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Parcel 030-2041-50-000 05/03/2005 11:40 AM
PAGE 1 OF 1
Alt. Parcel 25.30.20.492G 030 - TOWN OF SAINT JOSEPH
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
*
DENNIS L & JULIA A LOWE LOWE, DENNIS L & JULIA A
284 130TH AVE
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 284 130TH AVE
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE
SEC 25 T30N R20W 5A W1/2 OF S 1/2 OF Block/Condo Bldg:
S1/2 OF SE SE
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
25-30N-20W
Notes: Parcel History:
Date Doc # Vol/Page Type
08/23/2001 654562 1704/413 WD
07/23/1997 1120/163
07/23/1997 783/441
07/23/1997 451/534
2004 SUMMARY Bill Fair Market Value: Assessed with:
6068 274,200
Valuations: Last Changed: 07/09/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 5.000 129,600 140,200 269,800 NO
Totals for 2004:
General Property 5.000 129,600 140,200 269,800
Woodland 0.000 0 0
Totals for 2003:
General Property 5.000 76,000 109,100 185,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 305
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 ~TOWNSHIP SEC. T ' N-R W
ADDRESS ST. CROIX COUNTY, WISCONSIN
j 'j
SUBDIVISION LOT LOT SIZE
6 3o -a 6 62JD
PLAN VIEW , y9z
Distances and dimensions to meet requirements of I-LUR, 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
01 c~ 7-,
GIi
71.
i
HOMESITE SEPTIC PLUi161NG CO.
RT. 3 O'NEIL RD, HUDSON: WIS. 54016 16, ROBERT ULBRICHT
WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.& I i
I z- 3 P.:.INN. INSTALLER & DESIGNER LIC. NO. 90663 I ;
70,41 53
a u~ w
~'F 5'oli~ r 9 iy`
I lY""
Ilk
GIN SCcv t,4
35
%n~ce C
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used
Elevation of vertical reference point: Proposed slope at site:
SEPTIC TANK: Manufacturer: ~..'Ffs r~ tic Liquid Capacity:
~`ti~ JF~t ~-`J.c?t' _ / !~'i UG- !w !.;acv j-4 - •G'~i .Fi•t,'v~~ ,GEi.r- ~ /w
r _
Number of rings used: Tank manhole cover elevation: o/d: y 73,1
'L'c s4/ '
Tank Inlet Elevation: L:,//y Tank Outlet Elevation: c:'/~k'~`~
Number of feet from nearest Road: Front,OSide 0Rear, O `~crt'~ feet
From nearest property line Front,OSide,ORear,O feet
A-2 2,4 4)r - 75 -
Number of feet from: well 6# ' - building:
(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, 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: 5
! °i
Width: ~y Length: 3 Number of Lines: Area Built:
Fill depth to top of pipe: '?/_4
Number of feet from nearest property line: F - Side, 0 Rear,0 Ft.~
Number of feet from well: j
Number of feet from building:
(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 bow or distribution box been used on any of the above soil
v 0
absorbtion s71-t'ms? (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, 0 Side, 0 Rear, O Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
r
Dated: Plumber on job:
License Number : HnMFSITF SEp1'IIREyI-68IN6 GO.
RE B O'NfIL RD.: HUDSON; WIS. 54016
ROBERT ULBRICHT
VVI3. MASTER PLUMBER LIC. NO. 3307 M.P.R.S.
~-+NN. INSTALLER & DESIGNER LIC NO. 00653
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, r4l 53707
CONVENTIONAL ❑ALTERNATIVE state Plan LO-N mbe~
(1f assign edl
❑ Holding Tank ❑ In-Ground Pressure ❑ J Mound
NAME OF PERMIT HOLDER JADDRESS OF PERMIT HOLDER- INSPECTION DATE
Herb Florcyk R. R. 1, 130th Street, St. Joseph, Wl_
BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN EF. PT. ELEV.'. CST REF. PT ELEV
SE SE, Section 25, T30N-R20W, Town of St. Joseph
Na,,,,, of Plumf- MP/MPRSW Nrr CnuiY Santar/ Permit Number
Robert Ulbricht 3307 St. Croix 74973
SEPTIC TANK/HOLDING TANK: r p'
MANUFACTURER LI C ITV TANK INLET FLEV LANK OU TLET E LEV. WARNING LABEL LOCKING COVFVR
e' PH VIf?f D PROVIDED
YES ❑NO ❑YES' [NO
BEDDING'. VENT DIAi, VENT MAT I f(; H WIER ROAD O ERTV WELVENT TO RESH
NUMBER OF
LARM FEET FROM NE AIR 1NL
❑YES ❑NO ` ❑YES ❑NO-_jNEAREST etc'
DOSING CHAMBER:
MANUFACTURER BEDDING LIOUlf 11:nPA(. I T Y PUMP MITI,,, I'tr'.1P jlNrrtl~:,j,,CuE iii- Ai'I RF H WARNING LABEL LOCKING COVER
PROVIDED PROVIDED
OYES ❑NO ❑JYFS ❑N ❑YES ❑NO
GALLONS PER CYCLE: PUMPANOCONrnoLSOPERAnoNAL NUMBER OF IF ROPERTY JHELL A BUILDING vENTTOFRESH
(DIFFERENCE BETWEEN FEET FROM NE AIR INLET
PUMP ON AND OFF) ❑YES LINO NEAREST-0
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing - [1,',N1F Tf H JMATI#I~IAI AN[/NANKIN(,
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE
the soil is dry enough to continua.) MAIN
CONVENTIONAL SYSTEM:
WIDTH PT#11 No or u15rH Plvt.laclrvt, wEEV ~uslnEDln =al; LIQUID
BED/TRENCH nIENC Fs nTEHIAL PIT DEPTH
DIMENSIONS
(;RAVEL DEPTH FILL H DISiR PIP UISTH PIPE DISTR_ PIPS MATERIAL NO IJICTR ~ NUMBER ~ OF PROPERTY WELL BUILDING VENT TO FRESH
EiCtOW PIPES Ae(7VE COVER FIFV INLET ELEV LNn PIP[ FEET FROM LINE AIR INLET.
r
z > U NEAREST---►
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
SOIL COVER TEXTURE 0 HNIANI NT MARK[ FYS oltsEElvAUtmwFLS
YES No ❑YES ❑NO
DEPTH OVER TRENCH BED DEPTH OVfH iHENCH HE 1) DL PT1I r11 It)PS~7li tiOf7DEI) .OFF L MULCHED
CENTER EDGES
YES NO YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH LEN(,TH NO. OF LATE HAL SPACING7 HAVEI DF PTH HFLOW I' PI FILL DEPTH AHOVE COVER
BED/TRENCH TRENCHES
DIMENSIONS
MANIFOLD PUMP MANIC OLD DISTR. PIPE MANIFOLD MATERIAL NO DISTR DISTH PIPE DISTRIBUTION PIPE MATERIAL & MAHKING
ELEV. ELEV DIA ELEV PIPES DIA
ELEVATION AND
DISTRIBUTION
INFORMATION HOLE SIZE HOLE SPACING UHILLED COTIFit, C7 L Y COVER MATERIAL VERTICAL L ITT CORRESPONDS TO APPROVED
PLANS
❑YES ❑NO ____L__ -1YES ❑NO
COMMENTS: PERMANENT MARKERS =ATION WELLS NUMBER OF PROPERTY WELL BUILDING
FEET FROM NE
❑ YES ❑ NO ❑ YES ❑ NO NEAREST-
C,
WL ti
I r
~ t
Sketch System on
Retain iiI~Kunty file for audit.
Reverse Side. _
SIGNATURE TITLE f
DILHR SBD 6710 (R. 01/82) 'r
.NEEMMIll iuisconsm APPLICATION FOR SANITARY PERMIT
( .DILHR (PLB 67) ` COUNTY
OEPRRTiT1EnT Or UNIFORM SANITARY PERMIT #
In OUSTRY, LRROR 6 HUmAn RELRTIOnS
17119q3
-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 .T 2
PROPERTY OWNER
Y~N~ ~ MAILING ADDRESS
/30XSAZ
,~vv S ~vi5
PROPERTY LOCATIO
SE 1/4S~ 1/4, S ~-5 , TN, R 2-0 E (or W TOWS T-A - sr ~O
LOT NUMBER BLOCK N MBER SUBDIVISION NAME NEAREST ROAD, LAKE O ANDMARK STATE PLAN I.D. NUMBEI
/3 57
/F ,y -
44
TYPE OF BUILDING OR USE SERVED
1 or 2 Family Number of Bedrooms. ❑ Public (Specify):
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
Gallons Tanks Concrete Constructed Steel Fiberglass Plastic
Septic Tank Capacit 4X, f~/<J = /QlJ'D IVZ44, SO
Lift Pump Tank/Sip on Chamber
Holding Tank capacity
Manufacturer: ! X/ST/N 6- ,4A4<_ T/fUjC SLejk-5 : (.01E&_1C_ O.[>CcQ . OTC 176- At l C.
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 1 quuare Feet):
I k2_0 /f X U7` Q C Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation /of the private sewage system shown on the attached plans.
Name of Plumber Signature: D016 WMPRSW No.: Phone Numb r:
RT. 8 0' IL
ROERT RD.: HUDSON: WIS. 54,70 1115 ) ,~o -j1p
Plumber's AIMTs MASTER PLUMBER UC. NO. 3307 MAR.S. Name of Designer:
INFALL,ER & DESIGNER LIC. NO. 80663
COUNTY/DEPARTMENT USE ONLY
Signature of Issuing Agent: Fee: Date: ❑ Disapproved
~Q q ` ❑ Owner Given Initial
"2 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
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 applicahuo.
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
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 xt
Location of Property s~ Ste- ;4, Section Z S , T 30 N-R ~O W
Township S
Mailing Address
(J f~.s Q.v Gv ! ~ S - .
Address of Site S -
Subdivision Name a . =r"~.~~~•~ i ~a°~ f w~~
.
? Lot Number I
Previous Owner of Property C)
,S
Total Size of Parcel y ~f !
Date Parcel was Created
Are all corners and lot lines identifiable? Yes1 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 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) eeAti.6y that aet statements on this 6otcm ate thue to the best o4 my (ouh.)
knowledge; that I (we) am (atce) the owneA (,s) o4 the pttopW y dens ch ibed in th ins
.i.n4otmat%on 4otun, by viAtue o6 a waAAanty deed tcecotcded in the 066ice o6 the
County Reg4istett o4 Deeds ass Document No. 2 (3 ; and that I (We) ptLuentey
own the pttoposed Site 6otc the sewage diuspod system (otc I (we) have obtained an
ecvsement, to &un with the above desehi.bed properrty, Got the eonstAucti.on ob Zaid
,system, and the same hay been duty teeo&ded in the 04jice o4 the County Regatetc o4
Deeds, as Document No.
SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE)
DATE SIGNED DATE SIGNED
• H
z
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a
ST C- 105 r'
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a
SEPTIC TANK MAINTENANCE AGREEMENT ryi
St. Croix County z
OWNER / B~ AI L-504 ~/`W/ I2 C y
/ s 7
ROUTE/BOX NUMBER /,`p Fire Number
CITY/STATE //-A le-v ZIP 5`Ol
PROPERTY LOCATION:.S,~ ,4 Section Z S , T N, R ZD W,
Town of ST St. 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.
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- 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
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.
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1% I UL ISS1Af v
DEPARTMENT OF
INDUSTRY,
SAFETY & BUILDINGS
LABOR REPORT ON SOIL BORINGS AND
HUMAN D P.O. BOX 7969
RELATIONS PERCOLATION TESTS (115) DIVISION (H63.09(1) & Chapter 145.045) MADISON, WI 53707
LOCATION: SECTION/
SE ' 1/4 25 /Tao N/R .20 (o TS S~(j f LOT NO.: BLK. NO.: SUBDIVISION NpAME:
14
COUNTY: OWNER'S/•Bti~S NAME:
S'7' ~6l' _ MAILING ADDRESS:
USE x' &k//3 f-~a~ C ~ ~Pj • ~ QU,¢iPT ~U~v~ S~ S' ~
NO. BEDRMS.: COMMERCIAL DESCRIPTION: DATES OBSERVATIONS MADE
Residence PROFILE DESCRIPTIONS: PERCOLATION TESTS:
❑New Replace
Lx I
RATING: S= Site suitable for system U= Site unsuitable for system
CONVEN~VL:MMK~U D: IN-GROUNDPRESSURE: SYSTEMIN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(opt iiona1)
~s ~u as au ❑s ❑u os ou
If Percolation Tests are NOT required DESIGN RATE:
under s,H63.09(5)(b), indicate: ~G~ J s If any portion of the tested area is in the
Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS I,v _beCejjj_
BORING TOTAL DEPTH TO GROUNDWATER-IN CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABB V. ON BACK.)
B l /O o s%G~'~ ;Af "/f/
g 7xy s,,t,D . o opt'. UEe cs P--~
B- y13O /.off' o.Pf~tvic s 9az' BN, 1'-4. X.
~ q
B~ l S /lo AM- 0.Py~ U; c s • o s J
7 O rf
.a /o w S / S' ~i!•~ J'i/ 7. . G£7AI CS -3
(r e
B S ° ESr e 3.,5 rs. 75 6;ef s
.3.0 S/ Ho fY/EO ' ~ 11
B CP S~ b
Ar- y0 /•s' 4'V s!~ a.s, C-,e,y-acv. s , a• s 4.1
S wid4 S/t.T ~~~p ~i sT. Hods
e- oil 4Ai f s ~F 13 ; l so;/s 4e-' s,
s _ /ry I s~'~psa,v i~ sj7-4,,e~srEv
~'/E~tT~auf PERCOLATION TESTS
NUM ER D
H,i EPTH AFATERSWELLIN INTERVAL-MIN. DROP IN WATER LEVEL-INCHES
RATE MINUTES
PERIOD 1 PERIOD 2
P_ $ 2s <Z PERIOD 3 PER INCH
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P Z P-,e,,t .tQ
Q < Z 5 e
P- w firE
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 ~d70.~-t o { = 2 FT 4 TFT,p~Nsru p"ra S GoP
o f. o i S &p
B T-S Will EEO To &CbozeD oYf
3
s
_w 12
i4C~f~lo FO,'
1Q-ei-c_
y~ ,
,,,-e - yo
Top
yo' _ ~F /3aT7`orl -~tos7- TIC
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I, the undersigned, hereby certify that the soil tests reported on this form S
rrta' a in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the
,;W~s ~ r est of my knowledge and belief.
NAME (print): ~
HOMESITE SEPTIC PLUMBING CO. TESTS WERE COMPLETED ON:
RT. 3 O'NEIL RD., HUDSON: WIS. 540 0 S ~ 7 s-
ADDRESS: c
WIS. MASTER PLUMBER LIC. NO, 3307 M:, lc9 s^~ f fw CERTIFICATION NUMBER: PHONE NUMBER (optional): PSI
CST SIGNATURE:
DISTRIBUTION: Original and one co I I fir'
py to Local Authority, Property Owner an s
ester.
DILHR-SBD-6395 (R. 02/82) •
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ROE ERT ULBRICHT
"~G1 (EH _tIMBE Lti. NO. 3307 M.Td.S.
' Ihi}1G~1;_Fi; DESIGNER LIC. NO. 90663
V Fresh Air Inlets And Observation Pipe
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0 - Approved Vent Cap
Minimum 12 Above
Final Grade
9iP~l~E ~/~S s. FT`,
M~f~Ci.y vim,
yi Above Pipe - 4'' Cast Iron
-To Final Grade Vent Pipe
Marsh Hay Or Synthetic Covering
min. 2" Aggregate
Over Pipe
r Distribution - T"ee
So►I 7FSr Pipe 0 0 0 2eo ,
AggregaPerforated Pipe Below.
Beneath Pip_
0 Coupling Terminating At
Bottom Of System