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HomeMy WebLinkAbout040-1073-70-100 CD o o o a o N N C a � I r 0 ti � I o @ o Z m c _ � LL L c c � O co Q C M Z y rn E +' C Z 00 w a m Z c o c o z Z 0) Z N N r m a) z M N C O) U) c • a) O O N a U t I C O C U O O O Q w Z F- Z o N 4i Z r N J 01 w y (9 CL C .m n. c O W a N a E c co N Z N > CO O O O a Z *i O m Lo CL IL CL tJ) J U cO 00 00 Z N r r - LL O O .� J E ) N N E +�+ O d• O E O � L" O I� CO O O c TV' fi c 0 O O c N O. N N N C4 0) r 40 0 N 0) a 0) O H 4rP Z Z M t ' T C N N •=x11 7> co N N 4� O O U y O � r d t9 a 7 # L: d C • CC C E U 01 £ U CL I' O N V 1 Parcel #: 040-1073-70-100 02/12/2007 05:01 PM PAGE 1 OF 1 Alt. Parcel#: 18.28.19.2801 040-TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner JOHN &JANA L GAFFER O-GAFFER, JOHN&JANA L 342 CTY RD F HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): '=Primary Type Dist# Description "342 CTY RD F SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 5.050 Plat: N/A-NOT AVAILABLE SEC 18 T28N R1 9W PART OF NE SW LOT 2 CSM Block/Condo Bldg: 6/1697 EXC THE S 12.27'OF E 361.06 AS IN 753/45 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 18-28N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 850/144 07/23/1997 794/177 2007 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/20/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.050 71,500 201,000 272,500 NO Totals for 2007: General Property 5.050 71,500 201,000 272,500 Woodland 0.000 0 0 Totals for 2006: General Property 5.050 71,500 201,000 272,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch#: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON,WI 53707 NE4, SW4, Sec. 18 ,T28-19W El CONVENTIONAL ❑ALTERNATIVE Stet.PNn I.D.Number. III aeslgned) Town of Troy ❑Holding Tank ❑In-Ground Pressure ❑Mound Co ty F NAME OF PERMIT HOLDER: DOR ESS OF PERMIT HOLDER' INSPECTION DATE A John Ggffer 214 Church St. River Falls , WI 54022 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN. REF.PT.E EV.: CST REF PT.ELEV Name of Plumber. M I/MPRSW No County Sanitary Permit Number Paul C.J. Steiner 6780 St . Croix 1128632 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. OYES ED]NO OYES NO BEDDING: VENT DIA.. VENT MAT L. HI(i HWATER NUMBER OF ROAD' PROPERTY WELL. BUIIOING. VENT TO FRESH ALARM FEET FROM LINE. AIR INLET DYES ❑NO ❑YES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING: LIQUID CAPACITY JPUMP MODEL. PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED. OYES ONO ❑YES ❑NO ❑YES ONO GALLONS PER CYCLE: PUMPANU CONTROLS OPER ATIONAL. NUMBER OF PROPERTY WELL BUILDING VENT TOFRE H III (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET. PUMP ON AND OFF) ]YES ONO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing ENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH LENGTH NO IDISTR PIPE SPACING MATERIAL: INSIDE DIA SP17S ILBED/TRENCH TRENCHES IOUIO PIT DEPTH DIMENSIONS` r AV l DEPTH FILL DEPTH 1115TH PI F UISTR.PIPE DISTR.PIPE MATERIAL NO DISTR NUMBER OF PROPERTY WELL BUILDING V NT TO FRESH BELOW PIPES ABOVE COVER ELEV.INLF T ELEV.END PIPES FEET FROM LINE. AIR INLET NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM 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 OIL COVER ITEXTURE PERMANENT MARKERS OBSERVATION WELLS DYES ❑NO OYES ONO DEPTH OVER TRENCH;SED DEPTH OVER THENCH;BEU DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. ❑YES ONO ❑YES ❑NO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH LLE LENGTH. TRENCHES: LATERAL SPACING: GRAVEL DEPTH.BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS OLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. NO DISTR DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. ELEV. OtA. ELEV.: PIPES DIA.: ELEVATION AN DISTRIBUTION IZE E SPACING DRILLED CORRECTLY COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED INI'`itf~' CATION PLANS O ❑YES ON DYES ONO COMMEN PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL. BUILDING: M FEET FROM LINE. ❑YES ❑NO DYES 1:1 NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE-. TITLE. 71 DILHR SBD 6710(R.01/82) E:E:c SANITARY PERMIT APPLICATION ILHR In accord with ILHR 83.05,Wis.Adm.Code COON..� V&-'>f- - STATEI,YYPERMIT� -Attach complete plans(to the county copy only)for the system,on paper not less than v''QQ((JJ 33 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 �� e - Y. Sf) Y.,S /8 T.: N, R 1c7 Ls W PROPERTY OWNER'S MAILING ADDRESS LOT# BLOCK# CITY,STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER Ir a/ / / OG 7 M6 0 /G II. TYPE OF BUILDING: (Check one) ❑State Owned M 411 I o,,GE: NEAREST ROACV 10 TOWN OF: Tro ❑ Public ®1 or 2 Fam. Dwelling-#of bedrooms-! PAR L A NUMBER(S) III. BUILDING USE: (If building type is public,check all that apply) 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 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. 29 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 2.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) 9900 ELEVATION Y 5 D 1 60o . 75- </U. io/„ 'F f,L y Feet 1D3. Feet VII. TANK CAPACITY Site in ga ons Total ##of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank — S VIII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name(Print): Plumb e ' ignature:(N S mps) MP/MPR9W 14 Business Phone Number: .S Plumbers Address Street,City,State,Zip Code): IX, COUNTY/DEPARTMENT USE ONLY ❑ Disapproved itary Permit Fee(Includes Groundwater Date Issued Iss 'ng gent Signature(No Stamps) Approved El Owner Given Initial Surcharge Fee) Adverse Determinationi S'3 i u Q CONDITIONS OF APPROVAL/REASONS FOR SAPPROVAL: SBD-6398(formerly Plb-67)(R.11/88) DISTRIBUTION: Original to County,One Copy To:Safety&Buildings Division,Owner,Plumber y INSTRUCTIONS s 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. ib 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% 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 m °- 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) DOCUMENT No, WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF nCCWIISSCONSIN/�fFr'(OA�RM 2—1982 ` REGISTER'S OFFICE ------ -- --------------------_ --------- --------------- ST. CROIX CO., WI --.-. Rec'd for Record --------- ------------------------------------ ----------------------------------------- -----------------.. AUG 3 11989 ---- - ---- - at conveys and warrants to ___John Gaffer and Jana L. Gaffer 3:30 P. M -------------- ---- ----------- -------------- �" .__husband---and--v�ife--as---survivorship...mari.ta.1----------- o au -----propex.tit---------------------------------------------- - ----------------- - - '" RegisterOfDeeds --- ------- ---i----------------------------------------------- ------ -------.............._-_-._-____-__-__---------------.---------------------------------------------------- ._._ RETURN TO ------------_--------------------------------_------------------------------------___----------------- _____________________________________.----.___-_--_-_____...___--___.._-_--.....---__--.. the following described real estate in --. St. CroiX County, ............ State of Wisconsin: Tax Parcel No_ ______________________________ Part of NE 1/4 of SW 1/4 of Section 18-28-19 described as follows: Lot 2 of Certified Survey Map filed August 21 , 1986 in Volume "6" , Page 1E97 , EXCEPT that parcel deeded to David and Julie McLaughlin in Volume "753" , Page 45. TRANSF , $�1.�o FEB This --- is not homestead property. (is) (is not) Exception to warranties: Subject to easements, reservations and restrictions of record. ":� '? V'-� Dated this --- - - day of Au ust - - - --------- - 19_8.9.. --------- ------------------------------- --------------------------(SEAL) fiYy. - -------------(SEAL) * RAN L. KLETSCHKA ---------•--- ------------------------------(SEAL) ---- -------- ----- ------------------- - ------- -------(SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) ------------------------------------------------------------ STATE OF WISCONSIN SS. ----------------------------------- -------------------------------------------- St. Croix ------------------------------- County. Q authenticated this ________day of___________________________ 19______ Personally came before me this --- v-____day of August 19-_8 9_ the above named -------------------------------------------------------------------------------- Randy L. Kletsch�ta ------ ------------------------------------------------------------------------- ------------------------------------------------------------------------------ --------------------------------------------------------------•----------------- TITLE: MEMBER STATE BAR OF WISCONSIN -------------------------------------------------------------------------------- (If not- ------------------------------------------------------------ -------•-------------------------------------------------------- ---------- authorized by § 706.06, Wis. Stats.) to me known to be the person --------__ ___ who executed the foregoing instrument and acknow the same. THIS INSTRUMENT WAS DRAFTED BY STEPHEN J. DUNLAP - --- -- -------------- _ __ ___fiudson, Wisconsin Notary Public ------.-----------County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent.( are not necessary.) ------------------ 19--------- *Names of persons signing in any capacity should he typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Lena! laanlc (­. Inc. FORM No. 2— 1982 31 i;o,.0 kec- wis. + 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 `)o h P a n a a � I e l- Location of property _L_1: 1/4 /4, Section _, T N-R_Lq_Y Township TI'O Mailing address ( Ll h t-Arc h + R) Fu )Is . 'W i 8-'LLo3. ;3� Address of site aZ 0—o Rd F 14-ad sion W i SL/o 1 b Subdivision name Lot number Previous owner of property R o n d Y K le {6 KCL Total size of parcel J a c re<� Date parcel was created h Are all corners and lot lines identifiable? �Yas No Is this property being developed for resale (spec house)? Yes _N0 Volume and Page Number as recorded with the Register of Deeds. ------ s -----------------it- ------------------------------------------ INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. ---------------------------------------------------------7--------------------- PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty,deed recorded in the Office of the County Register of Deeds as Document No. 5y5///hf • ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the Co n Register f eds as Document No. ) . 9 � rS1 nat a of Owner t Si tune of Co-Owner 71A OplIcable) p Date bt Signature Date of Signature STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER Jn 11 r\ b Jana GQ +f e r ROUTE/BOX NUMBER a Ll Ch c h- FIRE NO. CITY/STATE �I'V_e r Fa S' W r ZIP PROPERTY LOCATION: 1/4 5W 1/4, Section T ?ON, R_Ly W Town of I f , St. Croix County, °v Subdivision , Lot No. . Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a LICENSED SEPTIC TANK PUMPER. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIts[1!I of $3000 of the cost of replacement of a failing system, which was in ope`r`ation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning ff' a within 30 days of the three year expiration date. SIGNED pip DATE/� 0 St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address DEPARTMENT OF SAFETY& BUILDINGS INDUSTRY, REPORT ON SOIL BORINGS AND DIVISION LABOR HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 (H63.090)&Chapter 145.045) LOCATION SECTION: TOWNSHIP LOT NO.:BLK-NO.: SUBDI VISION NAME: ti,E 14 1/ If l De N/R If E ( ►W T R o .Z 11-1S/4-i COUNTY: - OWNER'S S NAME: MAI LI IIJU ADDR SS: ST-CP61,C RAODy kLEZ5K+ 0(5 X, .2N0 S+. HOPS00 WI-f. T'vo/ USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE D ONS: STS: WResidence 2 �. ANew ❑Replace 2 Z_/fp 9 JA4 RATING:S=Site suitable for system U=Site unsuitable for system ` ONVENTI NAL: MOUND: IN-GROUND-PR U _ : S STE - N-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional) zS ❑U S ❑U ®S DU ❑S gu ❑S ©ll Cou( 'cJf1i�� c._ If Percolation Tests are NOT required DESIG1N RATE- If any portion of the tested area is in the under s.H63.09(5)(b),indicate: C�T ss + Floodplain,indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL PTH TO GROUP DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST.Al GHE TO BEDROCK IF OBSERVED (SEE-xABBRV.ON BA K.) B_ (� 9,S 02 Gf/� her" 9� ' /d ' Ba. sr� 2- s' WEy 4:j o - N 6.o Tv vE�e c5 w'0f4 G-R /l�L �� ' �� > /o' i3N_ sf� i.o &-I• 6A)- s �.O Tr1a B-7 q 9 - f.E t cs R . B-d 1. !� /OS.D8 '� > /2 Q f V3 RIO- S( 3. Li RrJ S 7.O ?�!�1 B- - B- F} LT ROAT6 APTAS 2 Sf ��S Rt poPT' o F M l FB- TOP Q` 'ti i S C-S T- I . PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD 3 PER INCH P_ P_ p_ Z P- P-3 &Z L 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. 5)"S7 M 0 SYSTEM ELEVATION 7— '" , '" f�• (� Y c,��'. goy ' � � � T ;QVT � / lip// �t1? ��,� _.. �-_.�I98T -- -! ZONING l P t WIN off -- - _ t �' ..... i �( g Y �is for c nv i L _ _ L TN p 3 A ff : ss � • j P N I ;O ter,I=API I flea` /QQ-D 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(print): HOMESHE SEPTIC PLUMBING CO- TESTS W RE COMPLET�QN: RI.3 O'NEIL RD.,HUDSON,MS.50016 0-- ? ADDRESS: ROBER I UtBRCHY CERTI}CA°TION NUMBER: P �l U-M�i R ospt�ion'al): WIS.*VER PLUMBER UC.N0.3307 MAIM a Z - CST SIGNATU DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — a Tor Rea�cP���e„1- A reo OX 1 t � .2 TrencA5 flw 1 1 6'wlelt- m x LD'.co�a 1 8g ® 1 1 1 t t 1 ► ;B M 13 re Elev f i Joo,00 ep ..1 Nor t h ore NO c�