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HomeMy WebLinkAbout042-1086-80-200 4) 0 X22 -6 kk k $§ � ED 0 8 m c c z C 4) z co E 0 z CD 4) LU CL CO z 0 E 0 z z E 4) co 4) W..6 (L kz o <2 z 0 z C 04 ) CL 4) c 4) ce) IL > 0 E 000 z IL IL CL V; a. U) 4) 00 ()o 0 d) d) z E CO 4) o CD z (f) cc ■ 0) CD 16 2 -S E co C� 6 - S CD a. 0 0 0 00 00 ,6 V: 9 $ \ } f 2 \ [ ' A § C 4) C� ca 0 (A 'R , It — , o 0 1 0 ce) 0 z m cn 4) CL IL 0 U) Q Q 0 mo� IL Parcel #: 042-1086-80-200 02/08/2007 01:10 PM PAGE 1 OF 1 Alt.Parcel M 31.29.18.484E 042-TOWN OF WARREN 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 O-PITTMAN, DONALD L&JUDITH A DONALD L&JUDITH A PITTMAN 947 65TH AVE ROBERTS WI 54023 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *947 65TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 1.730 Plat: N/A-NOT AVAILABLE SEC 31 T29N R18W NE SW 1.73 ACRES LOT 1 Block/Condo Bldg: CSM 7/1915 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 31-29N-18W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 807/450 2007 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/22/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.730 34,300 148,000 182,300 NO Totals for 2007: General Property 1.730 34,300 148,000 182,300 Woodland 0.000 0 0 Totals for 2006: General Property 1.730 34,300 148,000 182,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 205 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 DIVISION LAWR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING P.O.BOX 7969 MADISON,WI 53707 SW%,NE�,S31,T29N—R18W CONVENTIONAL ❑ALTERNATIVE state Planl.D.Number El Holding Tank El in-Ground Pressure ❑Mound (If assigned) Town of Warren lheth Drive NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE: Donald Pittman 701 Elm Stree t, Hudson, WI 54016 -/O —�1' BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: JLSl REF.PT.ELEV.. Name of Plumber: MP/MPRSW No Coumy'. Samtary Permit Number: Henry Nechville 3258 St. Croix 106131 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY'. TANK INLET ELEV: TANK OUTLET ELEV.. PROVIDEDLABEL PROVIDED OVER ES ONO I DYES [Sf�O BEDDING: VENT DIA.. VENT MAT HIGH WATER NUMBER OF ROAD: PROPERTY WELL BUILDING.(VENT TO FRESH ALARM. LINE: AIR INLET / FEET FROM ❑YES NO L I C" ❑YES NO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING'. LIQUID CAPACITY JPUMP MODEL. PUMP/SIPHON MANUFACTURER TMATERIAL LOCKING ❑YES 1:1 No DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPE RATIO NA L: NUMBER OF PROPER LINE (DIFFERENCE BETWEEN FEET FROM PUMP ON AND OFF) ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM.Check thesoil moistureat the depth of plowing LENGTH DIAMETER or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH NO.OF DISTR.PIPE SPACING. COVER INSIDE CIA -PITS LIQUID BED/TRENCH TRENCHES MATERIAL: PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL. NO.DISTR NUMBER OF PROPERTY WELL BUILDING V NI LE FRESH BELOW PIPES ABOVE COVER ELEV INLET 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 upsfope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES ❑NO SOIL COVER TEXTURE 7PERMAN-ENT MARKERS OBSEHVATION WELLS YES -]NO OYES ONO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER EDGES. ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH. NO.OF LATERAL SPACING.JGRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL NO DISTR DISTR.PIPE DISTRIBUTION PIPE MATERIAL.&MAHKINI: ELEV. ELEV.. CIA.. ELEV.'. PIPES ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER No PLANT ICAL LIFT CORRESPONDS TO APPROVED DYES ONO EYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF PR OPERTV WELL: 1`u I LDING. FEET FROM LINE: Lila 01 q .yg DYES 1:1 NO DYES 1:1 NO NEAREST—� 2 Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE DILHR SBD 6710(R.01/82) Zoning Adn, � O SANITARY PERMIT APPLICATION C0 SANITARY ffILHR In accord with ILHR 83.05,Wis.Adm.Code v A0/X �°• �� STATE SANITARY PERMIT# /049 / —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES 9 NO PROPERTY OWNER PROPERTY LOCATION .gar 1/4 Wet/4, S 3 T , N, R /$ E (o W PROPERTY OWNER'S MAILING AD RESS LOT N MBER BLOCK NUMQER SUB V S N NAME A � CITY, TATE ZIP CODE PHONE NUMBER CITY NEARE KE OR LANDMARK S © 4, O VILLAGE 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): 111. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. LrJ New b.❑ Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. I IV. TYPE OF SYSTEM: (Check only one in##1 and only one in#2) 1. a. LKConventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION- (Check one) 1. a. El seepage Bed b. L Seepage Trench c. ❑Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): .,ia1 .w�i , O0 ►Mea� � ' W.7 Private ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank Lift Pump Tank/Siphon Chamber VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number: #ff A LI-k Al�=g k I" t� 4-2 j ( )7f Plumber' Address(Street,City,State,Zip ode): Name f Designer: VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# tiro a�cj 45103630 CST's ADDRESS(Street,Pity,State,Zip Code) Phone Number: 'YS"S" .Dy + C%o! 7 Z 8 -3 5174 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature(No Stamps Approved ❑ Owner Given Initial &�2U,Oa S 4;6,ev /�� AJ Adverse Determination �pV' V /� W► - X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If yoj have questions concerning your private sewace syste .i, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1 Property owners narne and mailing address. Provide the legal description where the system is to be installed; 11. Type of building or use served: It public i; checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; 111. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new arid/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill i,n name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than EY2 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; dosing or pumping chambers; 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. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the \ result of over 2 years of steady negotiation and public debate. The groundwater bill' Ground# tBC included the creation of surcharges (fees) for a number of regulated practices which Wisco iYi'S can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that �' burled re suite is used in your building is returned tc the groundwater through your soil absorption u system or the disposal site used by your holding tank pumper. 0 s collecteo through these surcharges are credited to the groundwater fund adm nis- bi; _ Department of Natural Resources. These funds are used for monitoring ground­t ?dwater contamination investigations and establishment of standards. Groundwater, 1; protecting. Z.�3lSfl APPLICATION FOR SANITARY PERMIT STC - 100 his application form is to be completed in. full and signed by the owner(s) of the roperty 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 fi�-x.�_� 1 Location of Property S c2J k 1%, Section 2/ , T_ 9 N-R Township nailing Address Address of Site Subdivision Name `r Lot Number l Previous Amer of Property - V --- Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes !/ No Volume _� off_ and Page Number as recorded with the Register of Deeds. 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION 1 (We) Cutti.6y that att btatement�s on this 6okm ane true to the bust o6 my (oun) hnowtedge; that I (we) am (ahe) tile owneA(,Sl o6 the pnopeh ty du cAi.bed in thi s i"Wmation 6okm, by vi&tue o6 a wdAA;tnty deed neeonded in the 066ice o6 the Coiutty Registeh o6 Deeds ah Document No and that I (We) pnebentty sun l e pnopoaed zite bon the (sewage di�spo�s a ye em (on I (we) have obtained an CdAcnent, to nun with the above de cA.Zbed properrty, 6oh the eonatnucti.on o6 adid e yatemv and the dame hae been duty Aeconded .tn the 066ice 06 the County Reg•i.d•te)t o6 flttda, ad Ooement No. ) SIGNATURE OIL OWNER S NATURE OF CO-OWNER (IF APPLICABLE) 3 _ Q DATE Sld& DATE 9IGNED DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED a o,' ;A..f s i. REGISTER'S OFFICE This Deed,made between Cyril C. Cernohous and ST. CROIX CO., WI Patri c`i a i5 CPrnohn>>,-­ ht�shanA an��:* Rec1d for Recmrd Grantor, APR 12 1988 and Donald L Pittman and Judith d Pittman- hies a and wife as survivorship marital property. of 10:15 UDC, AMnn U Witnesseth,That the said Grantor,for a valuable consideration Grantee, Regtater of Deeds RETURN TO } conveys to Grantee the following described real estate in St. Croix County,State of Wisconsin: part of Parcel �` Tax Parcel No: 42-1086-80-100 A parcel of land located in the I'JE % of the SW % of section 31, Township 29 Worth, J' I Range 18 West, described as follows: Lot 1 of a Certified Survey 2.1ap dated October 12, 1987, recorded Pdovember 9, 1987 in Volume 7 of Certified Survey i,iaps at page ! 1915, as document No. 431982 in the office of the Register of Deeds for St. Croix County, Wisconsin, ExcEp,.'IOIi: The Westerly 33 feet thereof shown as a Private Road Easement. TRRN $ i FEE This is not homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And Cyril C. Cernohous and Patricia II Cernohous his wife warrants that the title Is good, indefeasible in fee simple and free and clear of encumbrances except I i and will warrant and defend the same. Dar this 12th day of April / (SEAL) (SEAL) Cyril C. Cernohous y(SEAL) (SEAL) 1 Patricia 14. Cernohous I, AUTHENTICATION ACKNOWLEDGMENT Signature(s)_ STATE OF WISCONSIN SS. St. Croix County. authenticated this-day of 19 Personally came before me this A-th day of 1 April 1988 the above named Cyril C. Cernohous Patricia I• . Cernohous TITLE:MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person r who excuted the authorized by§706.06,Wis.Stats.) for Ing instrument and acknowledge the sameA THIS INSTRUMENT WAS DRAFTED BY _ ���. Cyril C. Cernohous ` -d 486 County i,oad FF ' G p �L I` Hudson, 6tiisconsin 54016 Notar Au ke County,Wis. (Signatures may be authenticated or acknowledged. Both My CYt �' permanent. (If not, state expiration are not necessary.) y•..; date: 19 ) 'Names of persons signing in any capacity should be typed or printed below their signatures. NF 3573 WARRANTY DEED STATE BAR OF WISCONSIN Nelco Forms,P.O.Box 10208,Green Bay,WI 54307-0208 FORM No.1-1982 i H , z a STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z d a n H OWNER/BUYER M ROUTE/BOX NUMBER 70 �5�,tit _ Fire Number .CITY/STATE _� Q ��pn +/ c ZIP PROPERTY LOCATION: Ste , �' , Section , T .22 N , R_ Town of U)nx Aa ..A St . Croix County, Subdivision ly , 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 licensed septic tank pumper. What you pdt into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St . Croix. County residents m_ y be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which 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 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) the on-.site wastewater disposal system is in proper operating 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. 0 I/WE, the undersigned , have read the above requirements and agree to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- b ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Off ce within 30 days of the three year expiration date . SIGNED DATE Q1/ 3 C>6 St . Croix County Zoning Office P.O. Box 98, Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address . r i T . OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUS TR Y Y,, INDUS DIVISION LABOR HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 (H63.09(1)&Chapter 145.045) LOCATION: SECTION: TOWNSHI .IMUid OWALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: j '/0/ ? /T, ' N/R/x E (or(W /4-""f0 fAl COUNTY: OWN ER BUYER'S NAME: MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO.BEDRMS.:1COMMERCIAL DESCRIPTION: PROFI E DESCRIPTIONS:1PERCOLATION TESTS: ��Residence _ ��? QNew ❑Replace I n -, 7 RATING:S-Site suitable for system U=Site unsuitable for system CONVENTIONAL:IMOUND:�y IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDINGTANK: RECOMMENDED SYSTEM:(optional) ®S ❑U DS ❑U ®S ❑U El MU I ❑S ®U I a1 - isc' 5 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 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.) 8A 5/� £�-�Y /Z�n Sf X41 -7.2 rh �r S B- I C?C�' CJ ,95" �1J'0 h/S �' I nr' --7� 't �" er*'r s�s0 nf�c sr' -cs ! 0--)1 dh (3h 5/i i -31 /'dii 5, 3/ -/01/ 81, �rS B- �T C. `� 9S� j5 'cam J " 5CArTE4Fo nE'r' SnLCS D -`i cl�• Pn s r', 9-.)7 is ii l) s f c-7 7- 7 0 8A 13-_ zc> in It R 190,57 = /-00 SPrnE_ A c, F 31 I O -/a 2.k 5i ; &I -zf lZ -rqS, 7/ -70 /3h r B- /:v 9�''i_' 1 oC� L� •-/c� t S =fry, 1 " .S'ir >! ,2 ,ti p r,5 B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- 3-3 P (� hart ���ia�/Ui l' h • 15' P- P- 2.3 /L✓o < - 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 dirjaction and percent of land slope. /?tt� 7A_'fit '.f1 a j.. 97,us� tq vnR/?�4Ei- "iD Bi-f v /IwA IV%Z=- S6 or twit 64 SYSTEM ELEVATION 611 = 96•.17 .s� �'ri:�n!�a t ;o r/!1,t-elo f J_oC r,!j, a:,,' C . iJ 3 3 a E : E k i P. L j - LOT L� �•'�F'� u'_ ,moo f£ l4 r -,)7 l'c'-,'A)f r��w� �:/�tJ = /ITr� 1,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): TESTS WERE COMPLETED ON: It e ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): f I'� f%{�-✓`.;o>v Cti1 S �',�> fir) 31>=.0 (7 1s'.? -J CST SIGNATURE: , DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) -OVER - V, p A;N It r J t j 1 d 4 9" °� � yfX >a t i _ S x x a et- Lv �yF3�� 1 3 S E. L $ p L t: R( Qp x ,29 r t k • J: � ;. North line of the SW ' n� w z Saicin NW, � '` S89051' 2" 231. 27 ' x—-- -— — — 198.27'L6 a 331 r d 331 7 R ad R/ S89o24'36"W { cn 'f3 t 'kd4 +.,r.4r r• yw..t i// �_ M1 All !FICA. F •� 17 I I ' A 111/ /� ✓ / t r�t -7 11 to 1 ( u It • ��I �v \ P/li p tv ' 1 l"''' k - � _ E ;4� Fri t } 3 �. mss"- �`..rr. 905 ' 42"E 329 . 43 ' , t � i �,�: Pte. d' ��" d.�+' c�,.N,�. �s.f�`) f�� _ �� °�� -• `, '� R Unpl.atted lands owned by platter cm