - - - . .._ ! 1 I I I , I 1 I i 1 I � 1 j i I -- --- - - --- ------ -- - -------- -- -- - - - --- - - --T _- - � I 1 i I I I i + t" � 5 , 6da►6b! Air «n4r.'-; F.n!a f•'+ aa-yn.eiro�s '�?�w � ;'����`"' 4 t _ Yk iql Caa± Iran ' v ta' 2.0-+4TH .4 buys ;,Ips r r{ done F'pc z Grp ;a To F:nal !,.C;fia �p a! + ! m { Diaulbollan f t Y h7ks ` ' VI!7a �� •rw. l fi t� �F d u aoroled Pl00 "*low 44 n lenrimoo, tla AI P M P'iW1 ,+6°+•`"93 w• .t';dam, �, � { S t 0 tWn S � St ( 1 bp,� �l } i P; a4 ��P�+� �' �� �i¢-et{ Gm.1.3''+t"ag.'t 6?1�r., A.'PP'R£2'VEty�: �•�� Ka 7+�5' GCf4 Jk 4 ...••}Y+.1mMly 4y.+4 ,1� a t � L! sy� I 1#\ 31 k"� ��"l�Cr iL, � y�' Fa „.+-.H►p+''L%t '. r•�x�«;e ( ari('a(A "/'^'N +. q.`h: .<va` y� S�' �•; m-,, 4p G'.. 7W QRI{.IRA GR,aDE 01--rRjj+,JTIt- Tr? (1 pIrF M'L.OW FIA1AL r.pl AD£ L AT L LAST 40 1tJr,HE.., '1 3 IM is \,41 L UCH $ �� . MlMB//�! G ffi"!9 P k F l t , 1 ' • L«CEMSE UUMBER: q= DATE : . }�. °,yP