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HomeMy WebLinkAbout038-1095-70-000 c 0 ca f 3 w o d r1 r. > > n 3 ~ CA loft) ~Qy Cp CD 00 3 v oo 00 C B. 3 42 • D CD C Z w N A Q O M mF Co N CL 0 N ~~S CD CD CD 0 -4 D O 7 N N ~w y O N 7 O y N O w fn D a .lam m CD U) Z ' n o m c s rt a 0O o b N z o CD :t N. ii y N rn 00 W* o ~ O t~ 3 Pd 0 F- o a I! Z O O O Y 0 :3 00 0 (a PL > H (D co) o Im O O W H m y ILP U) -1- 1 _ O rt O r 00 00 a Z ~ Z Q r D 0 m 'O l' Or o 0 m ca CCD c. rn' H y cn m m rd w t=i w a ri r+ a 3 C° G~ Z o m CD (6 -1 cn o A n O 'd rt F-h r- 0 ~ A + N A CL En [n (D ct (D rt rt I- w pp m O a Z w C, W W Z N CA) I a I a ~ o - ! z ' o a CD I I ° A b I a t 0 I I o a I a ~ CD aro o O a I ~ O° : Parcel 038-1095-70-000 12/04/2006 01:26 PM PAGE 1 OF 1 Alt. Parcel 23.31.18.400A 038 - TOWN OF STAR PRAIRIE 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 TERRY P CONDON O - CONDON, TERRY P 2022 124TH NEW RICHMOND WI 54015 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 2022 124TH ST SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 1.870 Plat: N/A-NOT AVAILABLE SEC 23 T31 N R1 8W PT SE SW LOT 1 OF CSM Block/Condo Bldg: 5/1318 EXC THAT PT CONVEYED FOR RD PURPOSES IN 973/398 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 23-31 N-1 8W Notes: Parcel History: Date Doc # Vol/Page Type 06/02/2006 826654 QC 07/23/1997 973/398 QC 07/23/1997 749/236 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/18/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.870 31,100 169,400 200,500 NO Totals for 2006: General Property 1.870 31,100 169,400 200,500 Woodland 0.000 0 0 Totals for 2005: General Property 1.870 31,100 169,400 200,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 145 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form- STC-104 AS BUILT SANITARY SYSTEM REPORT OWNER y~ y~gyy TOWNSHIP SEC. o? T ,~?l N-R 1 S W ADDRESS ST. CROIX COUNTY, WISCONSIN I SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM r 40 IT I 33 s INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used S4."7--2 Elevation of vertical reference point: 00 Proposed slope at site: SEPTIC TANK: Manufacturer: N) ~ P,~GLiquid Capacity: Number of rings used: 0 Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: ! Number of feet from nearest Road: Front1 Side,o Rear, 0 ~6p ' feet From neare8t'property line Front,O Side, Rear , _ feet Number of feet from: well ~QQp, building: 3 0 (Include this information of the above plot plan)( 2 reference dimensions to septic~enk) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: quid Capacity: Pump Model: Pump/Si on Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevat Gallons per cycle: Alarm Manufacturer Alarm Switch Type: Number of fe from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: ZABSORPTION ude distances on plot plan). SYSTEM B ed: Trench: Cl>idth: 156,~ Length: 6-0 Number of Lines: _ Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front,/ O Side, O Rear, &Pt. Number of feet from well: i Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: umber of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area B t: Has e' er a drop box O or distribution box O been used on any of the above soil abs rbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings us Elevation of bottom of tank: Elevation of ' let: Number o feet from nearest property line: Front, O Side, 0 Rear, QFt, Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: c- License Number:'°2 J 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. 60X17969 BUREAU OF PLUMBING MADISON, All 53707 . 1 CONVENTIONAL ❑ALTERNATIVE Slate Plan ll.D.Number 1 El Holding Tank El In-Ground Pressure ❑ Mound (1 asslgnerl NAME OF PERMIT HOLDER. JADDRESS OF PERMIT HOLDER. INSPECTION DATE / Terry Condon Rt. 2, New Richmond WI 54017 A9-/ If p :9 0 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST I1E1 . PT. ELEV SE SW, Section 23, T31N-R18W, Town of Star Prairie, Lot#4,Pracht Sul). ) o+c) N:une nl Pluodrer. IMP/MPRSW No.. County Sanrtary Perms Numb- Gary Steel. 3254 St. Croix 83834 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY TANK INLET ELEV. TANK OUTLET ELEV WARNING LABEL LOCKING COVER G~ PROVIDED PROVIDED 70 YES ❑NO ❑YES fil-NO BEDDING. VENT DIA. VENT MATL. HIGH WATER NUMBER OF ROAD: PROPERTY WELL BD ING VENT TO FRESH ALARM FEET FROM LI"E IA's'"LET ❑YES NO C ❑YES O NEAREST DOSING CHAMBER: MANUFACTUR EH BEDDING LIQUID CAPACITY PUMP M()UEL PUMP. SIPHON MANUFn' TUREH WARNING LABEL LOCKING COVER PROVIDED PROVIDED ❑YES ❑NO ❑YES LINO ❑YES LINO GALLONS PER CYCLE: JPUMP AND CONTROLS OPERATIONAL. FET ER OF PHOPFHTY LI Illllt Dl N( VENT TO ERESII (DIFFERENCE BETWEEN FROM LINE AIR INLFT PUMP ON AND OFF) ❑YES ❑NO REST-0 SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing F Nan) IIIIA111 1111 111AN HIAI AND IIAE1K IN(, 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 J NO OF UIS7H PIPC FAN(, C ER INSII )f I)IA =PIIS LIQUID BED/TRENCH THE Fs NIA EIIIAU PIT uEPn` DIMENSIONS HAVFLDEPTII FILL DEPTH OI, f PII' UISTH PIPE DISTR. PIPE MATERIAL NO DI NUMBER OF PNOPEHTV WELL BUILDING; VFNT iO iHf SII 1f11 LOW PIPES ABOVE COVEN f I F9V INI f f ELEV END G, PIPES LINE 9 .~f AIH I ~E7EET i cl Z77~ / NEARESTO-► /L7 7 / 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- ❑ YES ❑ NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PEHMANf N1 MAHKI HS nISSI HVAI IIIN WI I I S _ ❑YES ❑NO _ ❑YES _ Li NO DEPTH OVER THENCFI BED DEPTH OVFR iHENCH BEU DEPTH OF TOPSOIL SODDED ~EEUIO MUICHfU CENT EH EDGES ❑YES ❑NO ❑YES ❑NO ❑YES UNO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO.OF LATEf7nL SPACING (;RAVEL UE PTH Hf LOW VIPI F Il L DEPTH ABOVE COVI H TRENCHES DIMENSIONS MANIF UI.U PUMP MANIF OLO D1ST R. PIPE MANt ELEVATION AND f OLD MATERIAL NO DISTH I)ISI11 PIPS DItiIIfIHOIH)Nt'IPI htP Ti-lilAl 19AIAIfKIN1, ELEV ELEV. CIA ELEV. PIPES DIA. DISTRIBUTION INFORMATION HOLE S11E H OLE SPACING UIi ILLEU C()HHE (I I Y COVER MATERIAL VL 1\1S nI 1 if T G.DFIHF SPON US TO APPItOVI D PLnN ❑YES ❑NO ❑YES ❑NO COMM S: PERMANENT MARKERS OBSERVATION WELLS NUMBER OF LIN PROEPERTY WELL BUtL DING FEET FROM ❑YES ❑NO ❑YES ❑NO NEAREST 7l4 3y~ g S ° z 010 Sketch System on tFietain in county file for audit. Reverse Side. j SIGNATURE TITLE DILHR SBD 6710 (R. 01/82) 0 v ~ i DlLHR SANITARY PERMIT APPLICATION COUNTY _ 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 PROPE TY OWNER PROPERTY LOCATION P '/a ✓511J S c .3 T, N, R W _(or) W PRO ERTY OW RP MAILING ADDRESS LOT NUM ER BLOCK NNUMB ER SUBDIVI N NAME dA44'""j CITY, STA ZIP CODE PHONE NUMBER CITY NEAREST ROAD, LAKE OR LANDMARK ~p I E3 VILLAGE : 046, VAA -0%~ 146 11. TYPE OF BUILDING OR USE SERVED: jj~, 03g IQQ~j z~- Number of Bedrooms if 1 or 2 Family .3 ORE] Public (Specify): Ill. PURPOSE OF APPLICATION: (Check only one in ##1. Check 2,3 or 4, if applicable) 1. a. KNew 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. &16 6onventional 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. ❑ seepage Bed b. Igee a e 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 ~®0 7-so / LFeet Private ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank Q 5 ❑ ❑ ❑ Lift Pump Tank/Si hon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for insta ation of the private sewage system shown on the attached plans. XIA" Plum is Name (Print): Plum r' ignature: (N Sta s) 4AWMPRSW No.: Business Phone Number: V (1:Wf1f ( f ~ - _j er- Ad . 0 0 Plu is A ess (Street, City, State, Zi e): Name of Designer: Vlll. SOIL TEST INFORMATION Certified Soil Tester (CST) ame CST #,Z ,2! 4;: 6 CST's D ESS ( treet, City, S Ate, Zip Code) f Phone Number: 7 CJ IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial h Sh rge ee Adverse Determination X. COMMENTS/REASONS FOR DISAPPROVAL: VVV Ls 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 Farm (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems'must bd pr6oerly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary; usually''every 2 to 3 years; 6. If you have questionw concerning your private sewage systr_ k: onta,_t 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 nan; ie and mailing address, Provide the legal description where the system Is to be installed; II. Type of building or use served: It public'- 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; Vill. 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'/2 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, water - included the creation of surcharges (tees) for a number of regulated practices which Wiscorisin's can effect groundwater. The surcharge took effect on July 1 1984_ All of the water that buried )reasure is used in your building is returned to the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. 1, U a~ The monies collected through these surcharges are c=edited tc) the groundwater fund adrninis- tered by the :department of Natural Resources. These fun is are used for mor,toring o oui;ok water, groundwater contamination investigations and establishment of standards, Ground,vater, r 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 property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property ~i~-i~7 Location of Property s~ 14 Section . ?Z T_/ N-R / 6~ W Township V ykk r:i-n - e _ S944-r Mailing Address M a Z Address of Site, Subdivision Name ~r yc1.l9~i'l-~' Lot Number Previous Owner of Property 4P- YJ r~ 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 Volume -7 and Page Number C-2-36 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 I (We) cvLti.by that aU .6tatement6 on thi.6 6onm au tAue to the best ob my (our) knowledge; that I (we) am (are) the owner(.6) ob the property de,6cA bed in this in6onmati.on 6onm, by viAtue o6 a wa Aanty deed recorded in the 066ice o6 the County Regi.6-ten o6 Deeds ass Document No. ; and that I (We) p tea enfity own the pupoAed z to 6ot the zewage d4zpod .6y Stem (on I (we) have obtained an e"ement, to nun with the above de,6cAibed pnopehty, bon the eon6tAucti.on o6 aai.d ay6tem, and th.e.6ame ha,6 been duty keconded in the 046iee o6 the County Reg+i6ten o6 7,(1 a6 Documen~ No. pin I A - P rra~, / f 4n SIG ATURE F OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED H , z a ST C- 105 r r a H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d a OWNER/BUYER ROUTE/BOX NUMBER Fire Number .CITY/STATE ZIP dy=Q/7 PROPERTY LOCATION: 4, X14, Section o-)3, Tom/ N, R _W, Town of ~V-~ Pin at ,c-- St. Croix County, Subdivision 0, , 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 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 grant for a maximum of 607 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 • E I/WE, the undersigned, have read the above requirements and agree En to maintain the private sewage disposal system in accordance with ac the standards set forth, herein, as set by the Wisconsin Depart- v ment of Natural Resources. Certification f rm must be completed' and returned to the St. Croix County Zoni Office thin 3 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. DEPARTMENT OF REPORT ON SOIL BORINGS A & BUILDINGS INDUSTRY LABOR AND ' ' =1q ~f, DIVISION .0. BOX 76 HUMAN•RELATIONS PERCOLATION TESTS (11 jA- N WI 3707 (H63.090) & Chapter 145.045) Al O,y' J9 LOCATION: SECTION: TOWNSHIP/ FP1 TY: LOT NO.:kL$A NO.: VISI NAW: ,'e o,3 /T3I N/R /Gj (or) W1 5 A-, 0, . F_ 14 COUNTY: OWNER'S BtMER'S AME: MAILING ADDRESS ,540,01)( : If #qC,4 E5 v) Q~ 0/7 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PER OLATION TESTS: Residence 3 _ KNew ❑Replace [LIN 1 y-~~-83 7-s3 RATING: S= Site suitable for system U= Site unsuitable for system ONVEN I1UNAL: MOUND: IN-GROUND-PRESSURE: S -FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) ©s ❑u ZS ou s ❑u o s ®u OS u If Per:s. ation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: ES , PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBERIBEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 7 nG 9 o N E > 7 i. s man, a8 IL's, B- 7 ,758 9,7 89 ~o NF_ 7 s~ •7~ ./J&n,SJ, 9911,5./, I eA, ,5~+ 2/-'Cj n, s So 03 So ~6 , 171 9z /17~ B--3 q8- 0/0 >7 ~~j 00 f33 B- (o , q9 )Ku o /J > (o S' 3 1151- 1, l 21 Si -19 08 f2, S, en, 0. r '75- SR (0 17 r7 /Q 0 A9 0- .2 an -51 1. B- FSIry~ o i PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER I,4GF+ES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERI PER INCH P_ 1 d 0o n P- 3 %z P- 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 9~ 38 Co/ E _ _ A E ~ E q0o _xi , t N a7- a 3 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): 0119~ TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 88itJ. G 1,12 60 1' -5362/2 z 9 1J 7i~-a zoo CST SIGNAT RE: DISTRIBU rION: Original and nne copy to s_ocai Authority, P, ope,y Owner and Soil Tester. DILHt~-SPD-S39;- 1-1 L _ S - 65395 A~ TItS C CRNR R , h "M 115 To he ~ c urate sail te 1 inc w} 3. 4. ALL 3. 7 { 7, A 10 'THE FIE Tj 0~ don 1 yrylA`` `~\A/, Nn- s (4 b 5r (0I 3 be