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Home My WebLink About020-1169-30-000 St. Croix County Planning and Zonin Monday, April 04, 2005 at 4:18:Ol PM Page 1 of I Detail Sanitary Information Computer 020-1169-30.000 Sub/Plat: Ranchwood Section: 7 TNIRNG: T29N R19W Parcel 07.29.19.1050 Lot: 23&24 114114: SE 114 NW 114 Municipality: Hudson, Town of CSM: Owner: Rolland, Rolf 329 Highvi udson, WI 54016 State Permit: 88416 Issued:1 V1986 POWTS Dispersal: Non-Pressurized In-ground Permit: New Bedrooms; 3 WI Fund: County Permit: 0 Installed: 1210311986 POWTS Detail: Bed - Seepage POWTS Pretreatment: NA Notes In Additional Notes Money Owed s ep ctor As Built Plumber Other Requirements Powers, Calvin 1000 gal. Powers Tank to 18'x 63' bed $0.00 Tom Nelson Yes Signed Off: Yes Maintenance Scheduled Puma Date Pumped 1 st Notification 2nd Notification 3rd Notification 61312005 - - - - - - - - Parcel 020-1169-30-000 04/04/2005 04:11 PM PAGE 1 OF 1 Alt. Parcel 07.29.19.1050 020 - TOWN OF HUDSON Current ,XST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner ROLF R & GAYLE M ROLLAND " ROLLAND, ROLF R & GAYLE M 329 HIGHVIEW RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 329 HIGHVIEW RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.120 Plat: 2362-RANCHWOOD SEC 7 T29N R19W SE NW LOTS 23 & 24 PLAT Block/Condo Bldg: LOT 23 RANCHWOOD Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4) 07-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 756/153 2004 SUMMARY Bill Fair Market Value: Assessed with: 49090 238,400 Valuations: Last Changed: 10/29/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.120 33,900 150,500 184,400 NO Totals for 2004: General Property 1.120 33,900 150,500 184,400 Woodland 0.000 0 0 Totals for 2003: General Property 1.120 33,900 150,500 184,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 109 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 1 Form- S T C - 104 ,r AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SEC._ T ~N-R W ADDRESS ST. CROIX COUNTY, WISCONSIN p~ p6R-3o -00 7`S ~s+koa~ o ~J~ SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimens ns to meet requirements of IZHR 83 So" EVERYTH =EET OF SYSTEM ~,Fw amp ti i G~l~ac,e /t /t'm usa 7-V /"v l INDICATE NORTH ARROW .~nJf7S /0/• lr ~ I ~,EA ~f. ~ l0 1 ~BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: /Me" Proposed slope at site: SEPTIC TANK: Manufacturer:p sL.'l;~, Tilot~ir~s Liquid Capacity: Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front, Side,Q Rear, OQ feet .From nearest property line Front, 0Side 10Rear,(D 3 $J feet i Number of feet from: well building: -_2 _57 (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer k` Liquid Capacity Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, Ft. Number of feet from well:...' Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length: / s Number of Lines:_,:S'_ Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, Rear,0 Ft .,/Z Number of feet from well: ~y/f} i Number of feet fronj building: ~'q (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has, either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number: 3/84:mj 4 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR& HUMAN RELATIONS ,P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WI 53707 BUREAU OF PLUMBING ERCONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number: ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound Of assigned) NAME Of PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTIO AT Rolff Rolland Rt. 2, Box 954, Hudson, WI 54016 % BENCH MARK IP manent reference Pointl DESCRIBE IF DIFFERENT FROM PLAN: y-ea REP. T. E EV.: CST REF. PT. ELEV.: SE NW, Section 7, T29N-R19W, Twn.of Hudson, Lot23, Ranchwood Est. Name of Plumber: \ MP/MPRSW No.: County: Sanitary Permit Number. Cal Powers 1563 St. Croix 88416 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LAUI'L LOCKING COVER W u J L SZ / P O IDED: PROVIDED: BEDDING: / ~ YES ❑NO DYES C~NO VENT DIA.: VENT MATL.: HIGH WA NUMBER O ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM. FEET FROM I (W) LIN~ gIR~ET DYES NO DYES ❑NO NEAREST IV DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER DYES ❑NO PROVIDED: PROVIDED: GALLONS PER CYCLE: PUMP AND CONTROLS oPERAT1oNAL: ❑ YES ❑ NO ❑ YES ❑ NO (DIFFERENCE BETWEEN OF PROPERTY WELL eUILDING: V NTT FRESH E F OM LINE AIR INLET. PUMP ON AND OFF) DYES '❑NO NEARE T 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 CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF FDISTR. SPACING C V INSIDE DIA *PITS LIGUIO DIMENSIONS 18 ~ 3 THE^HES: I MATERIAL: PIT DEPGRAVEL H FILL DEPH DI RPIPE DIDISTERIAL: NO. D R. OF BELOW PIPES, ABOVE COVER: ELEV. INLET. ELEV. END: PROPE TV WELL: BUILDING: V NT TO FRESH t PIPES FEET NUMBER FROM LINE r AIR INLET ~Jo : Sy 1.)1.7,? A)/& 2729 3 NEAREST I) N 39 3c~ i 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 IL VER TEXTURE PERMANENT MARKERS. OBSERVATION WELLS DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED ❑ YES ❑ NO ❑ YES ❑ NO CENTER: EDGES: DEPTH OF TOPSOIL. SODDED. SEEDED MULCHED: DYES ❑NO DYES ❑No DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COV R. DIMENSIONS TRENCHES: MANIFOLD PUM MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE OISTHIBU I ION PIPE MATERIAL & MARKING ELEV.: ELEV.: ELEV.: ELEVATION AND DIA PIPES DIA DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING GRILLED CORRECTLY COVER MATERIAL VELARTINS.CAL LIfT CORRESPONDS TO APPROVED P COMMENTS: DYES ❑NO DYES ❑NO PERMANENT MARKERS: ERVATION WELLS: r~ NUMBER OF PROPERTY WELL: BUILDING: C FEET FROM LINE: r 31 DYES ❑N T DYES ❑NO NEAREST x <ll i~ f. Sketch System on Reverse Side. l Re unty file for alit SIGN URE: ~ TI LE DILHR SBD 6710 (R. 01/82) -{SANITARY PERMIT APPLICATION COU Y , U ®'LNR In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. STATE PLAN I.D. NUMBER -See reverse side for instructions for completing this application. 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PETITION FOR VARIANCE ❑ YES ❑ NO PROP TY OWNER PROPERTY LOCATION %a, S T , N, R (or) 40 PROPER O NEWS MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBD VISION NAME CITY TATE ZIP CODE PHONE NUMBER CITY LEA ST ROAD, LAKE OR NDMARK 2_ 1 VILLAGE 11. TYPE OF BUILDING OR USE SERVED: _ '0" 41 a0 ~ 3 Number of Bedrooms if 1 or 2 Family OR ~Public S ecif ( P Y) ` III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. JAJ New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of ell 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. X 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. ❑ See a e 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): VI. TANK CAPACITY Feet ®Private ❑Joint ❑ Public in alions Total # of Site Fiber- Exper. INFORMATION New fisti Manufacturer's Name Prefab. Con- Steel Plastic ng Gallons Tanks Concrete glass App, Tanks Tanks structed Septic Tank or Holding Tank Lift Pump Tank/Si hon Chamber la~~ __H_ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation rivate sewage system shown on the attached plans. Plumber's Name (Print): Plu er's Sign ture: (N mps) MP/MPRSW No.: Business Phone Number: lum er's Address treet, City, te, Zip Co Name of Designer: /7 A6 1,i III. SOIL TEST INFORMATION Certified oil Tester (CST) Na e CST # CST s DRES treet, City, State, ip Co e) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY V❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial Surcharge Fee Adverse Determination -011,9 ~ J ~Z~ 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 SANITARI( 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 every2 to 3-years; 6. If you have questions concerning your private sewage systern, 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 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; M. 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 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 8'h 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 so.l 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 - 1 result of over 2 years of steady negotiation and public debate. The groundwater bill Groundwater included 'he creation of surcharges (fees) for a number of regulated practices which Wiscon~ in's ~ can effect groundwater. The surcharge took effect on July 1, 1984. Ali of the water tha` buried Treasure ~ is used in your building is returned tc the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund acminis- tk,rec' by the Departrent of Natural Resources. These funds are used for monitoring ground- 1 dater, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398 (R.03/86) 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 propert is sold-and submitted to this office with the appropriate deed recording. y - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property Location of Property Section . T,,=2!?-N-R~ W Township Mailing Address S-- Address of Site Subdivision Name Lot Number Previous Owner of Property Is) s i n /n~ Total Size of Parcel L 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 and Page Number - as recorded with the Register of D ds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warrant Deed which includes a Document number, volume and Pane 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. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPFRTV OWNER CERTIFICATION I (We) eenti6y that att statement6 on thin 6onm ane true to the but o6 my (oun) knowledge; that I (we) am (are) the owner (e) o6 the pro pen ty des c- ibed in this .in6onmation 6oAm, by viAtue o4 a woAAanty deed neconded in the 066ice as the County Reg.caten o6 Deeds as Document Na. own the pnopoa ed .6ite Ron the sewage d~,s po.s eye ems (andl(that (We puze we) Ihave ) obta ineddaan easement, to nun with. the above deachibed pnope ty, bon the conatnuction og eaid Qybtem, and the eame had been duty necdnded in the 046ice o6 the County RegisteA o6 Deeds, as Document No. 1. SIGNATURE ~OFWNER GNATURE OF CO-OWNER (IF APPLICABLE) tGNED DATE SIGNED s • H "ST C- 105 r ' r y SEPTIC TANK MAfNTENANCE AGREEMENT H St. Croix County z v 9 OWNER/BUYER G~ ROUTE/BOX NUMBER Fire Number CITY/STATE R L__ Z I P PROPERTY LOCATION:,:,C Section T N, R W, Town of St. Croix County, Subdivision/ALot numbere'l . 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 pui1L)er. What you put 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 v, rant 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. H 0 W. I/WE; the,undersigned, have read the above requirements and agree z to maintain the private sewage dis -cal s, W j rsten► in accordance with W the standards set forth, herein, as set by the Wisconsin Depart- ro ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. S I G N E D St. Croix County Zoning Office P.O. B'ax 98 Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. I,ElAHit4F41T(F REPORT ON SOIL WRINGS AND --~►l ,TY & BUILDIN l N l~) DIVISION N LAN P ~Fl. " N'AMJMA FLA7~ir~NS PERCOLATION TESTS (115) MADISON W1 53707 W63.090) & Chapter 145,046) _ q iII MUNiCtpAl ITY: T NO.; LK. Nq.:5 BDIVISI R E: -7 ~T24 N/R,st~o, w z3 - CN a COL NT 7 viral f~ a u An 5c, _ ._P0LT-T- K4LCAr4A USE' DATES 08siERVA'CI0141111 MADE Ft«ts,riarree Naw ❑Repleq ~C p SePT 2Z t SHPT 23,X986 ,C5'. vaaK 4 4R A>~~z _ raFatY RATING: S, Site suitgbto for sVmm Ur $ ft wswitelsit for system ~a LZ - 5 1 ~ iv t • t r_ ~ifC: RECtJRiitYIENDED SYSTEM lopj ~ionali U s+~U S ClU S oil ❑S Cc~ v r _ N T 0 16~Q If Percolation '1'0448 aro NO7'r ired TOE i N RA Ethe testedare~a is in the uncfers 1l6~i_U9IBIthl, °ndicCL.idSS FI 1 cate Floodplain elevation; AIA BORING A PROFILE DESCRIPTIONS NllwlIBER EPTH ELEVATION •1 H XCTEK OF L K E, ND EPTH ' Qf- • 70 BEDR CK fE O ER ED iSEE ABBRV ~ON.BACK.} B- 8.9z 6 LLTS tV& NL wGc 7 s"BakcstC,R /o"lT>3aNMS /v` .34 8 9Z *"Rh6k& MS wr'co6 AYEtt- 6.T~N S 8 t .Ub ic3 9C pv N 9kNSL 6S- Rt, MS Eft eo _ _ r-__.. ~-an~~_ _ _ ~>sye Rs ZT $ef~ ~ s ~G~ / C-r ~o $2N'SS ~ Cob ~a►, Z"R QN > N 7 9 Rr✓ at B ! (;,~£3. ~ /6S.47 _ AKI Sae w_IAY ks tr$e Jps'tGe Nccrr a &-N M`5 2 7S='80" e • 4 9.00 iez 6Z , > 9 oa 161~ BUTS iz" BaN L IMF"Ro$,~ co f h&WC-MWCa29"1_-dRq~'S46,t 4e R4 S ~C4k B- 8.58 /0s.V3 Y8.s3 5%LLTS /4'%k tS,L 75"Ikk N MSfG+t w 47C06 B- fj~t PERCOLATION TESTS i. r;Tr i w>> re 1~ 6I_E rs TIME CH rp7zArSbVELi.ih!{i VALALMIN. PR IN S 00 " -M _ - - o 8i , p73 f° 1. _ 'LOT PLAN. ' Sliow tnwtiont of percolation testa, soil borin and the dirnensiom of suitable soil areas. Indicate scale or distances. Describe what eta the hori :ontetl anti wrtical eirvatirsn rnfrrertca points and show their location an the plot plan, Show the surface elevation at all hori,f land s: >pw. and this direction and percent SYSTEM ELEVATION /Ws.60 t,. 'S,rt Lc LcaT 7 Z j f i j 41 j Yip e~ 3 : F ± ~ t ! 4 ~ tea ~ ° i , 45' 1 1 '-2, A 11~ TH /3 4' _ Q t 7 3 J y #3 - , I f t ~Z4 i- i- - i 4- I~IIwPTf,l(. i erns undersronad, hereby certif y that the toll 'nests reported on this form were r vKW by rite in accord with the procedures and methods specified in the Wisconsin lrninistWivtt Coale, end.tbat t1 wdeta recorded and the location of the tests are correct to the best of my knowledge and belief, fESTR~C LETS Ep 0N` _ StPremaER 7~ /1W. CEfi"f IPiCATION NUMBER: PHONE NUMBERfoptiorutll: 4o-7 SEcoNA S7 k/Uas4N ~,l f S4r r~ 34E~4 _ 40 0 17y, G-k URE MRIBUVON:Or;,linal anclonecopv to Local r - Authority, e oparty Owner anti Soil Tester. ori• t41)_t9:fpr'fpi.02ffl1) OVER oil 017 A7- .QSN.P ~6 49- 0 ii'~!/x5;83 .30 S8 ` t G; ,bin Q y1, _ PAGE OF CroSS S /1 ec 1 un o /^I 16e0 SySte rl Fresh Air Intel* And Observation Pipe Lam- Approvad Vent Cap jAbovefto 204- Casf Iron TVent Pipe t .Mush He y Or Synthetic Covering min. 2v Aggregota Over Pipe Oletribation j Pipe o o - Teo G" A Beneath Pipe ° Perforated Pipe BNevr Cftoing Terminating At Bottom Of System i i, Pao o3tD ~ina' 9r#- P SOIL FILL DISTRIBUT1 PIPE APPROVED 5jhT4ETIC GOVER OFg6GREGATFE ~`"MATERIM- OR 9" OF STRAW OR MARSH HA`.i ELEV. oF14024EET, G~ OF -2i/2 AGGREGATE e8 DIS'TRIgUTI0M PIPE TO BE AT LEAST INCHES BELOW ORIGINAL GRADE AAIp AT LEAS720 IfJCHES BUT K10 MORE THAM 42 INCHES BELOW FINAL GRADE t' t l MAXMA WN OF EXCAVATIO0 FROM ORIGINAL 6RADF WILL BE _ INCHES MINIMUM 9EPrh OF EXCAVATION MOM. 141WAL GRi49E WILL BE INCHES SI&I MED: LICEAISE AJUMBER: DATE: