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HomeMy WebLinkAbout030-2083-40-000 00 4 0 x o o bo 0 0 a) cli fn — (D 0) 0 c Z c x 7 f6 0 a) CD CL LL a 'o'p 0 ns (D E 0 :!t (D 6 E Cl) ZO e- co c') uj U) c .2 0 z v c 0 co ZW- '6 (D E -2 ce) CD .,N CL I C: .0 A < 0 4) Z CD z 0 Z 0 c "0 '0 1 c ca m (N E >m U) 0 CL C 0 Q) a CL E L) CL o o o R r- -0 00 CO —a) o CN Q 2 i:z a E m a. c cf) fn 4) 1 co U) 0 E LO rn 0 C4 4)0 r m CL m a 0 E w c O 'o 0 CD 0 -S Q) CD CN u) U) z Gi C 0 0 14 M 04 CD CD S S E • O (D 0 Z o m LL 0) CD O IL 0 o CL 2 o w 0 Parcel #: 030-2083-40-000 05/05/2006 07:49 AM PAGE IOFI Alt. Parcel#: 36.30.20.707 030-TOWN OF SAINT JOSEPH Current U ST.CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): 0=Current Owner, C=Current Co-Owner DANA R&JEANNE M SMITH O-SMITH, DANA R&JEANNE M 239 RED PINE CIR HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description '239 RED PINE CIR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.300 Plat: 2323-PINE TREE MEADOWS SEC 36 T30N R20W PINE TREE MEADOWS LOT 4 Block/Condo Bldg: LOT 4 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 36-30N-20W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 893/244 07/23/1997 870/105 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/12/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.300 67,000 156,800 223,800 NO Totals for 2006: General Property 2.300 67,000 156,800 223,800 Woodland 0.000 0 0 Totals for 2005: General Property 2.300 67,000 156,800 223,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 316 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 n NOTE . 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F o4 u • S °a•ap ) °++ a vP °� e P a � aa2• � o U� )' � *'G s�SJi� �i OC•� a �°at-°f•3+a` n i'e. a=y ,t+ a • ��'San � 3wo•° u Xa -a; •A b �jn l+,jo`$s°ia da*2 �3 oa:Y : ni;s� � •+:'a°+.P �+ Aoi =�� i ° t°Jb5'' ya � E3 .s, n` I§i:� �au:. ��• '+: -i wr:e \\ t°a)6\O aD:t'$ is tO A: x p8 l p e :og: ; o 'jo•:* c3 o °pac a•a esa a sr°D [o o:T 2 _ *ta P E03I°r°P !'4 not +4e041a a ° '[ •ap. )p \tot°° p�n iy !�]3Sya # ia�+ U a 14 Ea gig`` :•tj� a fr°E '• t • r^ PUMP CHAMBER Manufacturer: Liquid Capacity: Pump 1: Pump/Siphon Manufacturer: P ize Elevation of 1 et: Bottom of tank elevat Pump off switch eleva n: Gall per cycle: Alarm Manufacturer: Alarm per Type: Number of feet from neare property ne: Front, O Side, O Rear, Ft. umber of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: _ Trench: Width: S Length: Number of Lines: _ Area Built: Fill depth to top of pipe: i Number of feet from nearest property line: Front, �[ Side, O Rear,O Ft . r Y� Number of feet from well: 160 Number of feet from building: (Include distances on plot plan). SE E PIT Size: Number of pits: Diameter: Liquid dep Bottom of seepage pit elevation: Area Built: Has either a drop box O o distribution box O been used on a of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: pacity: Number of rings used: E ation o ottom of tank: Elevation of inlet: Number of feet from n rest property line: Front, Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: � c Inspector: S Dated: 1� a,C C� Plumber on job: ` e;ex—k--� License Number: Q S� 3/84:mj Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER (�/�/ ��2� TOWNSHIP SEC. T N-R W ADDRESS �( �,���_� ST. CROIX COUNTY, WISCONSIN SUBDIVISION L I MO_fW&''7' LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM tv LET �O2N�� N o Orr Top v �t /00 b N v -t, � y /8 x y/- goo r sjrSTg7�y �4 E rs7A w�E 95.93 INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used a T �G/ ��� L Elevation of vertical reference point: 1400 ` Proposed slope at site: S TANK: Manufacturer: Liquid Capacity: Number of rin ed: Tank manhole cover el n: Tank Inlet Elevation: ank et Elevation: :>e et from nea Road: Front, ide,o Rear, O feet rest property line Front,0 Side, Re feet t from: well , building: (Include this information of the above plot plan)( 2 reference dimensions to s c tank) SEE REVERSE SIDE DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY& BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS P.O. BOX 7869 DIVISION MADISON?WI 53707 BUREAU OF PLUMBING SE-, SW!4, S36,T30N—R20W XX CONVENTIONAL ❑ALTERNATIVE State Plan I.D.Number Town of St. Joseph ❑Holding Tank ❑ In-Ground Pressure ❑Mound (Ifassigned) HWY 35 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER INSPECTION DATE: Tom Fero Route 2, Box 92, Hudson, WI 54016 J'��y� 8 `l l� BENCH MARK(Permanent reference point)DESCRIBE IF IFFERENT FROM PLAN: J a ' REF.PT.ELEV.: 1151.E�PT.ELEV IMP/MPRSW No.: , C : Sanitary Permit Number: Donavin Schmitt 3205 St. Croix 96027 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELE V.. TANK OUTLET ELE V.: WARNING LABEL LOCKING COVER G T _ /'�Ir PROVIDED: PROVIDED �I/ __ ❑YES ❑NO OYES ❑NO BEDDING: VENT DIA.: VENT MA?;_.. 'HIGH WATER NUMBER©F ROAD: PROPERTY WELL: BUILDING. FRESH A LARA.,. EET FROM LINE: jAV'EFNTTO INLET: DYES ONO ❑YES NO NEAREST' DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY. PUMP MODEL PUMP/SIPHON MANU FACTIIRER :1:7-- ABEL LOCKING COVER PROVIDED ❑YES ONO ❑NO DYES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPE RTV WELL. BUILDING. VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE I AIR INLET' PUMP ON AND OFF) FEET NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE the soil is dry enough to continue.) MAIN_ CONVEN�yTIO�N�AL SYSTEM: B ©/TFlENCH WIDTH: LENGTH. NO OF DISTR.PIP SPACING. C VER ;INSIDE CIA. #PITS: LIQUID TRENCHES A ERI C3tMElONS f� PIT DEPTH, GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTH.PIPE DISTR.PIPE MATERIAL: NO.D r NUMBEROF BELO PIPES. AB VE COVER. ELlE V.INLET ELE V.END. /� PROPERTY WELL: BUILDING: VENT TO Fq ESH 011_411 -}�� PIPE NEAREST LINEO� / AIRINLE L !/" 661j /` 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- ❑YES ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER ITEXTURE PERMANENT MARKERS OBSERVATION WELLS DEPTH OVER TRENCH/BED DEPTH OVER TRENCHiBED =DEPTH01OIL. SODDED ❑YES ISEEDIA, NO ❑YES ❑NO CENTER. EDGESMULCHED. ❑YES NO DYES 1:1 NO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENG TH. NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMRISiQINS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. NO.DISTR. DISTR,PIPE DISTRIBUTION PIPE MATERIAL&MARKING. ELEV.. ELEV.. CIA.. ELEV.: PIPES. DIA.: , #. I_N A @.f(5 TION HOLE SIZE HOLE SPACING. DRILLED CORRECTLY. COVER MATERIAL: L AL LIFT CORRESPONDS TO APPROVED DYES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER ROPERTY WELL: BUILDING:FEET FRINE: ❑YES ❑NO ❑YES ❑NO I�EARI S , V 11 . . � U y 1 d� N 4 Sketch System on Retai ` in county file for a dit. Reverse Side. SIGNATUR TITLE: DILHR SBD 6710(R.01/82) �, '� Zoning Administrator 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. rXll revisions to this perm.it must,be approvedfby the permit issuing authority. A new perrrfJt rzray be needed:-, ' if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc,), depth of system, ot,,type of systerp; , 17 4. Changes in ownership or plumber requires a Sariitary Permit Transfer/Renewal Form (SBD 639$)'to be ` submitted to the county prigr to installation; 5. Private sewage•s�stems must6eprcperly°maintained,The septic tank(s) should-be-puiriped by a Iicenf ed -� s pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, co�lact 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: z r, I_ Property owner's name and mailing address. Provide the legal description where the systeM is to be_ installed; II. Type of building or use served: If public is 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; III. 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 and/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 in 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.,naw,,-E r ification number,,address, d 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 8'/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale ot.with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; buildMt 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; purop model a6d,pump manufacturer; D) cross sectipn,of the soil absorption system if required by the county; E) soil test-data on a 115 form. ----------------------------------------------------'"`'s------------------------------------------------------------------------------------- ------------ '• GROUNDWATER SURCHARGE Ql On May 4, 1984, 1983,W'isconsin Act 410 was signed into law. This legislation is more commonly knowljas the groundwater protection law. This change in statutes was the `result of over'2 Aars of 9feady negotiation an&pUblic debate. The groundwater bill Ground. included the creation of surcharges (fees) for a number of regulated practices which Wisco %nvS can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reclsllCB is used in your building is returned to the groundwater through your soil absorption u system or the disposal site used by your holding tank pumper. a The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) (DILH,R SANITARY PERMIT APPLICATION COUNTY Rd x _ In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY 7 RY PERMIT# —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 (� Z NO PROPERTY OWNER PROPERTY LOCATION Tatf rk 6 '/4 54 ' S c74 T p, N, R to E (orX0 PROPERTY OWNER'S MAILING ADDRESS LOT NUMB IBL' CK NUMBER SUBDIVISION NAME CITY STATE 92ZIP CODE PHONE NUMBER ED CITY NEAREST ROAD,LAKE OR 0 ANDMARK VILLAGE: II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family Y OR ❑ Public(Specify): Ill. PURPOSE OF APPLICATION: (Check only one in##1. Check##2,3 or 4,if applicable) 1. a. ❑ 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. IV. TYPE OF SYSTEM: (Check only one in##1 and only one in#2) 1. a. Conventional 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. X Seepage Bed b. ❑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): ,� �g �� v /V• Feet XPrivate ❑Joint ❑ Public VI. TANK CAPACITY Site in gallons Total #of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed 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 2gjhagjttached plans. Plumber's Name(Print): Plumb ' Signature:(No Stamps) /MPRSW No.: Business Phone Number: Plumber's Address(Street,City,State,Code): A e, • Name of Designer: / W r VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# CST's DDRE S(Street,City,State,Zip Code) Phone Number: h / —�" IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuin Agent Signature(No Stamps) 12 Approved cam( Su charge Fee pp ❑ Owner venlnitial /;11, �� ��^ U� �4 7 Adverse Determination UV d •,t,0 X. COMMENTS/REASONS FOR DISAPPROVAL: A ri,I �- 14�, ,,Jk,,_l by SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber 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 AO�a 3 4t L t � Location of Property !�6 _ k, Section -6 , T (, N-R 1(? W Township Mailing Address 0�_ Address of Situ Subdivision Name Lot Number Previous Owner of Property 69� 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 3sm and Page Number AMCM as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, vol_ ume 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) ce ti,6y that a t btatement6 on thi.6 60nm ane tAue to the but 06 my (0m) knowledge; that I (we) am (cute) the ownen(b) 06 the pupenty de�scfcibed in th.i,6 in6onmati,on 6onm, by vil tue 06 a waAAanty deed neconded eA the 066i 06 the Cow Reg,i..6.ten o6 Veed�s a6 Vocument No. ; and that * (we) pne6 en.tey own the pnopoaed site 6oh the sewage d4i6pob r eya em (on I (we) have obtained an eaa e►nent, to nun with the above du cA bed p)topeh ty, bon the con tAuc Lion 06 a aid 6ptem, and the .6ame ha6 been duty neconded to the 066ice o6 the County RegizteA o6 Deeds, a6 Voeument No. SIGNATURE Olt OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) -DATE SIGNED DATE SIGNED -mss rIwo pl. § k �. �5!j!jH �(. erotic Ce�ac� on © � icy, t� ' `< T S A B b Y 1 `yR t� urtaawn06 t11""flr ' elect of�aeornbr i�aoy, *w y ta_ � x H a STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT St . Croix County z V _ / a OWNER/BUYER 7h(o0�2(g S Is e ROUTS/BOX NUMBER e/ � Fire Number CITY/STATE ZIP ���j PROPERTY LOCATION: Ste" Section, TAN , R_j W, Town of 37,— �_,Tb !/j , St . Croix County, Subdivision� Pn Yi�� 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 may be eligible to receive a grant for a maximum of 60% of the coat 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 E I/WE, the undersigned , have read the above requirements and agree z to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- u ment of Natural Resources . Certification form must be completed and returned to the St . Croix County Zoning Offkge within 30 days of the three year expiration date. SIGNED DATE 6,�S Z27 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 . DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY&BUILDINGS INDUSTRY, DIVISION LABOR AN P.O. BOX 76 4UMAN RELATIONS PERCOLATION TESTS (115) MADISON WI 53707 (H63.090)& Chapter 145.045) LOCATION: TOWNSHIP/MUNKNPlktiTY: OT NO.:BLK.NO.: SUBDIVI ON NAME: = 5 %V/ 3(o /T3oN/Rzol(or)W -1 4 0sF P h j4) COON Y: OWNERS ME: MAILING ADDRESS: #Z t3 z wd.S ' . S JSE DATES OBSERVATIONS MADE NO.BEDR : CO R TIQN: R b STS: Residence G( ' ❑New V38eplace I [.J l/d RATING:S-Site suitable for system U-Site unsuitable for system /v CONVENT NAL: MOUND: IN-GROU -I -FILL OLDING TANK:RECOMMENDED SYSTEM:(optional) y1s ou 0s ❑u EA E]U o S � a S glu F6 rl t d„t4, If Percolation Tests are NOT required DESIGN RATE: �^ L� If any portion of the tested area is in the under s.H63.09(5)(b),indicate: 1. /�SS —1--6;Ql2/ LFloodplain,indicate Floodplain elevation: [�tQ1rY1 , PPOFII F_ DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH NUMBER N. ELEVATION OBSERVED H TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) WO B-_3 rJ 9 II 03 A5 > 1. I �i •S �. .cl B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PrEA10D I PE I PER INCH P- P- P- / J vzf P- P=— LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- 3ntal 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 4 land slope. 'YSTEM ELEVATION t _ i Ilt ! p rT 1 , / �► i p -3 h t _Y I \\1rrn i the undersigned,hereby certify that the soil tests reported on this form were msda by me in accord with the procedures and methods specified in the Wisconsin Wministrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. DAME pri TESTS WERE COMPLETED ON: 113DRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): t rid '.5¢oi -2 z 5' /s SSG-i6Zca CST SIGNATUR TRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. -6395 (R.02/82) —OVER — I � _ I � � I '' I i � � - # � l I 1 i � � Ii ICI C ._ +. � _ 1! i i it :. .. � I � .- t Ji 111 I� � , �' 4 � 1 I I III I i -1 _ -- - - - -- - -- - I � Ll � I `N Q - --- - � I I I i I I , 1 I ' i I ' I ' I �- I t _ I � I s t I t rt - I r I r I I I I I I I I I I