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HomeMy WebLinkAbout020-1112-60-000 Q o m 00 c o0 e O °6-., p °� a �c o n Q. o 0 z � I I 0 C�+ 3c.Dc i N C •< CO N y N N O -0 N c a j O O O ao O co a c ° a a�i w 8 O c U a) ° cco 0o c C 0 co UD m aO o - c a z aa 3 a� n z 0 3 ro c > :N ro 0 .0 LL c Y d N U.-) O O co_ a a) a— O E < LLZm3a E Q � U U _O r T M V CL a a) a) U) V1 L11 O N « O O Q� `O O` z N a m a m N Z j co I O z :j c c I :3 w to F- •- °' o °' o 0 v a 'O O a) 0 I I N_ N m CL fN/) N N O O ca m O z CA z O z m z O O O c) Z O I f6 c O t. .. fD L _ co a2S ! CO CL w O a 'w w V coo. .0 ooa. Q _� N y y O j H cn- H O O d c 3: 3: 3: d d O ny @ N a a a -o a s a _ O O L) U-) 00 W O M O) Q1 N !n J U M IOV 3 0 0 a, L 4 4 E O O I O ill "O m Q- frri O O — 1� a) � M 1p a7 U) cn r U) N cl 1�l O O v-• O v: cu N 3x} C C 3' 1 n n 0 o co O a s .�O w cq N o o m co o W N '0 CO o't CO o N O) M ,M O C L O ~ ~ (D N 1- z h S z O � j V � d R : •� a I '� a I CL Z a a a w rr`i�v E i c c d c 3 _1 A vat OHV OinV A ' r '`CDIIERCIAL TESTING LABORATORY, INC. 514 IwN Street, P.O. Box 526 Colfax, Wisconsin 54730 715 962 - 3121 800 - 962 - 5227 4:0k ST. CROIX ZONING REPORT N0.** 05988/01 PAGE 1 ST. CROIX COUNTY REPORT DATE** 6/08/90 COURTHOUSE DATE RECEIVE *+ 6/07/90 HUDSON, WI 54016 ATTN** THOMAS C. NELSON OWNER** Jeff h Colleen Murray LOCATION: 1037 Hwy 35N., Hudson COLLECTOR** M. Jenkins SOURCE OF SAMPLE: Outside faucet COLIFORM** 0 /100 ml INTERPRETATION. BacterioLogicaLLy SAFE NITRATE-N** 2 ppm Under 10 ppm is safe for human consumption. CoLiform Bacteria/100 mL Nitrate-Nitrogen, m9/L I i LAB TECHNICIAN; Pam Gane WI Approved Lab No. 19 �.\NOEVEVa p�y O O < Means "LESS THAN" IietectabLe Level Approved by: ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 ST. CROIX COUNTY ZONING OFFICE \ _ St. Croix County Courthouse / 911 4th Street Hudson, WI 54016 Telephone - (715)386-4680 The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. this form is essential so that the vrooer+v can _ be - located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING------------------------- -FEE: $ 25.00 X (For nitrates and coliform bacteria)FEE: $175.00 WATER TESTING (For VOCPS) --FEE: $25.00 X SEPTIC SYSTEM INSPECTION------- (Determines if system is properly functioning at time of inspection) Property owner's name Property owner's address /D A-7 Legal Description N.W. 1/4 of the ,a,& _ci/4 of Section /_, T,I,N-R as Town of �j Lot Number subdivision Name / Color of house 6 L 4 -e Realty sign by house?4-e-�;t If so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. m le that is fresh. If al water re p Testing of residential requires a sample Q the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If lease make proper arrangements with this this is the case P P P office to ensure time when entry may be gained. Firm or individual requesting services: -a �+'Telephone Number Number REPORT TO BFI SF,NT O: .- Closing date -- Signature W^ ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST.CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON,WI 54016 - - - Off-ELM M" - (715)386-4680 June 13 , 1990 Carol Farrell Century 21 706 19th St. S. Hudson, WI 54016 Dear Ms. Farrell: An inspection of the septic system of the Jeff and Colleen Murray property, located at the NW 1/4 of the SE 1/4 of Sec.12, Town of Hudson, was inspected on 6-13-90. At the time of inspection, the sanitary system was found to be failing as evidenced by effluent discharge to the surface of the ground. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, —;kx�/' Y C Mar J. Jenkins Assistant Zoning Administrator cj 4 FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~Q,,,,ti<; TOWNSHIP - .f SECTION_T~N - Rc 2/4 W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT,4ZLOT SIZE PLAN VIEW SHO EVERYTHING WI HIN 100 FEET OF SYSTEM art ~L ec" G. . l~ IND NORTH ARROW BENCHMARK:Elevation and description: 7 -s " -774 Alternate benchmark SEPTIC TANK: Manuf acturer: , Liquid Cap. Rings used:,.,jManhole cover elev: ~~.1 Final grade elev: Tank inlet elev.: Tank outlet elev.: No. of feet from nearest road:Front , Side, Rear Ft.~4 From nearest prop. line:Front , Side , Rear_X_Ft. No. of feet from: Well S' Building: (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE J ICI tl1. i J I , PUMP CHAMBER Manufacturer: ,~~-9e,~s /'✓~i'!~~...'~~ Liquid Capacit //1l-_ Pump Model:Pump/Siphon Manufact.: . Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle:, Alarm: Man.: 'w`itch Type: ocation Distance from nearest prop. line: Front_, Side_, Rear_,~Ft. Distance from: Well 4~x) Building s SOIL ABSORPTION SYSTEM Bed: J Trench: Seepage Pit: Width: 1_~2_Length &~Number of Lines: _Area Bui lt..2; _ Exist. Grade Elev. 4Z 2 Proposed Final Grade Elev. ~2Z 127 Fill depth to top of pipe: Vo. feet from nearest prop. line:Front Side , Rear_2_Ftc.~ No. feet from well: feet from building ,Z`e/' i 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: 6/90:cj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR &TIUW~N RELATIONS DIVISION P.O. 6OX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON W1 53707 State Plan I.D. Number: 4,SE,,,Sec .12,T29 -R20 2 a (If assigned) SWTown of Hudson CONVENTIONAL ❑ ALTERATIVE ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAM OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Thomas Schlief 1037 Old HWY.35,Hudson, WI G 07 9 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. Cr 149055 i~T P SEPTIC TANK/HOLDING TANK; 90, I tk , r 99,6~ 0' z• S MANUFACTURER LIQUID CAPACITY: TANK INLET ELE ANK OUTLET EL WARNING LABEL LOCKING COVER PROVI PROVIDED: YES ❑No ❑YES BEDDING: VENT DIA. VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO ESH I' ALARM: FEET FROM i LINE: ( AIR INLET: p ❑ YES ❑ YES NEAREST DOSING CHAMBER' ' Le It = M, MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL: PUMP i8FPF10N MANUFACTURER: WARNING LABEL LOCKIDE INGCOV DYES O ~6~"~1(LC~L~-'J ES ❑NO S ❑NO PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH GALLONS PER CYCLE: r FEET FROM LINE: AIR INLET: / (DIFFERENCE BETWEEN c, 7n3 4~. PUMP AND OFF ES ❑ NO NEAREST--* > C0~' ~f Pth / , fI3TM SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plo LENGTH: DIAMETER: MATERIAL AND MARKING: win=FORCE cavation. (If soil can be rolled into a wire, construction shall cease untij c r-. Q wL or ex the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DA # PITS: LIQUID BED/TRENCH / TRENCHES: MA L: DEPTH: DIMENSIONS Z GRAVEL DEPTH FILL DEPTH DIST . PIPE DISTR. PIPE DISTR. PIPE M ERIAL: N S R. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH FEET FROM / INLET, BELOW PIPES: ABOVE COVER: E V. INLET: ELEV. END: PIP S: LINE: AIR << t r~ l" ~C~i oc NEAREST ..Ja. ~~C~ MOUND SYSTEM: a 13 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 D H OVER TRENCH/BED DEPTHS OF TOPSOIL: ODDED: SEEDED: MULCHED: CENTER: GES: YES ❑ NO ❑ YES ❑ NO ❑ S ❑ NO PRESSURIZE ISTRIBUTION SYSTEM: WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEP BELOW PIPE: FILL DEPTH AB0 COVER: BED/TRENC TRENCHES: DIMENSIO S MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. PIPE D TION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: ELEV ~T[,ON AND DIST TION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST, L n T~ . l .o' _ r` etain in county file for audit. Sketch System on Reverse Side. SIGN ORE: TITLL. SBD-6710 (R. 06/88) DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code CO UN ,7 fin` . STATE NI /1 b,PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than dc-r^V 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. PROPE TY OWNER PROPERTY LOCATION S , N, V(orW PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 1D O .3 S l -3 Z C TY, STATE zip CODE PHONE NUMBER SUBDIVISION AME OR CSM NUMBER II. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ VILLAGE : NEAR PST ROAD ❑ Public [Z1 or 2 Fam. Dwelling-# of bedrooms PAR ELTA NU BER ) III. BUILDING USE: (If building type is public, check all that apply) 453 JE~> 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 8 ❑ Mobile Home Park 120 Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. X Replacement 3. ❑ Replacement of 4.E1 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) Nonni Pressurized Distribution Pressurized Distribution Experimental Other 11 9 Seepage Bed 21 ❑ Mound 300 Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy Vault Privy Pressure 43 El 13 ❑ Seepage Pit i 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 (5. ft.) PROPOSED (4q. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION e Feet Feet VII. TANK CAPACITY Site in allons Total of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App Tanks Tanks structed " Se tic Tank or Holdin Tank /,000 1,666 101~5~0___ A. D I El Lift Pump Tank/Si hon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation he onsite sewage system shown on the attached plans. Plum is me Z P ber's Sign ure: ( o Sta s) MP/MPRSW No.: Business Phone Number: Plumbs 's Address (Street, ity, fate lp Code): 141,r- IS4_L IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e Issued Issuin Agent Sig ature (No s) ,Approved F1 Owner Given Initial Surcharge Feel Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD48398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber APPLICATION FOR SANITARY PERHIT 9TC-100 This application form Is to be conplntod In full and tlgnad by the avntr(s) of the property being developed. My Inadoquacles will only result In delays of the pzrnlt issuance, .Should thin development be Intended for reaals by ovnet/contractot,(spec houaa)# thon a socond torte should be retained and completed vhan tits property Is sold and submitted to t h I a a f f I c a with the approprlate deed rtcordlnq. Own:r of property Location of property Tkl -1/1_1/1, 8ectlon T.Q-9 r-P=2a _V Tovnshlp Hailing address Address of .lea lubdivlslon meet Lot number previous ovner of property Total ■1:e of parcel ' I Data parcel vas created _ J-1-j,~ 79_ /gq~ At$ all cornets and lot liner ldentttlablet Yea No to this property being developed for resale (spec house)1 Yas_ Ko volnte4 ;,~~_and page Humber 42el-- an recorded with the Register of Deeds. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - + L nc WIT11 C + A VKAtA YTr D¢ID which Includes aDOCUNRNTHUHBYR?Ill VOLLrHa u t l.xDPAot Hvx1aR, and else 89KL Or TIIE 119018TBR OP DUDS. In Addition, a certified autvey, if ~valIabIv, would be helpful so as to avoid delays of the tevlevlnq process. If the deed description talerencaa to it Cattifled survey Hap, the Certified Survey Hap shall also be required. PROPERTY OUIIER C9RT1FICXTIOH I(ve) certify that all statements on this form are true to the best of •y (out) itnovledgc1 that I (ue) am (Are) the owner(s) of the property described In ibis Inlocn+atlon (arm, by virtue of a unrrrnty eed recorded In the olllce of the County Register of Deeds As Document ljo. ptesently own the proposed alto for the sewage disposals atetn, and that f (ve) obtained an easement, to run wILh Lhe Above d s a c r I b I d property,(vIar ht. he consttuctlon at said Ayatetn, and the rams hre been duly recorded in the of IIca of the County Reqlater of Deadsi as Document No. llgnature of Ovnet eI9natuta of Co-Owner llI hppllc•ble Date oI tJlgnatura Data of Signature - WARRANTY DEED - THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2 -1982 460200 11- 'Vol. 875PWAS - REGISTER'S OFFICE ST. CROIX CO., WI Je-ff_re,y M. Murra-yColl_ean -L, Murray.,.-_-_----___-- ReC'd for Record Colleen L Murray,_-husband a__nd wife _ -as- survivors-hi.-p--marit-al. pr-ogerty-l JIJL V 3 1A0 at 11:30 A. M conveys and warrants to -----'Tbom-as--.-------- Register of Deeds - - - - I~ RETURN TO li - " the following described real estate in -------5 t . C r o -1x County, State of Wisconsin: Tax Parcel No-.............................. NW 1/4 of SE 1/4 of Section 12, Township 29 North, Range 20 West, St. Croix County, Wisconsin lying South and East of State Trunk Highway "35" as now located EXCEPT the South 20 feet and EXCEPT Commencing N0053'E 357.29 feet North of the SE corner of said NW 1/4 of SE 1/4; thence N0°53'E 906.01 feet; thence S30 481W 950.00 feet; thence Southeasterly 480.91 feet to plape of beginning. I o o P.4 I' ~I This i- s----------------- homestead property. (is) (is not) i Exception to warranties: Subject to easements, reservations and restrictions of record. Dated this L 0---`----------•------------------ day of Jun-e------------------ 19. 9 D II - - - -------------------------(SEAL) - - - - - (SEAL) - i * F , -•.(SEAL) ...--.-.(SEAL) » * COLLEAN L-. M RAY- a/k~a II Colleen L. Murray I AUTHENTICATION ACKNOWLEDGMENT I Signature (s) STATE OF WISCONSIN ss. St. Croix County. authenticated this --------day of--------------------------- 19.----- Personally came before me this .---day of June , 199 0---- the above named Jeffrey M. Murray and C o 11 e -a r_ L. Murray , a/ k/ a • - - - TITLE : MEMBER STATE BAR OF WISCONSIN Colleen L. Murray, - (If not- authorized by § 706.06, Wis. Stats.) to me known to be the person who executed the forego' strument ~nd acknowled e, the. same. liy THIS INSTRUMENT WAS DRAFTED BY STEPHEN J. DUNLAP Hudson, Wisconsin ----i--- t. C'ro,~c Notary Public S ' ~Colinty, Wis. (Signatures may be authenticated or acknowledged. Both My Commission,-, permanent. (I~. ndt, , kbte ;expiration are not necessary.) date: 'Names of persons signing in any capacity should be typed or printed below their signatures. '•rl Htirit~rl\ WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc. FORM No. 2- 1982 Milwaukee. Wis. 7 T SEPTIC TANK MAINTENANCE AGREEtIENT w St. Croix County t5 ft 01MER/BUYER 0 ROUTE/BOX NUMBER Fire Number :3 CITY/STATE ZIP PROPERTY LOCATION:' Section, _N o R(-_-02d_W, Town of St. Croix County, Subdivision Z _ Lot number. Improper use and maintenance of your septic system could result in its premature failure to handle wastes.- Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licens'ed' 's'ept'ic tank pumper. What you put into the system can a ect the ' .unct on o. t e septic tank as a treat- ment-stage in the waste disposal system. St. Croix County residents,-may be eligible to recieve a grant for a maximum of 604 of the cost.of replacement of a failing system, whi.c 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 's't'ems agree to keep their system properly maintained. The property owner agrees to.submit to St. Croix County Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or..a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and •(2)•after inspection and pumping (if nec- essary), fl-he 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. 0 I/WE, the undersigned have read the above requirements and agree 0 to maintain the private sewage disposal system in accordance with the standards set forth, herein, as.set by the Wisconsin Depart- ment of Natural Resources, Certification form must be completed •v and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386-4680 Sign, date and return to the above address. LTA PAR CI\'t£=1VT OF REPORT' ON SOIL.. BORINGS AND SAFETY & BUILDINGS 'INDUS`iR°r; n► t*°' DIVISION L.AYOR ANU PERCOLATION TESTS (115) MADISON O 53969 HUMAN RELATIONS , 707 (H63.09(1) 9, Chapter 145.045) ~'r)Ci\II(1N: SFCIIOft IOWNSNIP/j t RtfI1Y: t6i 1101131 K . NO. ,;UF2DIVISS SO ONNAME: W '/44S1~_`_~ _ 11 x29 N/ R2OXk(or)IIHudson Il/a ; n/a n/a _ '~,,O"IJTJI _ v^ n11,j14ER'S E3k4 C- F1~RSZ9AME:--- --'MAILING ADDRESS: - ) St. Croix Jeff Murray 11 Hy. #11, Hodson, Wi. 54016 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILF_ DES IPTIONS: ]TERCOLATION TESTS: I)3~~13esidenre 1-1 New ~fteplace L--- 3 n/a 6--27-90 I n/a RATING: S= Site suitable for system U= Site unsuitable for system _ ONVENTIIONNAI_: MOUND: TN -GROUNDPRESrrS''URE:SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) S U u ❑ CAS ❑ U ❑ S ®U ❑ S conventional If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.03(5)(b), indicate: class 2 Floodplain, indicate Floodplain elevation: n/a - decimalt PROFILE DESCRIPTIONS page 49 Pmll BORIPIG "IOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DE-I'TFW4, ELEVATION OBSERVED ES IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 13-1 6.58 98.61 none >6.58 .42bl.1. 1.08bn.sil. .58bn.s.1. 4.50bn.l.s. B-2 6.91 98.90 none limhAne •83bl.1. 1.08bn.s.1. 4.00bn.l.s. 1.00bn.1s.w/mot Cl. g_3 7.2,5 99.17 none lim6.00pne .33bl.l. 1.00bn.s.l. 4.67bn.l.s. 1.25bn.ls.w/mot. 1. B- I - PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. E__ 0 15 11 P PER INCH P- P_-- see - lsiRn rate P P- t' P- PLOT PLAN: Show locations of percolation tests, soil 4orings and the dimensions of suitable soil areas. Indicate scale or dist3; ces. Describe what are the hori zontal and vertical elevation reference points and show theirlocation on the plot plan. Show the surface elevation at all borings and the direction and percent Of land slope. ~ SYSTEM ELEVATION 96.17 Lq_ _ duo, Ste. ~(w qt ti ' RIO ~?tJ-c vt P yL. I, tha 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 torrent to the best of my knowledge and belief. ~PJAMF: (print) TESTS WERE COMPLETED ON: Gary L. Steel. 6-27-90 DRI SS." CFRT IFICAI ION NUMRER: PHONE NUMBER(optional). 1:15-246-6200 988 N. Shore Dr., NC-W Richnond, W:>. 54017 ASIGNJRE CSD1STRIRUTIOPJ: Original and one copy to Local Authority, Pceperty Owner and Soil Tester. I I~ ,t?f) gn;pr IR. 02if?2) - (lyHFi - s 5~67 ~y src T~9/1; xo?o~J ~p,So,1J Ayd y9y 0 a ~z 1®r,~,a,~ a2po , r PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VENT CAP H"C. I. VENT PIPE APPROVED LOCKING WEATHER PROOF 2 5' FR C M DOOR, JUNCTION BOX MANHOLE COVER ~ WINDOW OR FRESH 12"MIU. I AIR INTAKE GRADE I 4"MIN. 18" MIA1. CONDUIT-- IB"MIN. IN I_. F_ 1" PROVIDE I AIRTIGHT SEAL I I i I V Ir I I APPROVED JOINT A I III APPROVED JOINTS W/C.I. PIPE I III W/C.I. PIPE EXTENDIN(" 3' I II ALARM EXTENDING 3' ONTO SOLID SCI:. B I I ONTO SOLID SOIL I I I C)N C I I PUMP -1 y OFF D CONCRETE BLOCK RISER EXIT PERMITTED ONL`J IF TANK MANUFACTURER HAS SUCH APPROVAL SPEC,IFICATIOPIS SEPTIC AND DOSE TANKS MANUFACTURER: : ' NUMBER OF DOSES: x PER. DAB TANK ;AZE : i:,Q J GALLOWS DOSE VOLUME fl ALARM MANUFACTUKER:s_ . _/1n! !541/r. INCLUV!&!v ZAC!tFLOW: //GALLONS MODEL NUMBER: CAPACITIES: A=Z_INCHES OR GALLONS SWITCH TtlPE: JE~ B=>>pp INCHES OK GALLOIJS PUMP MANUFACTURER: C= 1.p_INCHES OR .2tL GALLONS 7AP MODEL NUMBER: L _ D - -2 INCHES OR ~ GALLONS SWITCH TYPE: F'J i% ii- NOTE: PUMP AMD ALARM ARE TO BE PUMP DISCHAR(.E RATE GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFEKEMCE Di9owCE i PUMP OFF AND DISTRIBUTION PIPE... FEET + MINIMUM NETWORK SUPPLY PRESSURE . , , , , , , , tk FEET ~f ♦ ZT26 FEET OF FORCE MAIN X /.~YOFTFRICTIOU FACTOR.1,AM FEET L-?S' I = TOTAL DYNAMIC HEAD = 4;_/GILLt~ FEET INTERNAL RIMEWSIONS O AUK: LENGTH ;WIDTH ._-;LIQUID DEPTH SICsNE D: LICEMSE NUMBER: DATE:,~~ - k . 67 -117- PAGE OF Zz 1-3 p 1 fldkll All Inl►1► And Ob►►lvallan Plpd u0S6v\ uJI, 5~0 e --Approvld VeNj Cop weNmum 12* Above Flnrl Oro 20- 42' Above Plpp -4" Core Iron 10 fl°81 Orodo V&Al Pips wash Hor Or Sr°IMIk Corulny wu 2' Aypropolo Orel Pips ' Olurlb~llon 0 0 Too + Plpo - fA , Prriorbl yd PIpo dolov 6o ° o ~Covpllnp TormlAellna Al Bottom 01 91614m o tl1r.1 r~,~1< :~7 P~~p yep ~ ~j, Ion SOIL FILL: DISTRIBUTIOM PIPE APPROVED StiviidETIC COVER "-MATERI,\t- OR '1" OF STRAW 2"oF~GGRE6AIE J ! OR MARSH HAy .G.O f.~OF -2e/2 AGGKCGAT E ELEV. of&JZFEET•_•' J r 1 DIS'I•'RI5'JTI0IJ PIPE TU DC AT LEA57,5;2~ INCHES BELOW ORIGIMAL GRADE AAIU AT. LEASTtO IIJCHES BUT 1.10 MOKC THAI) tit IuCIIES BELOW FINAL GRADE. )"WM1 DEPTH of F-Y-CAVATIO13 FKDP+ OK161NAa 64AD~ WILL BE _ IIJCHES nalMuM AF-Fri of EACAVATION r-J~0Y 0~I4I14gL GRn0f- WILL BE INCHES SIGLICD: Au~ LICELJSC DUMBER: OAT E 110 G~?tlLDS SUBMERSIBLE ref a ? y ' S f S~ GE AND EFFLUENT PUMPS r{ ~W}J EP0311. +r« t Lisr nlsc. 1/2 solids Y56.80 172.10 x 142 EP0311 1/3 HP 115 V Effluent Pulp FPO311 Submersible " MODEL EP0311 ~n Effluent:. Pump SIZE '/a" SOLIDS u, METERS FEET r w t 25 • 1 'rr 'fig 20 - - r V........ ~~.1 ri }1 i r• +ti~.,,r.y3 ~ 15 s> ! A ~ ~ j~ 1~r,~wa G 10 ;fix 1 ~y`4r 2 ' i +a 12 16 20 2t 2• 32 36 40 0. QO S , GPM ' 2.5 ¢.0 7.5 m'M if 0 CAPACITY s ' iI T Performance r A. 3885 Curve ~ y>;, `E00 MODE L 3885 f~,t4" Solid 25 w 20 t ti ,s d. eo ti S` r WEO7H A: - - - - - - - - - - - - - - j'f~ WE06N r,` 40 s _ to WE 310 WE071 . 20 M~ 7s lu r 0 OO 70 20 90 AO 60 EO 70 00 OO 100 110. 170 ' OPY CAMCITY 5 uf LIST DISC. b r F x xy+r ajWWE0311I. 142 WE0311L 1/3 HP 115 V Low H 3/4' solids 191.55 329.35 a~; r 3/4" solids 491.55 329.35 x arr ClFWE0311M 142 WE0311M 1/3 HP 115 V Mod H' Y 3`, 3/4".Aolids 704.25 47.1.85 a:.ao QCUF_O511H 142 WE051'1H 1/2 HP 115 V High H a 3/4" •olids 843.65 565.25 :'pOlNT07121i 142 W£07i2H 3/4 HP 230 V High Hd. L T Y 4", f S{~ Efr*rSPE',FOD..LGWING PAGE FM PFRFCEN4F+NCE AND SPECIFICATIONS. PAGE Vu , rq, .v';,, 10/88 DEPT 30 _ i CEP rENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LA~ R &HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 f awlanl.D. Number: L CONVENTIONAL ❑ALTERNATIVE I IState assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDODORR EESS OF PERMIT HOLDER: INSPECTION DATEV BENCH MARK I7"" ent r ce point) DESCRIBE IF DIFFERENT FROM P REF. PT. ELEV.: CST• F. PT. ELEV.: Name of lumber- _ MP/M W No.: County: Sanitary Permit Number: • a? O SEPTIC TANK/HOLDING TANK: MANUFACTURER: ILIQU III CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV. WARNING OV D DIABEL PROVIDED OVER DYES ONO DYES ONO BEDDING: VE TDIA.: VENT MATL. HIGH WATER NUMBER OF ROAD: RIDE ERTY WELL: BUILDING: IAIR NLEET FRESH ALARM' FEET FROM DYES ONO DYES ONO NEAREST DOSING CHAMBER: ID ED OVER MANUFACTURER BEDDING: LIQUID CAPACITY PUMP MODEL . PUMP/SIPHON MAN UFACTURER. RWAR OVIID DLABEL LOCKING DYES ONO DYES ONO J I DYES NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PR GPERTV WELL. BUILDING: AVENT TO FRESH LINE AIR INLET: (DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) DYES ONO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LEI,,,TH uIAMeTR MATERIAL AND MARKING 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: - IL nulD BED/TRENCH WIDTH: LENGTH. - TRENCHES OF DISTR. PIPE SPACING. COVER INSIDE DIA. tPITS: DEPTH: HES. MATERIAL: PIT DIMENSIONS FILL DEPTH DIS TR . 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. LINE: FEET FROM AIR INLET. NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES NO PERMANENT MARKERS: OBSERVATION WELLS. SOIL COVER. rexruRE DYES ONO DYES ONO DEPTH OVER TRENCHBEO DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED r ED: MULCHED. CENTER EDGES. DYES ONO DYES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: VDTH: LENGTH. NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: BEI D/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEV.. ELEV. DIA. ELEV. PIPES. DIA.: ELEVATION AND DISTRIBUTION PONO OVER MATERIAL: VERTICAL LIFTCORRESPONDS TO APPROVED RMA TION 0LE SIZE HOLE SPACING DRILLED CORRECTLY PLANS OYES ONO [I~ DYES - COMMENTS: PERMANENT MARKERS: LLS: NUM BER OF LINE: PROPERTY WELL: BUILDINGFEET FROM DYES ONO S ONO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE TITLE: DILHR SBD 6710 (R. 01/82) REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM San.i.taAy PeAmi t State Septic NAME 7°L Townehi St. CAa%x County Lacat4'oii &Zsectionj,,LLot # Subdivision SEPTIC TANK S.i z e gad Lon,6 Numb e o A ea mpan tment,6 Di'stance. AA.om: Weft Buitding- 12 0 stope Highwaten PUMPING CHAMBER Size gatton,6 Pump Manu6aetu1Le4-_, __,_Mode.k Numben_--_-_- HOLDING TANK Size gaftonb NumbeA o6 CampaAtme.nt~5~_ _ _ _ _ P u m p e rs A t a n.m S y e t e m Di,6tanee. 6n.om: Weft 8uitd4,ng 120 Highwate4 ABSORPTION SITE Bed TA.e.nch Di s tanee 640m: Weft Buitding____ t2% e dope. HighwateA ABSORPTION SITE DIMENSIONS t0, dth oA tteneh At Requited area Ax Length o6 each fine. At Depth o6 hock bek.ow tike in Numbers oA fines Depth o6 n.oek oveA tike in Totae fe.ngth oA tinee 6t Depth aA ti e bekaw gAade in Di e tance between Qi ne..5 At Stape o6 tne.neh_ _____i n • y.)( ,l 100 6 t I04(AA ub5UA.Pt4.on anew At Type o6 Covek: Pape.A oil etAaw ~ 111T DIMENSIONS Numbers a6 Pits Gnavef aicound p~.,ta ye'6___.^____na Out6 i.de d.i.ameten At Depth betow in?.et Totat abeonption aAe-a At AA.ea nequii ed At INSPECTED BY TITLE APPROVED DATE_ 198 REJECTED DATE 198 REASON FOR REJECTION r. PLB 67 State and County State Permit Permit Application County Permit # for Private Domestic Sewage Systems Count J *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: S G► AC" v B. LOCATION: /4Ya, Section, T N, R OE (or)r„UV(„ Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township [-~';w C a;-? C. TYPE OF OCCUPANCY: Commercial *Industrial *Other .,(specify) Variance Single family Duplex No. of Bedrooms No. of Persons Z D. SEPTIC TANK CAPACITY l~ fi'r' Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured-in-Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New Replacement>_Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: Length Width Depth Tile depth (top) No. of Lines 1 Seepage Pit: Inside diameter Liquid Depth -No. of Seepage Pits Percent slope of land Distance from critical slope WATER SUPPLY: Private Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soil Tester, NAME C.S.T. # and other information obtained from / (off:/builder). z Plumber's Signature 00 MP/,MPRSW# Phone #.2 1- 3 Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. i 3 i i i Do Not Write in Space ~ Below V FOR COUNTY AND STATDEPARTMENT USE ONLY Date of Application 7'-:J7 d'0,, Fees Paid: State 3-1)11__ County Date wT' y~ r^J Permit Issued/Rejected (date) y-32, Issuing Agent Name Inspection Yes No State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1 /78 i ~ d ~ e IU 4 tb ~ 10~° 'J ~ V I Q- f f / a O z 1 3 `L In Jr Jo~ VMS ~ tAcM " ST. CROI X COUNTY r W , y 5 4x ("r:"T WI S C 0 N S I N r.;i,•°~` ,1 ZONING OFFICE 796-2239 c roc _HP rY. mr HAMMOND, WI 54015 April 22, 1982 ' Doug Strohbeen R.R. 4 New Richmond, WI 54017 Dear Doug: DILHR has contacted us on the permit for Al Guggemos located in the NW34 of the SE4, Section 12, Hudson Township. -They are requesting that a 115 be filled out by a Certified Soils Tester. We must have some borings done on the property to verify .the soils. Should you have any questions, please contact this office. Yours truly, P Harold Barber al ST. CROI X COUNTY x ' y :,~x Mk ry W I S C O N S I N ZONING OFFICE 796-2239 HAMMOND, WI 54015 June 1, 1982 Jeanne Hart Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Dear Jeanne: I am enclosing the 115 for Charles Dawson as you had requested. We are sending a second letter to the plumber that installed the Al Guggemos tank.' We had previously requested the 115 or on site on April 22. We will forward the information as soon as we receive it. Thank you for your call today. Your truly, Sally eier Zonin Secretary sl Enclosure Jr. ST. CROI X COUNTY r tkA W I SC O N S I N ZONING OFFICE 796=2239 HAMMOND, WI 54015 June 1, 1982 s Doug Strohbeen R.R. 4 New Richmond, WI 54017 Dear Doug: DILHR has again contacted us on the 115 that was not included with the Al Guggemos permit submitted to them. We must have a 115 filled out to verify the soils on this property. We will not receive state funding on this property until it has been done. Please,take care of this problem promptly. Y/tAet truly, y e ~ Harold C. Barber Zoning Administrator sl DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS rI46USTRY; CC DIVISION LABOR AND P.O. BOX HUMAN RELATIONS PERCOLATION TESTS (11J) MADISON WI 53707 LOCATION: SECTIO~Tx qN/R9vF5 W TOWNSH P/MUNICIPALITa': LOT NO.: BLK. NO.: SUBDIVISION NAME: COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: W4 - - R l o USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERC AL DESCRIPTION: DESCRIPTIONS: PERCOLATION TESTS: Residence I r_ ? ❑Newieplace RATING: S= Site suitabl or systerjr U= Site unsuitable fors stem CONQVENTfO❑NA M ND: IN-G~ ND UR ZY - N- L HOLD G AN COMMEND D SYSTEM: (optional) If Percolation Tests are NOT required DESIGN RA E: S ST M If any portion of the lot 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. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) F/ A B-;s B- B- r , ~Ij PER L TION T TS C~ TEST DEPTH WATER IN HOLE T T ME DROP IN WATER LEVEL-INCH S RATE MINUTES NUMBER INCHES AFTERSWELLING INT R L-MIN. P D 1 PERIOD 2 PERIOD PER INCH P- P- P- P P_ PLAN VIEW: 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 slop. SYSTEM ELEVATION n g : E 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin Admimistrative Co and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. 002 le rA 1-3 NAME (print): TESTS WERE COMPLETED ON: De ac; ;7- ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional): CST SIG ATURE: DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. DILHR-SBD-6395 (N. 03/81) 1 T D~PARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, , DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 7969 N WI 53707 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIPdatVjt§tbWTY: LOT NO.: BLK. NO, SUBDIVISION NAME: SW ~'/,CE'/4 12 /T29 N/R20)j(.r)w Hudson in/a In/a n/a COUNTY: OWNER'S BLAME: MAILING ADDRESS: St. Croix Jeff Murray 11037 Hy. 435, Hudson, Wi. 54016 USE DATES OBSERVATIONS MADE NO,BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILE DESCRIPTIONS: PER OLATION TESTS: i5t Residence 3 n/a ❑New Replace Il 6_27_90 n/a RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ®S ❑ U Dl ❑ U [ S ❑ U ❑ S ®U ❑ S conventional 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: class 2 Floodplain, indicate Floodplain elevation: n/a decimal' PROFILE DESCRIPTIONS page 49 PmD BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPT. ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B-1 6.58 98.61 none >6.58 .42bl.1. 1.08bn.sil. .58bn.s.l. 4.50bn.l.s. B-2 6.91 98.90 none lijs&e •83bl.1. 1.08bn.s.1. 4.00bn.l.s. 1.00bn.ls.w/m0t cl. limestone B-3 7.25 99.17 none 6.00 .33bl.1. 1.00bn.s.1. 4.67bn.l.s. 1.25bn.1s.w/mot. 1. B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. -PERIOD 1 PERIOD2 P R PER INCH P- P_ see isl rate P- 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 96.17 4 s- aL -e-11 _4 ; i o i , m t l t ! ! 3 , 4.1 t 5►`~~- E • i r E -i I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the proce res nd mQt#Wds specified in the W40c nsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge a d lief. U 0 'p 4. 0 cn NAME (print): TEST WERE CjM!,P~ETED @6`11U Gary L. Steel NN~ B PHO RIU tional): ADDRESS: CERTIFICATION 988 N. Shore Dr. New Richmond Wi. 54017 2298 724 = p CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) -OVER -