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Home My WebLink About026-1014-10-001 n cn Q 3 v 0 d -1 O d ° fD CD A -0a (D o ~ 'o ~ d m A 3 - O (n z z CD rn 2 X°° "*A, N N cn O ~ D7 .P N 00 0) (D E3 00 n d o (n W K 3 j O l^\ =3 ~o fV C2 co O n A 1 C, -0 C> CD CD Dpi m cn o ° p 3 n :E o r 7 N p N N V O C 4J O CD A (D cB cn N !Z 'C cn co C C 3 ° CC, Ln C/) C] Cn Z (D O CO A CD AEI N CC(0 (0 z 0 o CCC) CD !n O c. '0 g (D Fy e t7' a rD n. rC TJ o N w z o O O = "at• 0 o H O N C' N a p Z 0, F, n 3 D x - m U ~vvC ° 00 N O M .(D+ N C (P W 7 y 0 cn (D 00 H N d N N F--I £ N V Z5 CD o a F-3 z y z m z p r v ° D CCD 0 L D "AN o CD cn N (D a) O~ C c N 1 I - CD W m a- 00 H H O W z~ n 1 CD z ° Z CD 0o Cn ° .n. In ® J~ 0 CL A z o rfi F- w C 00 cn m 0 r ~ C * o Fl- a O O O C OD (D ° y z ti CD A W CO N ~D X ~ ~ y C Z d S o ° ° v ~ y m CD ) U A CD Irt, N tv ti 0 0 Cn a ~ w o o a Parcel 026-1014-10-001 05/24/2005 04:36 PM PAGE 1 OF 1 Alt. Parcel 4.30.18.49E 026 - TOWN OF RICHMOND Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner KENT P & LAURA A ELKIN " ELKIN, KENT P & LAURA A 1724 112TH ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 1724 112TH ST SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 1.625 Plat: N/A-NOT AVAILABLE SEC 4 T30N R18W 1.625A SW SW LOT 1 OF Block/Condo Bldg: CSM 5/1460 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 04-30N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1064/116 WD 07/23/1997 786/585 I 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/19/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.625 35,600 138,700 174,300 NO Totals for 2005: General Property 1.625 35,600 138,700 174,300 Woodland 0.000 0 0 Totals for 2004: General Property 1.625 35,600 138,700 174,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 143 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 026-1014-10-001 05/13/2005 09:39 AM PAGE 1 OF 1 Alt. Parcel 4.30.18.49E 026 - TOWN OF RICHMOND Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * ELKIN, KENT P & LAURA A KENT P & LAURA A ELKIN 1724 112TH ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1724 112TH ST SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 1.625 Plat: N/A-NOT AVAILABLE SEC 4 T30N R18W 1.625A SW SW LOT 1 OF Block/Condo Bldg: CSM 5/1460 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 04-30N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1064/116 WD 07/23/1997 786/585 2004 SUMMARY Bill Fair Market Value: Assessed with: 19635 192,100 Valuations: Last Changed: 06/19/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.625 35,600 138,700 174,300 NO Totals for 2004: General Property 1.625 35,600 138,700 174,300 Woodland 0.000 0 0 Totals for 2003: General Property 1.625 35,600 138,700 174,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 143 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER I-A /&a TOWNSHIP SEC. T N-R~W ADDRESS ST. CROIX COUNTY, WISCONSIN rTnn`1n,, SUBDIVISION LOT LOT SIZE C. PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i i f i ' ,/'SAt~ J ` sl ` INDICATE NORTH ARROW mf BENCHMARK: Describe the vertical reference point used ~o~ Sr6t'C Elevation of vertical reference point: Do,(1 Proposed slope at site: SEPTIC TANK: Manufacturer,'d Liquid Capacity: Number of rings used: - Tank manhole cover elevation: Tank Inlet Elevation: ) Tank Outlet Elevation: /y) Number of feet from nearest Road: Front, ~Side ,0 Rear, 0 feet From nearest property line Front,O Side ,(,,V Rear, O feet Number of feet from: well building: o (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE 1 . 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, O 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: Lenith:Number of Lines: Area Built Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear, Opt ..)o Number of feet from well: Number of of feet from building: rX Z (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: f ~6 i Dated: Plumber on job: License Number: 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR LABOR & HUMAN RELATIONS SAFETY & BUILDINGS P.O. Box 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, W* 53707 BUREAU OF PLUMBING (niWNVENTIONAL ❑ALTERNATIVE State Plan I.D. Number O Holding Tank ❑ In-Ground Pressure ❑ Mound (If assigned) NAME OF PERMIT HOLDER . ADDRESS OF PERMIT HOLDER: =INSPECTE: Richard Hailey R. R. 3, New Richmond, WI Oo BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: RV. PT. LE V.: CST qEF. PT. ELE V.. SW SW, Section 4, T30N-R18W, Town of Richmond Name of Plumber MP/MPRSW No. Cou my Sanitary Permit Number: Cal Powers 1563 St. Croix 64888 SEPTIC TANK/HOLDING TANK: ~MA NUF ACTU LIQUID CAPACITYWARNING LABEL LOCKING COVER 1 PROVIDED: PgpVIDD'.~r`OYES ONO OYES ONO DING: VENT DIA.. VENT MAT L.. HIGH WATER ALARM. NUMB ROF ROAD: / PR LI"E PERTV WELL. BUILDING. VENT TO FRESI. T, FEET FROM ! : / AIR INLET YES ONO OYES ONO NEAREST a DO NG CHAMBER: MANUFACTURER. BEDDING. LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER OYES ONO PROVIDED PROVIDED: GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL OYES ONO OYES ONO (DIFFERENCE BETWEEN NUMBER OF PROPERTY WELL BUILDING ( VENT TO FRESH : FEET FROM LINE AIR R INLET PUMP ON AND OFF) OYES NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LEN GTH 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 DISTR PIPE SPACING covER INSIDE CIA SPITS LIQUID DIMENSIONS _ THE"c Es , RIAL: PIT DEPTH. GRAVEL DEPTH FILL DEPTH DISTR PIPE DISTR. PIPE DISTR. PIPE MATERIAL ISTR 1 BELOW PIPES ABOVE COVER ELEV LEI FT ELEV. END. NUMBER OF PROPERTY WELL BUILDING. VENT TO FRESH J LINE o _ _ AIR INLET FEET FROM NEAREST t ~C J 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- OYES ❑NQ meets the criteria for medium sand. T•IONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS DEPrHOVERrgENCHeED DEPTHOVEgrRENCH/BED OYES ONO OYES ❑NQ CENTER DEPTH OF TOPSOIL SODDED SEEDED. MULCHED EDGES OYES ONO OYES ONO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO. DISTR. DISTR. 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 OYES ONO OYES ONO COMMENTS: PERMANENT MAR KERS: OBSERVATION WELLS: PROPERTY WELL: BUILDING. NUMBER OF LINE. FEE FR EARESOM OYES ON OYES NO NFEET Sketch System on Retain in county file for audit. Reverse Side. STITLE DILHR SBD 6710 (R.01/82) T,~ ✓ wlsmnsln APPLICATION FOR SANITARY PERMIT D I LHR (PLB r r COUNTY oERRRTmenroc UNIFORM SANITARY PERMIT # lnrOUSTRV, LRBOR 6 HUMTI RELRTIOnS V Y /V(l/O/ 1-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 PROP RTY OWNER MAI NG ADDRE S ; 1 _3 )v PROPERTY LOCATI N CI-Y: 1/4S1t) 1/4, S jT , N, R Zj~ V (Or& TOWN OF: , LOT NUMBER BLOC NUMBER SUBDIVISION NAME NEAREST-ED-A L OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): zj /v THIS PERMIT IS FOR A: 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. Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank 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 f Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: 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): Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of e ivate sewage system shown on the attached plans. Na of lumber (P nt): ! Signat MP/MPRSW No.: Phone Number: L214 _3~s P umb 's Address: Name of Designer: S COUNTY/DEPARTMENT USE ONLY Si nat re of Issuing Agent: Fee: Date: ❑ Disapproved El Owner Given Initial ~1.~`~ Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 . yt 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. APPLICATION FOR SANITARY PERMIT S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequawies 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 Location of Property Section, T _~o_ N - R /S W Township;/, Mailing Address Subdivision Name Lot Number ` Previous Owner of Property 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 No Volume and Page Number 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) een.ti.b y that aU 6 ta-tement6 on .thin bo tm ane true to the but o6 my (oun ) knowledge; that I (we) am (cute) the owneh (6 ) ob the pnopeAty de.6cA bed in .th.ia inbonmati,on bon.m, by viA.tue ob a waAAa.nty deed teco4ded in the Obbiee ob the County Reg"teA ob Deed6 " Document No. and that 1 (we) pacedent-y own the p4opo4ed site ban the aewage pod aya-tem (on 1 (we) have obtained an eademen.t, to hun with the above ducAi.bed pnopenty, bon the cond.tAucti,on ob said 6yb.tem, and the aame had been duty teco4ded in the Obbice ob the County .Reg-ib.ten ob Deedd, a.d Document No. ) . SIGNATURE OF 0 R SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED • H z H y ST C- 105 r" r 9 I SEPTIC TANK MAINTENANCE AGREEMENT ry+ 0 St. Croix County z d a OWNER/BUYER rn ROUTE/BOX NUMBER f Fire Number CITY/STATE `LIP PROPERTY LOCATION: 5u) 4, S'~J-4, Section, T&I N, RW, Town ofSt. Croix County, Subdivision _'~-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 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 E I/WE, the undersigned, have read the above requirements and agree 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 Zonin Office within 30 days of the three year expiration date. r 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. O r- N ~ m N A> ^'3 0 CD CD m 0 a O .3 SSQ1 C (p o c O W W `G Z 3 c, co N 7r ~ E = ~i (a tD •O a (D (D _0 O A H O - p~ (D - N N _ yi D a 0 O O ::z (D :3 (D t 0 CD ;r CD W 'a CD (D p A -4 N V 0 ~ "V ~p m (o oOa Oo0mm~ co 0 w o , 3°c ,cC- cwc co 3'Zo c 3 o ao S c`G QD j 'mac N-•CDD N 0 =r • ti =0' ( O a (CD =3 Co D (DD N Q •A~. m c " » CD Cn C G, co o e T,c0 °D~ano 0 c N O " a ry~A~ CD o ~ CL 0 N CD S -O N N C v 1 1 N -i N N fD (D N V) "n m W y n to z CD w --1 0 (a CD CD - - m (D A 3 CND (D y a D ? 7 D m ~o w Co fT1 (a 0) OL CD ~m 3 yw:ECDF c rn CD 0 a CD (a CD (n O a CO A> > Q. ~ N = = B l< CD 0 CD G'1 m 3 a cD ~`1 0 O m CL m w C c D v Z) 0. 0)0= m Q a d a (D N 0 CD CL ~.N m S. K~ S(D m0c -1 z ~ (D(D~3 cc ao~ 0Co a o0:,N nmo 0 eo a c w (CD -i CD c ((D o o a Ads' CL 0~CD w a 3' a CD o m co - CD ° o k z o , DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, C DIVISION LABOR AND I P.O. BOX 76 HUMAN RELATIONS PERCOLATION TESTS (115) MADISON, WI 3707 (H63.090) & Chapter 145.045) LOCATION: - (or) W SECT ON: TOW SHIP/Mb tCIPKLITY: LOT NO.: BLK. r10.: SUBDIVISION NAME: 1/4 COUNTY OWf)J1ER'S/ YER'S NA E: MING ADDRES XZ, USE i DATES OBSERVATIONS MADE l~ NO. BEI 1:1 1! COMMERCIA DESCRIPTION: r-~~1 PROFILE DESCRIPTIONS: PERCOLATION TESTS: Ey Residence } L~J New ❑ Replace / / < G RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTE -1 -FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) S DU ZS ❑U S ❑U ES [:]S [ZU If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: 41 Floodplain, indicate Floodplain elevation: Cjf Fj PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHM, OBSERVED EST. HIGH/EST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 1 l B7 A2 6_1 A) C L- - PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWEI_LING INTERVAL-MIN. PERT 1 PER 2 P oD3 PERINCH P- Abldti 30 12 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, ` %I r C s r ~ I f 'o~ J ' r E IN 1 f E_ I r ~ } 1, - I , • . t z.. R, I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specifi d 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. NnM?I(,Pn nt ' (TESTS WERE COMPLETED ON: L;tA ADDR S. CERTIFICATION NUMBER: PHONE NUMBER (optional): 7<1 5... CS GNATUiE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. -CRD-6 . OVER - F;IE' *J,i`t. x.17-p. t .r, E' .r f.34,r R t t ~a' 6.~: .F t 11 _•'i ht,1C-~, aK 41 .,,u . y S; -1 v 9 L :3onn sas.~. y, :i C'f t ,`i 'e, 3I'vf6;i f$ E ,EE_~k ~,•,rr z ~ ~'9,.g _a _rr s+ ~x ,tr } t, , i~.~ 3. ,~d }3x t"t`_. _s P A C.E OF CUSS zc~►Ur1 p ~l ~Jr►) Jy5 <'-nl . s ~ai7 Fresh Al(Inlets And Observation Pipe ~J Approved Vent Cap Minimum 12" Above Final Grode z0 - 42" Above Pipe _ 4" Coat Iron To Final Grads Vent Pipe ;;rah Hay Or Synthetic Covering afro 2" Aggregate Oyer Pipe Dietrlbulion - Tee - P1pe 0 0 0 0 0 6" Aggregot• ° Perforated Pipe Below Beneoln Plp• _ o Coupling Terminating At Bottom Of Syalem SOIL FILL DISTRIBUTIOf.1 PIPE sTH APPROVED S r1INETIC COVER OP 1~6GREGATf< '"'-MR Iii^u HAJ sTRAw ~~s0 aOFAGGREGATE 'LLE V. QF,SY FEET D1',7-R15'.JT10IJ PIPE TC) BE AT LEAST . IIJCHES BELOW ORIGI"AL GRADE AMU AT LEAST20 IUCHES BUT 1.10 MORE THAK ti2 IIJCHES BELOW FINAL GRADE MAXIMUM DEPTH OF EXCAVATI(DO FK01*1 ORIGINAL 69AoF- WILL BE J-1( HES MINIMUM Mpr-t1 OF E'XCAVATIOW FRoM .1*1611bQL 6RdQF- WILL eE ir\-ICHE s LIC,LUSE QLJMBER: DATE ~S- llo 16,60 slelc i r i~ya~ as, f r~ joins 81~