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HomeMy WebLinkAbout020-1146-40-000 nO 3. a C `i1 m Z 3 3 a~ °Y ►~y (n 'S 2 N z p W 00 0 C N `C ~tOy; • O ]f :r =3 CL a L CDD` m w N O CO ~ ~ ~~CA11111 C: w CD O CD fD p G l o W G rt o a m N o v o o (D b o r, tZi7 y r C) C Er CO O Fl- 1 V o m va ~r CD CD 00 Ln O m "*Aid Z 00 O C. o (D F- Q a N o r- CA 10 2 _ ca y OD 00 N Ta Q" 7 z y o O O rt o p 2 `ttv r n s vi c~i~ ch o c8 0) c 11 c v v t7j o M y i 3 d w ~ :3 N Z 3 N ~ 0 C D W o ~r 00 00 zi O a N cn o m CD x N t+~l i r• m m m C ~t •s, v rt c CD J (D CD ' . (xD Q. N O fin . c ti d a A Z 3 x Cl Z N m W A m C 0) I, Z o a a A °o x m co H Z U) I 0 a a m c a o a v m N • A n A W I ti O ON A O °p CD _ b ts+ O pO i Parcel 020-1146-40-000 05/22/2006 11:45 AM PAGE 1 OF 1 Alt. Parcel 26.29.19.773 020 - TOWN OF HUDSON Current FX11 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 GREGORY A BROWN O - BROWN, GREGORY A 780 MEADOW DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 780 MEADOW DR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.147 Plat: 2077-HIGH MEADOWS SEC 26 T29N R19W HIGH MEADOWS LOT 8 Block/Condo Bldg: LOT 8 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 26-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 836/599 07/23/1997 749/237 07/23/1997 698/283 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.147 75,600 181,600 257,200 NO Totals for 2006: General Property 2.147 75,600 181,600 257,200 Woodland 0.000 0 0 Totals for 2005: General Property 2.147 75,600 181,600 257,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 119 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form - ST C- 104 AS BUILT SANITARY SYSTEM REPORT I OWNE& j &&,pe'f r TOWNSHIP ? ~c L,5 e'er SEC. T 'Z,~N-R~W ADDRESS Gi~.Sa-'-f 7,wp ST. CROIX COUNTY, WISCONSIN SUBDIVISION ~:h fyle~~,~s LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•I,HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM c~ t 1 j i V INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used ;5;"" e Q S //5- Elevation of vertical reference point: /ed. SIP Proposed slope at site: SEPTIC TANK: Manufacturer: 6)"-- Liquid Capacity: led d { Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: /es Number of feet from nearest Road: Front 10 Side 0 Rear, ~ feet From nearest property line Front 10 Side,O Rear, O /'/e7 feet 'T ~ Number of feet from: well building: a (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: 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, 0 Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: k Trench: Width: Lenth: S, Number of Lines: SL Area Built: l Fill depth to top of pipe: 7 02. Number of feet from nearest property line: Front, 0 Side, O Rear,O Ft. Number of feet from well: l~1O f- Number of feet from building: ya aLy ~ (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, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: zzza Plumber on job: License Number: 3/84:mj 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 nCONVENTIONAL ❑ALTERNATIVE State Planl.D.Number: 111 assigned) ` ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER INSPEC ION /1E : Larry Bennett Rt. 1, Hudson, WI 54016 101 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. F. PT EL V.: CST REF. PT. ELEV.. SW SE, Sectdon 26 T79N-R19W, Town of 14udson.Lot8, High Meadows Name of Plumber: JMPIMPRSW N,, Cnunly Sanitary Permit Number: William Schumaker 6382 St. Croix 83781 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY. TANK INLET UTLET ELEVWAR NING LABEL JLOCKING COVER / ~J PROVIDEDPROVIDED/Owl ~a / YES ONO DYES ONO BEDDINGVENT DIA.: VENT MATE JHIGH WATER NUMBER OF ROPERTY WELLBUILDINGJVENT TO FRESH ALARM FEET FROM AYES LI AIL l• DYES O NO NEAREST - J ✓ DOSING CHAMBER: MANUFACTURER J BEDDING. LIQUID CAPACITY PUMP MODEL PUMP,SIPHON MANUF AC TUREH WARNING LABEL LOCKING COVER PROVIDED: PROVIDED DYES ONO DYES ONO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY 11111 LL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM NE IAIR INLET PUMP ON AND OFF) DYES ONO _ NEAREST-~ SOIL ABSORPTION SYSTEM. Check thesoilmoisture atthedepth ofplowing AMFTEH IMATIHIALANDMARKING 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 DISTR Pl Pjjj svnclNn COVEN INSIDE Din =PITS LIQUID THENS M1,tp~i.FgIAL' PIT DEPTH. DIMENSIONS / I;HAVrL UFPPI FILL DEPTH UISTH PIPF BELOW PIPES A UISTH PIPE DISTR. PIPE MATERIAL NO iH NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH BOVE COVER E EV. INLET ELEV. ND ~~ggI IPI FEET FROM LI/~ ~j ~LETP at~ aJlr^ NEAREST- / ► i ✓/~(]/J 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. OYES ONO SOIL COVER TEXTURE PI HMANI NT MAHKFHS OHSEH VA TT ON WELLS DYES ONO DYES ONO DEPTH OVER TRENCH BED DEPTH OVER TRENCH BED DEPTH OF TOPSOIL JSODDFU SEE UFO MULCHED CENTER EDGES DYES. ONO DYES ONO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER TRENCHES: DIMENSIONS 71-7N I FOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO UISTH DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. FIEV ELEV. CIA. ELEV. PIPES DIA ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING LHILLED COHHECI LV COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES ONO _ OYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROP ERTV JWELL: BUILDING: FEET FROM LINE: D YES ❑ NO OYES ❑ NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIG UR TITLE- DILHR SBD 6710 (R. 01/82) } SANITARY PERMIT APPLICATION COU" D_ILHR In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT 1 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 ❑ NO PROPERTY OWNER PROPERTY LOCATION Map a 1/ '/a '/4, S aC Tat , N, R E (or PROPERTY OWNER'S MAILING ADDRESS/S~ LOT NUMBER BLOCK NUMBER SUBDIVISION NAME O- CITY, SATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD, LAKE OR LANDMARK II. 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) i 1. a. ~ New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. E1 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. [KrSeepage Bed b. E1 Seepage Trench c. ❑ Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minnuttes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 001 J /'7 0 Feet Private ❑ Joint El 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/Si hon Chamber ❑ ❑ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system sho on the attached plans. Plumber's Name (Print): Plumber's Signature: (No St s) MAP// PRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): Name of De igner: VIII. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST -d S 's ADDRESS (Street, City, State, Zip Code) Phone Number: IX. COUNTY/DEPARTMENT USE ONLY j ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature (No Stamps) . L] Approved ❑ Owner Given Initial S rc arrge Fee / • Adverse Determination f/ 190 J 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 4 - 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 permitmay 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 you have questions concerning your private sewage system, 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; 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. Tanis 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, received lift/siphon product apprdovalfrom tanks Dfor this ILHR system. Check experimental approval only if tanks re 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'Y2 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 ears of stead) y negotiation and public debate. The groundwater bill Y Groundwater included the creation of surcharges (fees) for a number of regulated practices which Wisconsin's can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried treasure is used in your building is returned to the groundwater through your soil absorption, { system`or the disposal'site'used by your Iholding tank pumper. 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- water, groundwater contamination investigations and establishment of standards. Groundwater,t it's worth protecting. SBD-6398 (8.03/86) Y 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/contractQ ,("spec house"), then a second form should be retained and completed when the property is :;old and uubmitted to this office with the appropriate deed recording.. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owrinr of Property IaM & Annej-j!Q B-_ernPtt Lucat iou of Property SW k SE It, Section 26 T 291 - R 19 W -r--- Tuwnship Hudson Mail ing Address, Cty Rd. N Rt. 1 Hudson W1s~Ao~nSin--.'4O16 Subdivision Name High Meadows Lot Number Previous Owner of Property Glen & Vveella Waxon Tutal Size of Parcel Two 1/2 Acre Date Parcel was Created October 1. 1984 Are all corners and lot lines identifiable? x Yes No is this property being developed for resale (spec house) ? Yes X No volume 698 and Page Number 2 843 as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office 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 the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) ee4ti 6 y that aU ata temen,te on -th i6 6o4m ane -tAue to the be6,t o6 my (ouA ) knuw.(tdge; that 1 (we) am (ane) the owneA(b) o6 the pnopenty deac,%i.bed in .ti" in6ulunatiun 6o4m, by viAtue o6 a waAnan.ty deed seconded in the 066.iee o6 #1►e County RegiAteA o6 Deed6 as Document No. 397095 ; and that I (we) pne,senttey own .the, pnopoaed ad te. bon the 6ewa9e podat .ey.6tem (oA I (we) have obtained an eaeemen.t, to nun with the above deeeni.bed pnopeA.ty, bon the conb-tAuct on o6 said &y,6tem, and .the same has been duty neeonded in the 066.i.ee u6 the County RegiA teA o6 Deed. 6, ab Document No. 3 97 02,E ) . SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) 7- ! - p!i DATE SIGNED DATE SIGNED 1 r • H STCT 105 r r a SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County 0 a OWNER/BUYER joar y & Annette RPnr~a++ H ROUTE/BOX NUMBER jet. 1 Fire Number s CITY/STATE Hudson. Wisconsin ZIP _5401.6 PROPERTY LOCATION: -,92 _14, Section~6, T__29I, RI_W, Town of Hudson St. Croix County, Subdivision Hlgh bQeadaWS Lot number___8_. 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 put into the system can affect the function o"f- 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 cost of replacement of a failing system, which was in operation pr#u°L L„ }ul-r-1-- -}978;- 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. ,j 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- v 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. SIGNED DATE 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. 13"Xl I-AvAi` 13E•v vE-ii IPoAcers , w/s . 7y y- 3 y31 NDUS RY, OF REPORT ON SOIL BORINGS AND ,INDUSTRY, SAFETY & BUILDINGS LABOR AND P.O. BOX 7969 HUMANIAELATIONS PERCOLATION TESTS (115) DIVISION (H63.09(1) & Chapter 145.045) MADISN, WI 53707 LLO'CATION:6 ill,, SECTION: TOWNSHIP LOT NO.: BLK. NO.: SUBDI V ISION NAME: SLv 1/ 1/ Zle /T 27N/R/1 E (or uDSo~v G J ~Efll~au~~ 57NTjY: OWNER'S S NAME: MAILING ADDRESS: Gtve 0Ai C~ 1~0tp 41 USE NO . BEDRMS.: COMMERCIAL DESCRIPTION: DATES OBSERVATIONS MADE anq ILA 3 1 A1,4- 10 Residence New PROFILE DES RIP IONS: ER OLATION TESTS: EIReplace T RATING: S= Site suitable for system U= Site unsuitable for system scs g J' Q .S, L . CONVENTIONAL: IMOUND: IN-GROUND-Pa URE:5Y Y STEM-IN-FILL HOLDING NK: ~COMMENDEDSYSTEM:(optional) $ ❑ ❑ U - NS U S ©U ❑ S ❑ ov ,ul'iov,~ ,4-~Q - ~,3 If Percolation Tests are NOT required DESIGN RATE: under s.H63.09(5)(b) indicate: A, If any portion of the tested area is in the ' V Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS siv Z-eCiMA4- F-f BORING TOTAL DEPTH TO GROUNDWATER CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION TBS D 7;! HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B I(5'd / 93t 0(0 ~ ',7'G~ N67' / v s, /4,v B- /o. 'o ~A3. .93 cs T,~,~ a cs > A3 B-3 /0 - 00' 73 4' D . v C ~^nY • s 7S~ 3.43. S /,D' .(3,~. S/ ~2$ 4y" Rr,. S/ 2.0 B-S . NY ,3Q > 9 v ' • 33' De 4,a . s/~ o ' /6.u • S/, . 67' i Ra • s , / • a N - o.P . ~,v e s B- ET__T y ~ ~ TAN v e~' PERCOLATION TESTS TEST DFPTH WATER IN HOLE TEST TIME NUMBER AFTER SWELLING INTERVAL-MIN. DROP IN WATER LEVEL-INCHES RATE MINUTES PERIOD 1 PERIOD 2 PER PER INCH P eO~Y U -.r iv P- !/E,t1( C s .E3ltjrr4s . G „ zf 7FW PA4fAAev 3 P- L IA" L& ST ',ovT~ s 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 z _ . . E 7 v~ 7/1 . r elf si ~ f 4-_ -~or~ven fio PPPOVEt v _ •I _ P a 8yat r l 40 r _ ..P ' { C _ 1 15, } lilt, 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): HOMESITE SEPTIC PLUMBING CO. TESTS WERE COMPLOETED oN: ADDRESS: 0G/' 8 -0 y ROBERT ULBRICHT CERTIFICATION NUMBER: PHONE NUMBER(optional): L WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. 2_____ _ MINN. INSTALLER & DESIGNE LIC. CST SIGNATURE: / DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) OVER - c _ t ~ , .J G✓/'~f ~ J~ .yam U~ 7e5 bed 1~ a~7ns 5 ,'mot-C D b ' f fT`x 35 fed y ~Z C o- G S ~ X35 0 ~a ~ ee~Qr Ilk ~ t~