HomeMy WebLinkAbout038-1163-50-000
n cn O r. -u n d
3 m o
I °
:3 (D (D 0 c
n
Q
chi ~ v v v 4 C:) c cn n b o w
:CT C)
N C. fl. cn N j
4 co co
CD 0) cn
n
O a Q Q Cb D m
C~ O
~ W
- - CD
C ° W co 'O A7 Q
r N x
ro C)
~l 00 r- o
m
m ro n 0 ° Q) a ;
.J (D U) I- I ~ W
rt pq o I-d (D
rt 9 3 a I rn °a CD
o H. ~ • O ~y
r v
N H
V N W co Cl) Ch p c
to rn rn ° r
Z O ~ • In rl ~ 3
CD
N O z v. !r .
N w z 0 0 0_
cn o ' v
z " o = ° aiaiv~i*'I ~n
H ° N
~vv0 tQ
o ~ :E ;z
d I to N CD
ti N
X-1 CL 0
z
ON 0'. 0 b H D a
Q
N ri W m O
V W I - ~
0. n I (D
ON a
00 cn C: CD
rl E (D w a
rOt rni ty" a CD
~ ~ H W t~ Z CD cn ~ -I y
10 CD
U) CL
A 7
fD O O
rt Z
W C)
G cn
CD CD
r"D• W C' CL
a
E o 'r Cl) w
m
°D
Z
(D a
W ~ 'I
o v, a
c. -
c° o
m -n
- cn w c
y s -
CD o °
I n ~ ~
I ~ m
a
x
v
0
I o N I Z9
a
X (D
00
SD fi4
CL O C :3 Q
O
G ICK
CCD N
G
b w
N
- IN-OP 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
DENNIS D & JO ANN E TR DWORSHAK O - DWORSHAK, DENNIS D & JO ANN E TR
833 W RIVERVIEW LN
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 833 W RIVER VIEW LA
SC 5432 SCH D OF SOMERSET
SP 1700 WITC
Legal Description: Acres: 1.854 Plat: 0227-CRESTVIEW ADD
SEC 30 T31 N R1 8W LOT 5 OF CRESTVIEW ADD. Block/Condo Bldg: LOT 05
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
30-31 N-1 8W
Notes: Parcel History:
Date Doc # Vol/Page Type
05/10/2004 762021 2567/605 QC
12/21/1998 594223 1389/26 WD
07/23/1997 739/197
07/23/1997 706/566
2005 SUMMARY Bill Fair Market Value: Assessed with:
120010 173,800
Valuations: Last Changed: 10/13/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.854 31,000 139,800 170,800 NO
Totals for 2005:
General Property 1.854 31,000 139,800 170,800
Woodland 0.000 0 0
Totals for 2004:
General Property 1.854 31,000 139,800 170,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 126
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
~ i
Form- S T C - 104'
AS BUILT SANITARY SYSTEM REPORT
OWNER Eck, 4L k iY, (G TOWNSHIP STQI ®ra r.`c SEC. T IL_N-RJ_W
ADDRESS ~OF~ C L., ~ 'cr D,. ~ 3 ST. CROIX COUNTY, WISCONSIN t
SUBDIVISION C ros7k,'c LOT S- LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of 11HR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
IL,
R,
r9~
C
~ ~ cF 4re ~
~ood~r b
L
1l tic
y' 4=
v~C y3 /3ed roo -
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used Imo o~ 7" STeeCTaipe
Elevation of vertical reference point: Ioo' Proposed slope at site: Slo
SEPTIC TANK: Manufacturer: Liquid Capacity: /ooo0a.t.
Number of rings used: Tank manhole cover elevation: jb!_
Tank Inlet Elevation: `jg',ggr Tank Outlet Elevation:
Number of feet from nearest Road: Front 10 Side,Q Rear, O x/80" feet
From nearest property line Front, OSide,ORear,® 7 -feet
Number of feet from: well p building: 3--
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE REVERSE SIDE
Manufacturer: Liquid Capacity:,
y,
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, Side, O Rear, 0 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: Area Built: 971
Fill depth to top of pipe: /S~- " s
Number of feet from nearest property lin~:a Front, O Side Rear, 01?t.
1 -61 Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
1ti/d~
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).
HOT 1) K
Manufacturer: Capacity:
Number of rings used: Elevation of bottom of tank:
Elevation of inlet:
t
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: - -22 21 Plumber on job: Ie..w~
License Number : 4 J rV
I
3/84:mj'
J
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. krx 7 969
BUREAU OF PLUMBING
NjADISON, WI 53707
1 CONVENTIONAL ❑ALTERNATIVE StatePlan l.D.Number:
I
❑ Holding Tank El In-Ground Pressure ❑ Mound If assigned)
HOUSE TO BE INSPECTED BY ZONING OFFICE AFTER CONSTRUCTION
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DA E:
Paul Kirk 208 Cloutier Dr. #3, Somerset, WI 54025 -W7J-4.
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.:
NW SE, Section 30, T31N-R18W, Town of Star Prairie,Lot#5,Crestview
Name of Plumber: MP/MPRSW No.. County Sanitary Permit Number:
Mike Wilson 6388 St. Croix 75042
SEPTIC TANK/HOLDING TANK: a
MANUkYU7R: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
G C` PROVIDED: PROVIDED
> ? (J tJ YES ONO DYES ONO
BEDDING: VENT DIA.: VENT MATL.: HIGH W E NUM ER OF ROAD: 1p, ROPERTY WELL: BUILDING: VENT TO FRESH
ALARM. FEET FROM LINE: Al. INLET:
YES ONO OYES ONO NEAREST 14.
OSING CHAMBER:
MANUFACTURER. BEDDING: LIQUID CAPACITY. PMANUFACTURER. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED
DYES ONO DYES ONO DYES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL. JBIJILDING. VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET:
PUMP ON AND OFF) OYES ONO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LEN ,TH 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:
I L
J
ENGTH NO.OF DISTR. PIPE SPACING COVER INSIDE DIA #PITS LIQUID
BED/TRENCH WIDTH:
/ / TRENC4C~. t1A PI T DEPTH.
DIMENSIONS ;~1
GRAVEL DEPTH FILL DEPTH DIS R. PIPE DISTR. PIPE DISTR. PIPE MATERIAL TTEET UMBER OF PROPERTY WELLING: VENT TO FRESH
BELOW PIPESABOVE VERE V. INLETv. END FROM , LINAIR INLETEAREST Oel
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-
DYES ONO meets the criteria for medium sand. TIONS MEASURED.
SOIL COVER TEXTURE JPERMANENT MARKERS: OBSERVATION WELLS
DYES ONO DYES ONO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED. MULCHED.
CENTER. EDGES:
DYES ONO DYES ONO DYES ONO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH: LENGTH NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER.
TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE IM ANIFOLD MATERIAL: NO. DISTR. JDISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING
ELEV.: ELEV.: DIA.. ELEV.: PIPES. DIA.:
ELEVATION AND .
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS.
DYES ONO DYES ONO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING:
FEET FROM LINE:
DYES ONO DYES ONO NEAREST
Sketch System on R in county file for audit.
Reverse Side.
SI N U E t_ TITLE: ^
DILHR SBD 6710 (R. 01/82)C~~L
Wisconsin APPLICATION FOR SANITARY PERMIT ~
DILHR C~~~XCOUNTY
- DEPRRTTT1EnT OF
(PLB 67) UNIFORM SANITARY PERMIT #
I670USTRV, LRBOq 6 HUmRn RELRTIOns
-Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size.
-See reverse side for instructions for completing this application. PLEASE PRINT
PROPERTY OWNER MAILING ADDRESS
A 1C 'r C ► e r 3 S". c.- 07" w~ X- ®1.S'°
PROPERTY LOCATION CITY:
VILLAGE: e
/vw1/41/4,S 3p,Tz,N,R/g E(or T : Srar r r,~
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME INEARESTC2U), LAKE OR LANDMARK STATE PLAN I.D. NUMBER
S w/~ CierT iti K
TYPE OF BUILDING OR USE SERVED
5. 1 or 2 Family Number of Bedrooms: 3 Public (Specify): /y IV
THIS PERMIT IS FOR A:
X New System ❑ Tank Replacement ❑ Repair
❑ Replacement Soil Absorption System ❑ Revision ❑ Privy
❑ Alternate System ❑ Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
E. Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank
Ell System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Permit # issued
❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
Total #of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity / 1001
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer: lriitStvS Goy, r
IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total #of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump/Siphon Chamber
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
~O 9/S' 9 z~ Q' Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber (Print): Signature: /MPRSW No.: Phone Number:
1^h,'CL,A#4 Wi t~v~ 1 G./..~,r,. lo? r'k ( .-N
Plumber's Address: Name of Designer:
x l (E 19»~ er wi r CD A/ AV
COUNTY/ DEPARTMENT USE ONLY
Signatur of Issuing Agent: Fee: Date: ❑ Disapproved
/J Q/ ❑ Owner Given Initial
O~J ~l7 O (p Approved Adverse Determination
Reason for Disapproval: j~K
Alternate course(s) of Action Available:
DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber
i
INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398
To be complete and accurate the permit application must include:
1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in
a city, village or town);
2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant,
etc.);
3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks.
4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of
square feet to be installed;
5. Complete the section on water supply;
6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi-
fication, place your license number in the space provided and sign the permit in the signature block;
7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the
permit;
8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation.
Failure to comply will void the sanitary permit.
9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable.
10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system,
depth of the system, type of system.
11. All revisions to this permit must be approved by the permit issuing authority.
12. A complete plan including a plot plan, drawn to scale or with complete dimensions.
13. Horizontal and vertical elevation reference points that are permanent and clearly shown.
14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s)
to system, building sewer and vent observation pipe(s).
15. The permit issuing agent may require a cross section drawing of the effluent disposal system.
TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems
must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning
your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin.
. Form- S T C 100
Owner of Property t~
Location of Pro ert
p Y-tw ' Section , T N RjS_W
Township
Mailing Address
Subdivision Name
Lot Number -0 C:-~
Previous Owner of Property
Total Size of Parcel
Date Parcel Was Created
Are all corners identifiable? Yes No
Include with this a lication one of the followin :
.Certified Survey Map
.Deed
.Land Contract, or
.Other laegal Document which describes the property
PROPERTY OWNER CERTIFICATION I
I (We) certify that all statements on this form are true to the best of my (our)
knowledge; that I (we) am (are) the owner(s) of the property described in this
information form, by virtue of a warranty deed recorded in the Office of the
County Register of Deeds as Document No.; and that I (we)
presently own the proposed site for the sewage disposal system (or I (we) have
obtained an easement, to run with the above described property, for the
construction of said system, and the same has been ck~ Iy recorded in the Office
of the County Register of Deeds, as Document No. t C° L J,
51GNATURE OF OWNER '
SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE QNED
DATE SIGNED
• H
ST C- 105 r
a
H
SEPTIC TANK MAINTENANCE AGREEMENT H
0
St. Croix County z
d ~I
OWNER/ B U Y E RQ1",,_' 1O` F~.i v~ty c~ {-a.Y
ROUTE/BOX NUMBER Fire Number
CITY/STATE ZIP
PROPERTY LOCATION:',, Section T 3t N, R06 W,
Town of%~&, St. Croix County,
Subdivision~JL&jUA.;, Lot number j
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 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 stems 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. ti
0
I/WE, the undersigned, have read the above requirements and agree N
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 Office within 30 days
of the three year expiration date.
SIGNED ' ~
DATE d~-gyp
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.
v _
r y
2 ro
~ m
N
W (J)
N = ^ CD CD B CD C C N 0
o~CL m0m >
>
3 v-,°~w 3
z 0 C 0 m w cA•<~,
N a vC: ?(D' "0 aCD CD0=3
m:moo ~wo~9~(0 g
rr CD X- CD 4) 00
CD w
CD CD Co CL.
CD 0
CD cA g
00
>>c co~co~c~ r
co o
Zcn o C 3 o N
A)4) ~~0
o~? m
77~ 00 m c ° 0
CD Ca Cc 0 - co)
° " ° D C CD ,
to wcw ~o a -o O
c
~Sm o' w cc 0~ a o= w O
CD fu C y
~ ~ ~ Ch 0 Z D
4 N CD cD = v
CD
aCD n 3 Q' CD s Z
A a
c CD ° y (o 14 a H
con -,~Foo-
' -1 D
a W c c.• ~c 4) m 37
v,'wa mv,~acoc
~m o a~ 0 F M ~
j\b jN? omM:3 C M
CD CL CD
CD (0 - CD -i
O o Ch p 0 c
C ca
Q A co
W j w co) C C C F G)
-z ~yo' m
0~~ tiom aQaOL
C -4
o
~.v, v,
0 c ~ t0 ~ •c CD cD ~ 3 to
a° CL ° n m o d n
w W a c `O w c e°
fD - fD C cD ``O
'
aioi 1 ~Col- _ aj ° o 03 ~
"Ct fD = 0
CD ca CL 0 <
to - CD
o Z
~P 4
I
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
,LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969
HUMAN RELATIONS 1 / MADISON, WI 53707
(H63.090) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/ht"fff6ff4ft+1rY; LOT NO.:BLK. NO.: SUBDIVISION NAME:
1/ ~ ~ 3o /Uu N/RI®~ I Or) W y ~ / E /U i9 ~i V ~57~ 111g~Cd d
COU TY: OWNER'S 'S NAME: MA LING ADDRESS:
it 1j-' n _S'~IUD"- a
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILE DESCRIPTIONS: PERCOLATION TESTS:
LK Residence s~ New ❑Replace
L7 ~Q cC~ -8'SG yt/A
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
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: /p Floodplain, indicate Floodplain elevation:
s A i PROFILE DESCRIPTIONS
BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER f9EFFthPJ, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
33 o0 33
B- o A)&
7, A)Q A)
B- cg~ 8'S~~ O > 8~ j ,ra G7 4,7
B- 16 9' /7 A) 0 1)6 /7
Jt / O A)
B_
PERCOLATION TESTS
TEST DEPTH, WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER I, ICWiS AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH
P-
P-
P-
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
j /l ~ /C r I I j ~ ~ ~T 1 r~i
w~m~ rld _ fOa _
E F
~.m. k
E
F I
E
'5ed .30
' F
~ < I I f ~ ~ a f
f
IN&
i
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 l: / c TESTS WERE COMPLETED ON:
e- 9_(9'_7/
ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional):
88 7 2Z5 =z
CST SIGNATU
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
I
DILHR-SBD-6395 (R. 02/82) -OVER -
l
INSTRUCT' F- 4 -'.1PL T-- " ~-M 115 - S BD - 6396 -
Ti7 be a cornoletB "
1 a ornn
3, Md
4.
)ING TANK ONLY E ALL
A
e permanent;
tion test exernp-
10
Tel T
L N
1AT" ")R CERTI, -RS
n
aarn
- - f .;3 rem
T I
i
-J
u A LA
a £ ®
s r
TID
0 A a
Li
fl `
s
a
► °i o
-b
b
A 0 .tom Q t3
a~
~ s
Li
Q w~
°o a ab =.C ti
~r QA
O n L7' *41
r
a ,V
~ A
.r
o a
A
C 0