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HomeMy WebLinkAbout026-1135-21-000 Wisconsin Department of Commerce Count PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 430029 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: P.C. Collova Builders, Inc. I Richmond Township 02(, ,1 CST BM Elev: Insp. BM Elev: BM Description: 1J„ Sectionrrown /Range /Map No: lZo.� kIZZ .O $YJN• 24.30.18. j TANK INFORMATION EVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic � �, �� Benchmark ( � � (9 ` � e ��.fj r D . Dosing Alt. BM +L Aeration Bldg. Sewer 3•ir nP Holding St/Ht Inlet • 40 7'S t St/Ht Outlet TANK SETBACK INFORMATION , :fD y4- Z0 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration �ielrPf(J2 Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM 0.r,5' 8 •(o Model Numb r TDH Lift F ' ion Loss System Head T Ft 1--*1 Forcemai Length Ia. Dist. to well S6 1 _ L , ABS ORPTION SYSTEM O S REN H VV idth Length t No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM ONS / r •� -� .- o) SETBACK SYSTEM TO � P/L JBLDG IWELL LAKE /STREAM LEACHING Ma cture INFORMATION CHAMBER OR iOQLZ Type Of System: / • / UNIT Model Number: �V♦ C DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) 3 # L Length 0 i Leng D' T 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 J Yes ! No r Yes C] No COM T - : (Include co discrepen les ersons present, etc.) Inspection #1: / 16 Inspection #2: ! 422 143rd St New Richmond, WI 54017 (SE 1/4 SW 1/4 24 T3 w-I—lr el No: 24.30.18. r �l TbP� s t ,. 1.) Alt BM Description -T D'( 2.) Bldg sewer length = p 9�_�I �� • frD r �3.9a I amount of cover = t f •I , S load q �s'rs � q--r _ � - - -- Plan revision Required? Yes No z Q 3 J� Use other side for additional mformatfon. L ` Date �` _� Ids ='s Signat re ^ Cert. No. SBD -6710 (R.3/ 7) > C� 'I'�'N"� aS�` �ks�t�►,- �!�«.RQ �s ,e,ti,.� �f �L�2�� �aDrt coeea,► r 201 V7. WuMVm Ave., P.O. Boxyti82 Visconaf AdwNsw6WI 5707 - 7092 SmiteryPettabN I (tabowediabyCo.) Department of Comawee (608) 2614546 3 B O 2- - � Sanitary Permit Application Him LD`"` to accord wbhCommU21, VrM Adm. Code, ,� �y y may be used for secooday proposes . L- • f teOED = 98 E ® �r Addle$ Of�amt � �) L � Lttor -MUM Print All lof + Z7 - I �-3 '[ S4-. Pt"aW(lwwes Patadd 0 Blocs# l�Ldo CI,UIIX, COUFi - Y 7 Pn y OamePs Addttss ZO i` 1 N G 0 F F C rE Y p - � .secam city.. siffie , Pb.Nataber F D iL Type aft (cLedc sB t alrply) ./ a� p¢r S AAA - S�ebffivsaoa lbana tSb1 1 or2 �►Dwddft- Numbero ms fBahaa Q O Pabh CommacW -D Use V O stems owned- Desctibe Uae b 3 3 X C� Z, Sn OCrey_ orowasbip f' - aL Tyype of Perm b (Check only one box an NeA. Complete Nae B;yap s) " A. Syamem 17 RW..m s1a— O Tx=m w mA§ddft TlmkRqAwaumMOnly o Momkoo 3yot m B. Q PamitHaa:waI 11 PtxmitRevisioe O (2nnReof OPeambTi8es6srtoNtw I iatmviousl'NaadwraQaIImeT�ra BefinsE Phoub r owner IV. ofPOWTS an that ` au - rimed b4awmd O ildomd>24 ie. of=ftg a wd Mumd <24 its. of double sail ©AI.Cwaae bffiq&P=S=dF&w 0 e7-Nmkeaod tveasaa a pawmima o NdkrwxTmk 0 Pee Mor 0 Aembic Treatment Uolt 11 k madft Chaetbec ODdp O C=vel4ms Pipe O amrr Z ' ? gadm iBPd) Deem, SM Di�1.Awa 8epioed asal Db Atee Proposed ( EkvWoe - vLTamlcLeft copeft in T OW ANOW ofunits Pew c am SepfieorNTaeic AgRoWl e tt Dodv vii, StAttm -; t>se r ty tm fsbandm otdie POWTS sbown ea me aftded plans. pis MP/MPRSNnmber BusmersPhooeNamber � I a �,a tsitmt. csri►, e. Vol 7 viII. urx o SaQimry Permit Feermciades tiwtmdw�s A� (Ne � QowaerCmrcARpaea�rDtaiei) PA M Gone of AWO"WRUSGM for Dlsspproval 4 14— Mc" Attaei u• theCaimtyalY) � thesysts os pper teas Sara: rr soda sin SBn -6399 (R. 08/02) f 430N/ OT PLAN PROJECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 SE 1/4 SW 1/4s 24 / 8 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 5 /28/03 BEDROOM 3 CONVENTIONAL XXX IN -GROU PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambers 30 BENCHMARK V.R.P. Top steel fence post ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL sH.R.P. Same as Benchmark SYSTEM ELEVATION 95.2/94.0/92.8 5.2' below grade Alt. BM Top of Sign @ 98.3' 143rd St. Vent >6 Standard Biodiffuser 8% Leaching Chamber Slope of Cover with 31.1 ft2 of Area B -3 5 35' 15' Vents 6' Long 11 " 34" Grade at System Elevation 2 Plans Designed Using 50 B- 0' Conventional Powts Manual Version 2.0 3 -3' X 63' S Cells with >3' Spacing 30' B -1 Pro 3 Bedroom House 30 , T a� .S a� a N 289' Prop Line P OT PLAN PROJECT P.C. CoJlova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 SE 1/4 SW 1/4s 24 /T 30 N/ 8 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE5 /28/03 BEDROOM 3 CONVENTIONAL XXX IN -GROU PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambers 30 BENCHMARK V.R.P. To steel fence post P P ASSUME ELEVATION Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 95.2/94.0/92.8 5.2' below grade Alt. BM Top of Sign @ 98.3' 143rd St. j L Standard Biodiffuser 8% Leaching Chamber Slope 5' with 31.1 ft2 of Area B -3 Vents 35' �' 15' po 34 Grade at System Elevation 2 Plans Designed Using B- 0' Conventional Powts 50' Manual Version 2.0 3 -3' X 63' 5 Cells with >3' Pro 3 Spacing 30' B -1 ' -.--. Bedroom House 30' T a� 0 N 289' Prop Line Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division Sf Safdty and Buildings in accordance with Comm 85, 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 not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information I Z wed by ate Personal information you provide may be used for secondary.ptp ses (Privacy`ayr, s. 15.04 (1) (m)). Prope Owner Property Location ! Gr <�� ,F r G 1/4 /4 Si T 1,0 N R E(or W Property Owner's Mailing Addre s Lot # Block # I Subd. Name or CSM# SO CJ City ' State Zip Code Phone Numb Icity [] Village own Nearest Road Lq ew Construction Us !g Residential / Number of bedrooms Code derived design flow rate GPD F1 Replacement ❑ , 9 Public or commercial - Describe: Parent material C 1 '2 1 - Jc v�r Gam, Flood Plain elevation if applicable �l/ )'q ft. General comments and recommendations: - �� <�✓° 1�cI�n,�, r) • �y U 'f F Tl Boring # Eq Pit Ground surface elev. C/+ ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 .61 fs - � �� � /,, ✓✓i - s' 9s.2o Z T `( 4g -Y r Boring # ❑ Boring r Z �J Pit Ground surface elev. ft. Depth to limiting factor _ /,!� <.) in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 r E q . ' Effluent #1 = BOD > 30 < 220 mg/L and TSS 30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) / �/ nature CST Number � � Address Date Evaluation Conducted Telephone Number SBD -8330 (R07 /00) r J ' 1 Property Owner Parcel ID # Page of Boring # ❑ Boring ® pit �, / Ground surface elev. ?�ft. Depth to limiting factor "7 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 �S C'+ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring Boring # E] ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = BOD, > 30 < 220 mg /L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD -8330 (R.07 /00) Soil Test Plot Plan Project Name P.C. Collova Builders Inc. Sha i Address 507 cty Rd E Hudson Wi 54016 M #226900 Lot 21 Subdivision Evergreen Date 1/31/02 SE 1/4 S W 1/4S 24 T 30 N /R W Township Richmond n Boring Q Well PL Property Line County S T. CROIX BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post System Elevation 95.2/94.0/92.8 *HRpSame as Benchmark Alt. BM Top of Sign @ 98.3' 143rd St. Alt K B.M. 98' 8% 99' Slope 5 B -3 35' 15' 20' B- 0 , 50' 5' Pro 3 r_ 100' Bedroom House a� a t a 0 N 289' Property Line I i Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan 1. If system fails, determine cause of failure, use alternate area and install new system or install system at a lower elevation. 2. Replace any other failing components as needed. Plumber: Shaun Bird 715- 246 -4516 St. Croix County Zoning 715 - 386 -4680 Pumper Tom Mondor 715- 246 -5148 Shaun Bird #226900 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer P. C. Collova Builders, Inc. Mailing Address P O Box 489 Somerset, WI 54025 Property Address C7'iCJ. (Verification required from Planning Department for new construction} City /State &:,n) l i�t C10W A C Parcel Identification Number LEGAL DESCRIPTION Property Location 5 r--- %,, 5a y., Sec. T Q,.) N -R]W, Town of 1 1'Yl Subdivision Lot # �. Certified Survey Map # . Volume , Page # Warranty Deed # �i?o� �J `�i Volume C3� Page # Spec house ❑ 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 masterplumber, journeyman plumber, restrictedplumber or a licensed 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 1/3 full of sludge. I/we, 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 MUM be completed and retumed to the St. Croix County Zoning Office within 30 days of e three year gcpimtion date. /4v IGNATURE 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 e ro described above, by virtu of a warranty deed recorded in Register of Deeds Office. SIGNA OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** r � * 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 I I - f ~J Is � G V 4 , 0I v> i s i' I i FROM P C COLLOVA HLDRS, INC PHONE NO. : 715 549 5911 Jul. 21 2001 01:54PM P1 01/C3r00 TUE U.33 FAY 716 34$ 4687 RU;ISTSR OF DEEDS QOp1 5i►2�2 fo ST,: , arert; tusc Of 11ntcewsb►taa.a 3•- Mom 13tt1tAlYTY Dl{ '1'Itla 3?ad, msao t►atw4ta 6�tw � �,�� Y _ Qraator. and P Calbaa tiylae »� inc., st NlNtttca11ta Carootrtlua Q m m' hi a valdnt w considmdo11, V44011012msta11 to A1lio dtaa Imd mi ttaat11in SL .op couMYt Swe OfwiSCOasM( itmaec�tttekAear tsd,�fi� _ ` 8ae0Klht ►ka T1to Sautltwx QUZ1Wf of du 9a1ifwgt Qmtet (SE .Q of SW 14) of Smm= caws 24 and sisutunof ot9naim .jyia11Natht*v 7 yO its ALL Is ;OK Rop is Nast, & Caaltc may, wkm§K AO N 0 EXCgrr cwt ai follows C*=R=adn11 u r K m ko. of kaW s11abs I S: *mac Honk B davit its siW" Won Ntlisl; i)ae 11f aald tiad11n iS; 6C3 fiat,theaal scuds a l d�11e Z3 stsaautts tt� art liii � d►ana Bede A91o 0a adarro hart t?90 fees: QMttee 3aims.eamo S Te.ior}'ra-ato Help 144111/1/123 mimta11£ 134.1 £ktto"Ngras literetmmNueW 84 lr9MlutttdCatimsNauarOtN) dgr11w Di erlomeu West as =W N Mw OX7 f4w to DMa of Pa11iaaW& Se 7Wg tr iat lossotte �� Cant 1.1111ntY. Wltcex�t. OU m aotl lscaptlent so w11rra11dar C "^� eptl. ic4Ricdsrs asd a Qlq.ofaral oftvweC WNW. Dat114 ab 1 r UY or buy + .�..W..,.,...w a tll AUTITI NTICA390H r LCXHOWL@DCUZXT TiBaawa4a) Seaver. J, tSsfllsk STATE OF visewi N CoMty ) swAwdauM s f�� et si�L_ --�.�. 1wc rew0a.ltr woe bslars me 6b _ Say of tcitxtasOa4ird --- -- TrTLV WRLU ASTATEAAAOF wiscaws,m _ (iraot q m• keoWa 111 M& y oraoa(s) wtro eapap { ska seragotng " W AAA by ! 7tli.tli, W Is. drsu.) laatr11Reae an4 i0lhovinigeC ts.e rasa Ystt� stmstut4�rr w4s na�rt�sa nv ' �r�. - .-- ...- _...,. • KwK7 tc0i14.3tato or Wtieaet,n My 011 - mi-io11 tt pwaw4nt. Qf atl4 ruts InAt' 4p duc. mp"m MW 44Mowuml e< xbgwadpL 911th Pitt nnmmo.) ) rtat�strtwrdintsW61t49osPsaBr it rw.n.awtwr..e�e.�.. 3tAS£ tux Ot iM1900K 4iit1 1q0 si WAP&1HTY atcD sostt Mal. teen L IRON � 1 'W C-4 o U o� :%, J oo to 0 a H st m coo Z t/t DATER 1 ,00'L9 t ,00'09 t OO'OS L JATION DWN 00 ,60'ft8 3.9b,C1.00N -- w 0 ,OZ' LC ON 24, z 't t� to o, o, N I J rn w b z l =� 1 • �. °0 Q N ao TED TO al Z 1 ° N a N °f O � w N 0I z - Lo � ° O _ -- c V w do Im O ONTROL ai rnrn w may / i O M � �� -- to — I F— Q i 10 ,CT THE :OADWAY ,!i!<' L9 v' O �WZ9t 3 ,c9•ZtZ M„£ £.ZOS - - 133&S ` \ N �,GON_ S N �<< ' o to A; 21 400 04 _ •, \ EtiUOT ~ O Co Q \ $•13�N W1 o J n M , l— — Or HODS Yn O / N as cn LJ (f LLJ Q < ao c` 0 '-t o J to _ iJ Y ao COUNTY, \AINIMUM o�'ti t ,09'S8Z 9 ,Zc !ELOPING OFFICE I INS � UNPLATT ALLATION � ANY LOT LINE ENE IS A EASEMENTS AS VATE /PUBLIC `Wisconsin Department of Commerce SOIL AND SITE EVALUATION ++ Division of Safety and Buildings Page I of 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, �Ioc distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Pie print all ig ormation. Reviewed by Date Personal information you provide may be used for ary pu 0 Law, s. 15.04 (1) (m)). Property Owner ., Property Location Govt. Lot s r 1/4 Sc, 1/4,S mac/ T 3G N,R E (or)® Property Owner's Mailing Address " =- ;_ _ L t # Block# Subd. Name or CSM# 21 ve teen OverlWK City State Zip Code ' ; Rhone Number Nearest Road f ❑City El Village [� To ` New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement LJ Public or commercial - Describe: Code derived daily flow G ,! \\god Recommended design loading rate � bed, gpd/ft L trench, gpd/ft Absorption area required V bed, ft &U2 trench, ft Maximum design loading rate ' J -- bed, gpd/ft 64 ' trench, gpd/ft Recommended infiltration surface elevation(s) // /0 -6 q ft (as referred to site plan benchmark) Additional design /site considerations ('� A Tr q `. Co �' Parent material C) C S t Flood plain elevation, if applicable S = Suitable for system Conventional Mound ln- Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuitable for system ❑ s [� u Us El u El [4PU ❑ s q u ❑ s Liu ❑ S F SOIL DESCRIPTION REPORT Boris # Horizon Depth Dominant Color Mottles Structure GPD/ft 9 Texture Consistence Boundary Roots s. in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench l I -►z is I N 3 'c 2n--abk- Z Iz -zg io `04 Ls 1 m (n�r C -_7 Ground o AH 1• �� C 5 Y m J ( C's . S, elev. Depth to limiting factor 29 in. Remarks: Boring # L l I Z 3b ! f �j — 2 a !Y) f r c 5 — - y2. 4 jC 4 f1 4P C Z - 7.5 4��, F5 I m5 m c S Ground elev. Depth to limiting factor 3y in. Remarks: CST Name (Please Print) S' nature Telephone No. Address Date CST Number 2\ 1 w 1 5 10 Z ^ (� l 2, 5 SOIL DESCRIPTION REPORT « PROPERTY OWNER Page of PARCEL I.D. # "} Z Boring # Horizon Depth Dominant Color Mottles Structure G�p in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed .Trench 10 J2> S; I 2m b q)fr Z 13- i U y I t MSC4 Ground "fir- F Pr C-S elev. ` l / J T -" - ter/ C Depth to limiting factor _(min. , Remarks: Boring # >.:, _ s Ground elev. ft. ' Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. tt. Depth to limiting factor in. Remarks: SBD -8330 (R.9/98) I PAGE 3 OF NAME Ca ( (CQQ LOT# �) l LEGAL DESCRIPTION SC ' /4 Jam! /4 S2 �t U6 ,N,R /8 E (or) � SCALE: F'= (0(')' cc BM 1 ELEVATION /00 • U BM 1 DESCRIPTION -/ooT BM 2 ELEVATION BM 2 DESCRIPTION - j6p evc ,'Q w/ (a fit SYSTEM ELEVATION /00 •6 q ALTERNATE ELEVATION CONTOUR ELEVATION Q W � -� DATE SIGNATURE l J