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DEVARTMENT OF REPORT ON 'SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, C DIVISION P.O. BOX HLABOR UMAN NDLATIONS PERCOLATION TESTS (115) MADISON WI 7969
(H63.090) & Chapter 145.045)
LOCATION: SECTION: WNSHI N~CIPA QTY: ~ 0.: BL .
Itdar SU ISI ~ NAME:
'/al(~~ E (o VIA Ol C J Fs/ 16
COUNTY: OWN R' MAILING ADDRESS:
t' t r
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: 1COMMERCIAL D SCRIPTION: PROFI L D R TIgNS: PERCOL 10 ESTS:
~esidence 2 flew ❑Replace U 1,;2
RATING: S= Site suitable for system U= Site unsuitable for system 020-1 - - 6&O0, 1 0'" U AL:MOUND J IN-GROUND URE: SYSTEM-IG TAN : RECOMMCon'/- I PA
MOM EIS a1
If Percolation Tests are NOT required DESIGN RATE: 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 DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST- IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- / .oo 'dd 6AI L' 0 Aoo 43ra me As ' 5se) b cs q C r
B-a _00 75` l"~vll l l.oo e g, es r
B-3 x.00 do rbL) s~ l ooIfi s ` ~ct
,~61 e -3 54 Gr
YoD ~r
B -
PERCOLATION TESTS
TEST DEPTH" WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES" AFTERSWELLING INTERVAL-MIN. PERIOD 1 PER D2 P R 0" PER INCH
P_ r 1,911 y
P- tt r' S Y
P-
P-_
P_
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable 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. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION
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I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME( int TESTS WERE COMPLE D O
ADDRES CERTIF C TI N MB PHO E NUM ionall:
CST SIG E:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) - OVER -
k , FOR14710015-1
M - STC - 104
f
AS BUILT SANITARY SYSTEM REPORT
OWNER r y ;)TOWNSHIP` rf~~1z s
SECTION Z Y T G~ N-R W
ADDRESS ::r!~ ST. CROIX COUNTY, WISCONSIN
SUBDIVISION (i~%c✓ f~~i 5,> LOTLOT SIZE
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
10 1
.S
~ I
G1
1.1e aA~
t ~ Qro~o~.e~ i.J ~
U ~ 5 ~~v,a ~ YJrvs KJ{ '
Aw
INDICATE NORTH ARROW
BENCHMARK:Elevation and description: ors
Alternate benchmark
SEPTIC TANK:Manufacturer: -u ks Liquid Cap. D~
Rings used: J Manhole cover elev: Final grade elev:
Tank inlet elev.: Tank outlet elev.:
No. of feet from nearest road:Front , Side X Rear Ft. 104
From nearest prop. line:Front , Side , Rear Ft. ~06No. of feet from: Well Building:
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
1
PUMP CHAMBER
Manufacturer: Liquid Capacity:
Pump Model: Pump/Siphon Manufact.: Pump Size
Elevation of inlet: Bottom of tank elevation
Pump on elev.: Pump off elev.: Gallons/cycle:
Alarm: Man.: Switch Type: Location
Distance from nearest prop. line: Front-, Side_, Rear_Ft.
Distance from: Well Building
SOIL ABSORPTION SYSTEM
Bed: Trench: A Seepage Pit:
Width: > Length c. Number of Lines:
Area Built az
Exist. Grade Elev. 7~.a Proposed Final Grade Elev.
Fill depth to top of pipe:
No. feet from nearest prop. line:Front , Side , Rear Ft.
No. feet from well: o No. feet from building 6.1
HOLDING TANK
Manufacturer: Capacity:
No. of rings used: Elevation of bottom tank:
Elevation of inlet:
No. feet from nearest prop. line:Front , Side Rear Ft.
No. feet from: Well , building , nearest road
Alarm Manufacturer:
INSPECTOR:
DATE: PLUMBER ON JOB:
LICENSE NUMBER: f ~l lr~~1 i Z Z
6/90:cj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING
j LABOR & HUMAN RELATIONS DIVISION
P.O. BOX 7969 i ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION
MADISON WI 53707 State Plan I.D. Number:
NW , , N$ a , S e C . 2 8 , T 2 9 - R 19 CONVENTIONAL El ALTERATIVE (If assigned)
Town of Hudson Lot 9 Holding El Mound
Tank ❑ In-Ground Pressure
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
Halar Circle, Hudson /Az
rr
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: PER PT. V.: C REF. PT. ELEV.,
Name of Plumber: MP/MPRSW No. County: Sanitary Permit Number:
Roger Timm
SEPTIC TANK/HOLDING TAN ~1✓" 7r 61 cJ
: - LIQUID CAPACITY- TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING GO
PRO
MANUFACTURER AWN
VIDEDPROVIDED: 7 YES NO E_ YES
_t\C4 BEDDING: V&f•T DIA.: MATL.: HIGH WATER NUM ER OF ROAD: PROPERT WE L~r BUILDING: VENT TO FRESH
4 FEET FROM LIjE.. AIR INL T:
C p, r/ ~7 ALARM:
A
❑ YES NO ❑ YES NO NEAREST
DOSIN C AMBER: CKING
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING pROVIDED:OVER
NO ❑ YES ❑ NO L] YES ❑ NO
PUMP AND CONTROLS OPERATIONAL: NUM
(DIFFERENCE BETWEEN PROPERTY WELL: BUILDING: VENT -)FRESH
GALLONS PER CYCLE: FEET FROM LINE AIR INLET:
PUMP ON AND OFF ❑ YES El NO NEAREST
LENGTH: DIAMETER: ERIALANDMARKING:
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE
or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
WIDTH: LENGTaO.O DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUI
BED/ TRENCH MATERIAL: P DEPTH:
DIMENSIONS ~ 2/GRAVEL DEPTH FILL DEPTH DISTR. R.PIPE T IA N D TR. NUMBER OF PROPERTY WEL BUILDING: VENT TO FRESH
`ELOW PIPES: ABOVVEELEV. /IPESFEET FROM LINE: AIR INLET:
M _117) • 72 NEAREST ~ . g3 ' 7S~
MOUND SYSTEM:
Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
slop s thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW
❑ YES ❑ N 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: I EDGES:
❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH: LENGTH: TNO.OF RENCHES: LAT L SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE M OLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING:
ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.:
ELEVATION AND
DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COV TERIAL: VERTICAL LIFT CORRESPONDS TO
INFORMATION APPROVED PLANS
❑ YES ❑ NO ❑ YES ❑ NO
PERMANENT MARKERS: OBSERVATION WELLS: NUMB PROPERTY WELL: BUILDING
COMMENTS: FEET FROM E:
❑ YES ❑ NO ❑ YES ❑ NO NEAREST
f
„ti-'may. e r r ,..a , -
te, l2
fain in county file for audit.
Sketch System on TITLE
Reverse Side. SIGN URE: /
SBD-6710 (R. 06/88)
SANITARY PERMIT APPLICATION d 0 51
~LHR In accord with ILHR 83.05, Wis. Adm. Code couNT
C77DR awnwr~w,s~
STATE SANIT Y ERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than / VY41
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
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
w~ t/4 /J' '/a, S ~ T Z j, N, R (of~y i
PROPERTY OWNER'S ILING ADDRESS LOT # BLOCK #
A-1;6 -
CITY, TATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
U XU
11. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD
❑ State Owned VILLAGE :
Public ❑ 1 or 2 Fam. Dwelling-# of bedrooms - AR T NUMB ( )
III. BUILDING USE: (If building type is public, check all that apply) / Q
1 ❑ Apt/Condo L P?4 u
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
50 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.'N 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 # - Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 '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 12. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
I? ~ 9 , ci Feet 9s- ~ Feet
J ~ t_5 •
VII. TANK CAPACITY Site
in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper.
INFORMATION New lExistin Gallons Tanks Concrete structed glass App.
Tanks Tanks
Septic Tank or Holdin Tank
Lift Pump Tank/Si hon 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): Plumber's Signature: (No Stamps) c MP/MPRSW No.: Business Phone Number:
77 L Z
Plum is,A ress (Street, City,, S te, Zip Code):
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e Issued Issuing gent Slgnatur (No Sta
Surcharge Fee)
Approved ❑ Owner Given Initial /Ys-
Adverse Determination i
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (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.
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 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'f 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)
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 11 ?X k 0k, Section L , T N - R W
Township Gi 7
Mailing Addressr
~ 7
Subdivision Name ~l "'16 /A
Lot Number
Previous Owner of Property ✓ -'r'r ~f = K
Total Size of Parcel
Date Parcel was Created
Are all corners and lot lines 'identifiable? x 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 ONE OF THE FOLLOWING:
1. Warranty Deed
2. Land Contract
3. Other recordings filed with the Register of Deeds Office
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 the Certified Survey Map shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) ceAti6y that atZY 6tatement6 on th.i6 jonm ane true to the beat of my (ouA)
knowledge; that I (we) am (aAe) the. owner. (a) ob the pnopenty de,sc i.bed in thi,6
injonmati.on Jonm, by virtue of a wanAanty deed neconded in the 066.ice oj the
County Regi6lteA o6 Deeda as Document No. 1 =Z' y ; and that I (we)
pneaentty own the pnopr.tie.d s4te box the aeluage di4po4aX .eys tri (on I (we) .have
obtained an ea.6emen:t, to nun with the above ducAibed pLopvay, Jo& the
eomtauetion;oA aai.d 6y6tem, a,ad the aame ha,a been duty neconded in the 066ice
o6 the County Reg.ieten o6 Deeds, as Document 'No )
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
Drt,s,IF,l~• -
• r
r
STC - 105 ,y
y
SEPTIC TANK MAINTENANCE AGREEMENT o
St. Croix County
• v
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0WN1'R/BUY1:It
Eire Number
ItowrE/BOX NUMBER
z 11) 41
CITY STATE
i ! Sectic.~n T_2LN,
PROPERTY LUCATION:4.
St. Croix County,
Subdivisiun (_=L✓ Lot number'
Improper use andmaintenance of your septic: system could result in
its premature"failure to handle wastes Proper maintenance cun-
sists of pumping out the.sepcic tank every. three years or sooner,
if needed, by a licensed. septic tank puwper. What you piit into
the system can affect the function of the septic j:ank as a treat-
ment stage in the waste disposal system.
St.-Croix County residents u►a_X be eligible to receive a grant for,
a maximum of 60% of the cost of replacement of a failing syst•em,,
which was in.operation prior to 'July 1, 1978. St Croix County
accepted this program itt August of 1980, with the require menc,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 veri-
fying that (1) cite on-Site wastewater disposal system is in proper
ti.perating condition and (2) after inspection and pumping (if.nec-
essary), 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.
x
I/WE, the undersigned, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with, r,
the standards set forth, he•rei.n, as sec by tl►e Wisconsin Depart- "d
ment of Natural Resources. Certification form must be completed
and returned to the St. Croix County Zoning Office within 30.days
of the three year expiration date.
/
S I C N E D
llATE Z 1\~_.~\ '
St. C;oix County Zoning'Office
P.O. ttox 95.
klammo-pd; WI 54015
715-7 16-2239 or 715-425-8363
Sign, date and return to abuve address.
i
DEPARTMENT OF REF RT ON SOIL BORINGS -*.ND SAFETY & BUILDINGS
' INDUSTRY, DIVISION
LABOR AND TS 115 P.O. BOX 7969
PERCOLATION TES MADISON, W153707
HUMAN RELATIONS (H63.09(1) & Chapter 145.045)
_K,../~ WNSHIP.I U~SPA~TY: LOT_ O.:BLKO•• ~~QC AON IV ~ .
LOCATION: S
1j? ' 'L 4(,E (o
v/ cJ' d
COUNTY: OWN R'S-NAME:' =NADDI
ESS:d17
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMI AL DES RIPTION: PR I ONS: I ESTS:
Residence QNew ❑Replace
RATING: S- Site suitable for system U- Site unsuitable for system / -PRESSU CONVEN ST❑u• MMS.❑u INGElROUNDs ❑UR .SFYSTEM ]S-IS~LH0SG~U:RECOMMENvE/I UYSTEI~'`~ptf~n'aIXSC
OLDIN TANK
Il UU
If Percolation Tests are NOT required DESIGN RATE: I 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 DEPTH T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EtiI H TO BEDROCK IF OBSERVED (SEE ABBRI V. ON BACK.)
B- J btr~C~ rJD~I~I f C1 S~C~ eel cs qC
B- ? CIO 95. Sr , 46)h G00 o CS c C ~
B- )06)
CD S t I OCR n S t _ _ ~
e s C r
.o6)bl s~ l•
60 ~rn s~Gr
B•
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. p D t P R QQ2 P PER INCH
P L• 3 "
P-
P
P-_
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
~ontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION
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I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME l / TESTS WERE COMPLE DO
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ADDRESS CERTI 171A~NOMBEjA: PHO E NUM~~ional):
CST SIG T E:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02182) - OVER -
K~aGr~
y JOB
TIMM EXCAVATING SHEET NO. OF Z
Route 1 Box 192
WILSON, WISCONSIN 54027 CALCULATED BY DATE
(715) 772.3214 (715) 386-5443
MPRS #3224 WI MPCA #696 MN CHECKED BY DATE
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PRODUCT 205-1 A~ Inc.,Groton, Mass . 01471. To Order PHONE TOLL FREE 1-800-2258380
JOB /r(/Cf2u✓C ~lerOZ~i
TIMM EXCAVATING 2 OF Z
- SHEET NO.
Route 1 Box 192 {U 1 a i9- y/
WILSON, WISCONSIN 54027 CALCULATED BY ~ DATE
(715) 772-3214 (715) 386-5443 DATE
MPRS #3224 WI MPCA #696 MN CHECKED BY
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PRODUCT 205-1 ~ Inc., Groton, Mass. 01471, To Order PHONE TOLL FREE 1-800-225-8300