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HomeMy WebLinkAbout020-1365-22-000~~ ST. CROIX COUNTY ZONING DEPA ''' Q •~- AS BUILT SANITARY REPORT Owner / ~` ~~- Property Address ~o Co City/State !~ L~-t..Z, Legal Description: Lot .~~ Block Subdivision/CSM # _ %a !~.%a, Sec. ~, T T~N-R~W, Town of _ ~ -~ [~ r ~ sv' ~ ~~:C~€~~~Q -- i 4 s e ~+ / ?C:7ii~Pi~JCzOF~iGIm ~,. ` ,~, /f i °~ PIN # C7oZG - 10 /O -d0 5EPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer • 1• ••- Size ST/PC O~_ Setback from: House Well --- P/L ~`~ Pump manufacturer ---~ Model ~' Alarm location (HOLDING TANKS ONLY) Setbacks: Service road _ Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: H•!a U~e~-'` Width 3 Length J~ lumber of Trenches oC Setback from: House ,~„~ Well --- P2 ~~Ya Vent to fresh air intake ~"' ELEVATIONS: Description of benchmark Description of alternate be: Building Sewer ~• a ST/IiT Inlet _ PC Bottom ~ Header/Manifold _ r~° ~~.ay Distribution Lines () to • $ c~ Elevation 9~' ~ yS Elevation • ~ ST Outlet y PC Inlet --'"" y~•3 ' Top of ST/PC Manhole Cover To~ ~!y• 2 ~ ~•~s () Bottom of System () ~~ ~ g~ () _ yo7• ~ ~ ( ) Final Grade () ~ 7• yd < () ~~ ~~ ~ ( ) Date of installation 3 /!d/ DoPermit number .3 S3 3 / a State plan number ~- Plumber's signature License number /`~~°• av~03J`? Date 3 / /a e o Inspector ~~~- Complete plot plan ~ Vent to fresh air intake Water Line x .r 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. • Sfiow alternate benchmark, if applicable. -~ PLAN VIEW , ~~ i ~,1 ~~ 0 ~~~~ .,, ,~a ,bOA _ ~ 'O i ~~ ~r 3 i ~ ' /wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM ~ 3af~Yy and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m}]. Permit Holder's Name: ^ City ^ Village ^7~own of: 'ollova Pat Hudson Township CST BM Elev.: Insp. BM Elev.: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. Vent to Air Intake ROAD Septic '~ ~-~ r - NA Dosing NA Aeration NA Holding PUMP /SIPHON INFORMATION Manufa~ Model Number TDH Lift _ Ion Syst~ Form I Length ,Dia. SOIL ABSORPTION SYSTEM ~q~ Demand GPM Ft Dist. To Well ELEVATION DATA County: St. Croix Sanitary Permit No.: 353312 State Plan ID No.: A.- Parcel Tax No.: pending STATION 85 HI FS ELEV. Benchmark ©~_a ~ c~G , ~b• Alt. BM a, 9B• S-5G Bldg. Sewer T• ~ ~j(. Z ~ St / Ht Inlet 6 .O q~ ob St / Ht outlet j, , ~$ 9~ ~'~ Dt I n I et ,r______._. Dt Bottom ~.------ Header /Man. Dist. Pipe ~S S ~~ Z ~ , z/ Bot. System •29 `j,2 ~0 Final Grade ~. c~~g ~~~` Sa.~- f,0~.r St cover ~ ?ZD qb- 35 h..n ~.~ nAr 1 ~ l/1A i.. ~+1iD TREN Width t Leng i r No. f nches PIT No. Of Pits Inside Dia. liquid Depth DIMEN I N / . ~1- DIM N I N SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O r ~ r ~ ""-" CHAMBER OR UNIT Model Number: System: ~+ D15TRIBUTION SYSTEM v ~-3~ ~ ~,.... Header /Manifold ~ Distribution Pipe(s) _^ x Hole Size x Hole Spacing Vent To Air Intake Length Dia. ~ Length ~- Dia. Spacing ~ ~ 3~ ~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over ~~ Depth Over xx Depth Of xx Seeded J Sodded xx Mulched Bed /Trench Center ~ Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: / / Inspection #2: / !_ Location: 666 Laurie Lane, Hudson, WI 54016 (SW 1/4~jSW~1lo4 10 fT29N R19W) - 10.29.19. River Park Meadows - Lot 22 e~Mu'OM1'~ ~ u~~i"" ~ hp,~~-.~q_u,~e/~?.u,¢r> 1.) Alt BM Description = ~ U / 2.) Bldg sewer length = ~ • ~ , -amount ofcover = > -~` ~°'"`' ~~"r" Plan revision required? ^ Yes (~ No Use other side for additional information. 3 1 ° [sD ~ ~ ~• SBD-6710 (R.3/97) Date Inspector's Signature Cert. No ~ 6~ G C, ~ E LSE ,,. ,`~SC0115%/1 SANITARY PERMIT APPLICATION Department of Commerce In accord with Comm 83.05, Wis. Adm. Code • .Attach complete plans (to the county copy only) for the system, on paper not less than 8 to x 11 inches in size. • See reverse side for instructions for completing this application Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04 (1) (m)]. Safety and Buildings Division 201 W. Washington Avenue POBox7162 Madison, WI 53707-7162 County Skate Sanitary Permit Number ~+~ 3S33~Z ^ Check if revision to previous application State Plan Review Transaction Number 1. APPLI ATION INFORMATI N -PLEA E PRINT ALL INF RMATION -~ Prope O er Name Property Location ~y sU,l t is ~ va, S 1 ~ Tar( , N, R ~ ~l~l ~o'~vJ Property Owner's Mailin~ dc/res Lot Numb~~ Block Number b ~5 r City, Stat Z Zip Code s Phone Number is>s s9~ Subdivi n Name or CS umb I1. TYPE F B ILDING: (check one) ^ State Owned 3 ~ Ity ~ town o Nearest Road / Public 1 or 2 Famil Dwellin - No. of bedrooms f !/lGt..t.lhr~ G. GI. III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ^ Apartment /Condo ~ 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 S ^ 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) - q) t. New 2_ ^ Replacement 3. ^ Replacement of 4, ^ Reconnection of 5_ ^ Repair of an ______System ________System_____________TankOnly______________ Existing System _________ExlstingSystem 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 1 t ^ Seepage Bed 21 ^ Mound 30 ^ Specify Type 41 ^ Holding Tank 12 'Seepage Trench a _ g ~.In-Ground Pressure 42 ^ Pit Privy 4~3 ^ Vault Privy 13 ^ Seepage Pit f~r_ ~~ S ^ 14 ^ System-In-Fill OZX ~ , 7a, VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Pert. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) G OQ~,~ ~ Elevation _ ~ SD Feet • CxJ Feet S 7 , L e .~- ) VII. TANK INFORMATION tapaclt in gatlo s Total # of r Manufacturer s Name Prefab. Site ~~n- l s Fiber- plastic Exper. N E i ti Gallons Tanks concrete tee glass App. ew x s n strutted Tanks Tanks Septic Tank or Holding Tank ~~Q d ^~ f 000 ~ t ~ ^ ^ ^ ^ ^ Lift Pump Tank/Siphon Chamber ^ ^ ^ ^ ^ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumb r' me: (Print) Plumbe Sign ure: ( St mps) P MPRSW No.: Business Phone Number: ~i~~D 033 7~s- $ ~9ys Plumbe Address (Str~ey City, Skate, ip ode): ~ ~_~ O~ IX. COUNTY /DEPARTMENT USE ONLY ^ Disapproved Sanitary Permit Fee nn~i~desGroundwater ate ssue Issuing Agent Signature (No Stamps) Approved ^ Owner Given Initial Surcl,argeFee) ' Adverse Determination a-o~-S~ '"~-~--~ X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD-6398 (R.12/99) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS k 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe 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: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to oe 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 i nformation. 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 1 1 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) horizo°ital 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 1 15 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices vvhich can effect groundwater. ' The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. ME E'cx (( o ~1~ ELEV. FL( ASCRIPTION-~, ~`2 ELEV . _ ;SCRIPTTON-~ 'STEM ELEV. T. ELEV. TOUR ELEV. . y~ ~ ~ . ti-- ~. ~, Z.~a ~ ov~ LOT # ~ Z LEGAL DESCRIPTION N% ~~ ~ ~ l3mZ !~" ~ !--/a -Z4-/~~-w ~7 ~ ~, a~ 3 • ~scon';in Department of Commerce SO1L AND SITE EVALUATION • Diufsion of Safety and Buildings • Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel I.D. # Page ~ of J t - ~roix ~ APPLICANT INFORMATION -Please print all information. R viewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). .ZZ~ Ora Property Owner Property Location ~~ C U I I OJ(~ Govt. Lot'! ~ 1/4S~ 1/4,S w T ~ y ,N,R / y E (or) l1~ Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# -115 C (~r_1 C 22 Qtue~r ~o.rk S s City State Zip Code Phone Number E~uclSen ~ l~ t ~ 5~-ic~l ~ ~ c~t~=, )S~Iq-Sq'1~ ^ City Village [`~ Town Nearest Road i-~t t~~~v, ~ G~ ~ ~,°-~ i~ ,~ ~_~ B.New Construction Use: Residential ! Number of bedrooms ~! Addition to existing building ^ Replacement ^ Public or commercial -Describe: Code derived daily flow (~C~b gpd Recommended design loading rate - f bed, gpd/ft2 - v trench, gpd/ft2 Absorption area required ~_bed, ft2 1 trench, ft2 Maximum design loading rate ., bed, gpd/fl2~trench, gpd/ft2 Recommended infiltration surface elevation(s) ~ z ~ ~~ ft (as referred to site plan benchmark) Additional designlsite considerations 1~L~ . -e (-c ~ . ~ Z ~ ~ C~ Parent material (>h-~lx jl;'`~ Flood plain elevation, if applicable f`~)1~ ft S = Suitable for system v~~ ivci niv~ ini rvi~ui na n rwvui iu r ~ aaoui c n i -u~aua ..ayaici i i u i ~ m ~ iv~un ~y ~ a~ m u = Unsuitable for system ®s ^ U Q s ^ u ®S ^ u (~ s ^ u ^ s ®u ^ s ®u SOIL DESCRIPTION REPORT Boring # 1 Ground elev. qG ~-ft. Depth to limiting factor min. Boring # Ground elev. 9G1~ft. Depth to limiting factor I ZI in. Horizon Depth Dominant Color Mottles xt T Structure Consistence Bounda Roots GPD/ft2 in. Munseli Qu. Sz. Cont. Color e ure Gr. Sz. Sh. ry Bed ,Trench 1 v-lb t~ z S; I I ~- I v~ . 2~. 3 Z f~ 31 t ti ~y se m-F; c.,5 -- , 3 3i-lzc~ !L~ r `-t (tp -- t^n5 rn 1 c5 -- . 7 ; . g Remarks: I 0-Ib I~ ~ 3~z Si I ~ ~r ~ ~ ~ • Z ; . 3 ,_~..n ; ~ ~ ~ - <, R Z. 80 ,„ , ~y~ z ~ ~~ , . ~ .,~ Remarks: • ~" 4 ° ~`"~ :,ST Name (Please Print) Signat Telephone No. l-~ ~`c1z g'' ~ ~ ~ -- ~tS~Z`t7-yao~ Address Date CST Number la t- ~, ~* `~ ~mc-~- e w ~~o ZS l1-8-49 Z q ~! SOIL DESCRIPTION REPORT PROPERTY OWNER 1 G ~ ~ U ~~ Page ~ of'~a ' '' PARCEL I.D.# Boring # /, Ground elev. t. Depth to limiting factor lain. Boring # ~{ Ground elev. 9~ zoft. Depth to limiting factor _ l min. Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed .Trench ~ ~-IZ 1(~ r 3 Z ~ s, ~ 1 rin~.bk mfr C I v~ . 2~. 3 Z ~ Z-3Z t r y ly S. I 2 mwok ~. - ' 0.8 Remarks: I v-~[ 10 3~Z ---, Sr I ~ bk m~'r c- ~~~ . Z ; • 3 3 ~-I ~ ~ ~- I ms ~ i ~5 -- . ~ ~ ~ ~ Remarks: Horizon Depth Dominant Color Mottles Te t e Structure Consist nce nda B Ro t GPD/ft2 in. Munseli Qu. Sz. Cont. Color x ur Gr. Sz. Sh. e ou ry o s Bed ,Trench 1 0-~~ Ib 312- Si blr/ c.. v~ . Z ; 3 -[zS ~ fyl~ -- ~~~ ~s - .~ ~ .8 ~b ~(• Boring # 5; i Ground elev. y~, ~ o ft. Depth to limiting factor ~z5 in. Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Remarks: SBD-8330 (R.9/98) -. ~_ __ NAIaIE' . C'o {~ ~ ~/'~ SCALE 1 "= ~C~ U BM1 LEV. DESCRIPTION-~, BM2 ELEV. DESCRIPTION-6 SYSTEM ELEV. ALT. ELEV. CONTOUR ELEV. ~~. y s r~,~~ ~! Z ~ i5 CS /'I Ov' 3mi t'~ ~ LOT # 2 Z __ . _ _ PAGE ~ OF 3 LEGAL DESCRIPTION ~J-~litl -/~.-Z~I-/4-w N • ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer P. ~.. [ b { ~ oV'A ej ~ c~ n 5 ~nl L. Mailing Address ~70~ ~r~ . fit' c~ ~ 5 u~v I.UL Property Address y~ X ~ A U/t' ~ ~ 1~ ~L" - ,,Co-~-' 2Z 1(~, (Verification required from Planning Department for new construction) City/State ~~ LEGAL DESCRIPTION Parcel Identification Number C7 a O - !D /b ^ o?B Property Location NW %,, ~/ E %,, Sec. !~ , T~N-R~W, Town of rj v~ S©!~ Subdivision ~ ~,V t=om Certified Survey Map # . bo~a~ 7 Warranty Deed # .~ ~.»- Voltune - ,Page # / 5~ 3 ~ Volume "' .Page # Lot # ~~ y~. Spec house ^ yes no Lot lines identifiable~es ^ 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 mastcrplumber, jouraeyruanplumber, restrictcdplumber or alicensed pumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 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 a year a iration date. `.` a.2 ! Z(1 p o IGNA OF APPLICANT 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 the pro described above by virtue of a warranty deed recorded in Register of Deeds Office. . 62~--~ a,1 1..2~ j a SIGNATURE F 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 '• iv STATE BAR OF WISCONSIN FORM 2 - 1982 W RRANTY DEED DOCUMENT NO. y.'. ~. PAG_ ~~ f ~~'t39 r ~'r2 ~~3 Marjorie Malernee, Frances August and Paul Katner as tenants n common a/k/a Francis August conveys and warrants to •C. Co ova Builders, Inc., a .Wisconsin Corporation Survey Maps, page 2089 as Doc. No, 447303, also excepting 020-1010-20 the railroad right of way. 020=1024-9T)' 020-1025-90 NE 1/4 NW 1/4 Sec. 15-T29N-R19W excepting therefrom Lot 1PARCEL IDENTIFICATION NUMBER of Certified Survey Map recorded in Vol. 10 of Certified Survey Maps, page 2701 as Doc. No. 507728. 606267 KATHLEEN H. lJALSH REGISTER OF DEED5 ST. CROIX CO., WI RECEIVED FOR Rf.CQRD 07-06-1999 9:30 AM E)~T ~ ~ CERT COPT FEE: COPT FEE: TRANSFER FEE: f3f0.40 RECORDING FEE: 12.00 PAGES: 2 TNIS SPACE RESERVED FOR RECORDING DATA the following described real estate in t • Croix County, L:QV ~~ ~ J. ESTRC~: V S[a[e of Wisconsin: 3~ L'~CU~ ,~'• SE 1/4 SW 1/4 Sec. LO-T29N-R19W excepting therefrom Lot I +iUDSON. W~ 54Q'~ `' of Certified Survey Map recorded in Vo1.7 of Certified NW 1/4 NE 1/4 Sec. 15-T29N-R19W This 1s nOt homestead property. -~ic1-- (is not) Exception to warranties: day of June ~~ , A~., 19 99 ~, •, . ~"CXiL(,{! 1~t ~'~"(~ (SEAL) tn~, = :`.'."`,r19D~:i,''.r~1$~ Panl Katner Signature(s) AUTHENTICATION ' authenticated this day of , 19~ (SEAL) i~ ~Ay~CKNOWLEDGMENT State of Wtt scQirst'ROn SEE ATTACHED'' (EXHIBIT "A" J ss. King County. Personally ame before me this 26th day of l June , 19 99 ,the above named , I' Frances August ~' ([E not, authorized by §706.06, Wis. Stars.) to me known to b e person ---- who executed the foregoing inst tan c n wledge sa e. ' THIS INSTRUMENT WAS DRAFTED BY Heywood & Cari, S.C. by Walter Hodynsky 204 Locust St., P.O. Box 125 Hudson, IdI 54016 Notary Public, King County,-11tib- WA (Signatures may be authernicated or acknowledged. Bnth are not My commission is permanent. (If not, state expiration dale: necessary) September 1, 2001 X~ij .) _..... , • Names of persons signing in any capacity should by typed a printed lxlow their signawfes. STATE BAR OF WISCONSIN NNSCOn„" tegN ~' Ca.. ~~ WARRANTY DEED Fortn No. 2 - 1982 ~"'~'~• w°~ , TITLE: MEMBER STATE BAR OF WISCONSIN ~f /~~~ Dated [his y Vl~~..~'2~JPAGE ~ ~3 EXHIBIT A ACKNOWLEDGMENT State of Ohio ) ss. Franklin County. ) Personally came before me this zathday of June , 1999, the above named Marjorie Malernee to me know to be the person who executed the foregoing instrument and acknowledge the same. Notary Public, Franklin County, OH My commission is permanent. (If not, state expiration date: 4-77-?003 ,'~~•) PAMELA B. B07KiN NOTARY PUBLIC. STATEOF OHIO My Commission Expves ACKNOWLEDGMENT Mx. 27, 2003 State of Illinois ) ss. County. ) Personally came before me this .2-9 day of ~, 1999, the above named Paul Katner to me know to be the person who executed the foregoing instrument and acknowledge the same. Notary Public, o~°.~ County, IL My commission is permanent. (If not, state expiration date: .~/ iS/o7oo o , X999:) OFFICIAL SEAL LAVERNA R SNEED NOTARY PU6F.IC. STATE OF IL(LIN015 MY GOMMNfSWN EXPME!<:o4/16/00 M1.^Mf~ -. ` , LT . , -, ~._ V c~ c~ N ' ~ ao ~ o i ~ . ~ V ~ ~ -i ~ i (WO ' ~ , . ~~ . • ~ '~ -lap ~ I ~ ~ ~ ` .` ! rn v Cn ~ • ~ z I , ~ n ~ i ~ I , ~ rn ~ 'S3T 5, 4 N I ~ , ~ r• m ~ , p nz I ~ I , I I ~ i ti x I I ~ I I rn: r n : , z~ . n as w o, 33' 33' ; ~ co m 'p I ,' ~ y 1 la 1 I I r _ ~ w -la ~ I ' I • N ~ 1 I f p I , ~ m ' -'` ~ •. ,.,p6 ` ~ I ~ ~ ~ ~ ~ ~ ~ ~ ~ .~ O y N W ~ ~ :o ~ ~ ~~ ~ ~ ~ ~ ~o i~ ~\, ` ~ c3'-~ ~ i i ~~ \ ~~ ~ i ~ Q p N. ~~4 ~ CS COQ \~ ~~ ~ ~ ~~'• ~ ~O . `,,~,., • •'s 0 ~~, ~ j '•. n ~ a+ ~ ~~ gZog ~ ~,, ~ ~- '~Z , -' ~ ~ ~ \, s .\ ~ ~ ~9 \ ~~ ~ $ \\\ O O\~ \ , i ~ •;N 1 -J I rn cp r ~ O I 616 ~x ~ N I o x .~ N O I ao : ~ ~ co m , ~ m N O I ' ~ W N ~ O 1 ; I ~ I U1 ~ N o _ Ag ~ O N - ~ .~ `~ a I ;~ -S',~~T . ------ ~ ~ ~ y f" o- ~ o N -i :~ n o~ N ro ~ N rn ;-+ ~~ ~_ ti 1 i 1 1 1 I I I wa, z b i I o I s I s lO 1 s I J I 1 ~ I 3„£I ,BOoQOS 11 ..S00° 01 ' 14" W... 3 19. 39'............ coo !V r. 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