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HomeMy WebLinkAbout030-2072-50-000 nv>O 3d o C7 `~1 1 _ 1 0 CD 3 - ~ O cn 0 ~ Z ° ~ > C/) W Ow (J• v m o m a C- w° CD 3 (D (D p O N .'1 ZJ C7 Z C) N N N O r+ O w c N O O O D O N C L v (n S O Q O C) co CD 0 w co c p o D O 7 N d 7 °O O w C N 2 [n ~ D m CD O j -0 :3 N C F' N a C:) o E; z~l 3 O D~ N O CD W CD ° G (O (O C p (W (07( (D O C O C v v v o z O O O C:) 0 o 9 1 ~ ~ * Z "IC cn cn en - D N N -ice v v v A C:) 0 0 C) G) r CD y N a Z 0 c Z Z D m o m O ~ s N Cl) N (D CD C (D c Cv CD (o n w CD 7 z CD -i Z CD A Z 0 W a O 75 Z w CD C m o CD CD C Z 3 A Cn o 3 m o rn z CD w ~ x w D cq + O T ll a z a o CD 0 to v CD CD Z] ~ z N 4 7 F O Y' N ~ CD O 7 O N C O i CD O O ~ cn a (moo D~ (N.( rfl O ~ o (DD o a n CO) O 3 "o n d `r1 M C ems' F C A p fD C • ~ ' N , 3 - A~ 3 !G* O A7 co v O N O O A 7 Co W ~C• \ a n m m o o s ~~~lll m l^\ v o C O O O N O 1 0 -4 N ~ Q ? 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CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): = Current Owner " ANDERSON, DONALD L & LOIS E DONALD L & LOIS E ANDERSON 275 125TH AVE HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 275 125TH AVE SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 37.620 Plat: N/A-NOT AVAILABLE SEC 36 T30N R20W NE SE EXC AS IN 623/346 Block/Condo Bldg: EXC P622C Tract(s): (Sec-Twn-Rng 401/4 1601/4) 36-30N-20W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 950/375 07/23/1997 725/349 07/23/1997 709/497 07/23/1997 695/519 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 72,000 305,900 377,900 NO UNDEVELOPED G5 23.000 31,300 0 31,300 NO PRODUCTIVE FORST LANC G6 12.620 116,200 0 116,200 NO Totals for 2005: General Property 37.620 219,500 305,900 525,400 Woodland 0.000 0 0 Totals for 2004: General Property 37.620 219,500 305,900 525,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch 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 ' iSEC. T 3J N-R Z W OWNER 11 / -y TOWNSHIP eti Sr-~ r~ ADDRESS IUD ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT IN 0 r- LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IZIIR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ` l INDICATE NORTH ARROW ~C BENCHMARK: Describe the vertical reference point used> 1 d Elevation of vertical reference point: Proposed slope at site: ~eJ SEPTIC TANK: Manufacturer: r✓~ Liquid Capacity: Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: L~ Tank Outlet Elevation: Number of feet from nearest Road: Front Side,Q Rear, O 4 F feet From nearest property line Front,0 Side,oRear, O C;~) feet Number of feet from: well ''C4~~ , building: (Include this information of the above plot plan)( 2 reference dimensiE SIDE septic tank) SEE REVERS 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: L 2,)4idth: 8/1~75 , Length: Number of Lines: Area Built: Fill depth to top of pipe: cx /1 Number of feet from nearest property line: Front, O Side, Rear, O Ft Number of feet from well: 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 Bu; YIt : Has ei er a drop box O or distribution box O been used on any of the above soil ;bs btion sytems? (Check one). OLDING 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, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number: 3/84:mj DEPA%3TMENT OF INDUSTRY, INSPECTION REPORT FOR LABOR & HUMAN RELATIONS SAFETY & BUILDINGS P.O. BOX 7969, PRIVATE SEWAGE SYSTEMS DIVISION KADISON, WI 53707 BUREAU OF PLUMBING CONVENTIONAL ❑ALTERNATIVE sate Plan ID.Numer Holding Tank 1:1 In-Ground Pressure ❑ Mound ~II a ,qnej, I I Q ;ADDRESS OF PERMIT OLD EH' INSPECTION DATE. i Lois E. Anderson R. R. 2, Hudson, WI BENCH MARK (Permanent reference 54016 Point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELE V.: CST HE F. PT. LEV NE SE, Section 36, T30N-R20W, Town of St. Joseph Name of Plumber MP;MPHSW No County Sanitary Permit Number'. Gary L. Steel 3254 St. Croix 64911 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV WA LOC KING C VE RNING LABEL - i '1 1 ; PRO DED: PROVIDE /'l-2) LI ❑Y$ BEDDING. VENT DIA VENT MATL HIGH WA ER YES NO NO rr f ALARM NUMBER OF ROAD PROPERTY WELL BUILDING JVENTT. FRESH ❑YES O FEET FROM ,11 LINE 9 ,I AIR INLET: DYES ENO NEAREST 7..7 V s` u ✓ DOSING CH. MBER: MANUFACTURER BEDDING: LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER I WARNING LABEL LOCKING COVER i ❑YES LINO PROVIDED PROVIDED GALLONS PER CYCLE: PUMP ANUCONTROITS OPERATIONAL ❑YES LINO ❑YES LINO (DIFFERENCE BETWEEN NUMBER OF PROPERTY WELL BUILDING VENT TO FREER FEET FROM LINE I AIR INLET PUMP ON AND OFF) ❑YES LINO SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing NEAREST 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 BED/TRENCH WIDTH.M LENGTH NO. OF DISTR PI E SPACING COVER 7RE HES INSIDE CIA >S PITS LIQUID DIMENSIONS ~ IJt~ P;T DEPTH I GRAVEL DEPTH FILL DEPTH DISTR. PIPF DISTR. PIPE DISTR. PIPE MATERIAL N tSTR BELOW PIPES- ABOV C VER Ei f EU EN Of if I PIPE NUMBER OF PRO~lERTV WELL: BUILDING VENT TO FRESH FEET FROM AIR INLET NEAREST MOUND SYS EM: Mound site plowed perpendicular to slope upslope: Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- ❑YES meets the criteria for medium sand. TIONS MEASURED, LINO SOIL COVER TEXTURE PERMANENT MARKERS. OBSERVATION WELLS DEPTH OVER TRENCH BED DEPTH OVER TRENCH RED ❑YES LINO ❑YES MULCHED LINO CENTER EDGES DEPTH OF TOPSOIL SODDED SEEDED I ❑YES ONO 1-1 YES ENO EYES ENO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE TRENCHES. FILL DEPTH ABOVE COVER. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE ELEVATION AND ELEV ELEV DIA MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV PIPES DIA DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES LINO ❑YES LINO COMMENTS; PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL BUILDING. 0, 1 FEET FROM LINE ' 7 v ❑YES LINO ❑YES LINO NEAREST . 0 Sketch System on Reverse Side. Retain in county file for audit. SIGNATURE. • ~ - TITLE. DILHR SBD 6710 (R. 01/82) t l -J j CD wisconsin APPLICATION FOR SANITARY PERMIT DILHR 1 COUNTY fT7EnTOF (PLB 67) - If~0U5TgV,LR...&HUMRnRELRT1On5 UNIFORM SANITARY PERMIT # -Attach complete plans in accord with s. H 63.05, Wis. Ad m. 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 PERTY OWNER MAILING ADDRESS PROPERTY LOCATION CtT,?- L- 1/451` 1/4, S~3(~ . T3C}N, R f(or) W TOWN LOT NUMBER JBLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER )06 A2 61 TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms. PSpecify): THIS PERMIT IS FOR A: KNew System ❑ Tank Replacement ❑ Repair LJ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed X 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 Capacity Litt 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 Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): WATER SUPPLY: 7-6a K_Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installatio of the private sewage system shown on the attached plans. Nam f Plumber (Print): Signature: I /MPRSW No.: Phone Number: Plu ber's A dress: Name of Designer: COUNTY/ DEPARTMENT USE ONLY [Reason gnature of Issuing Age Fee: Date: ❑ Disapproved 7 Owner Given Initial Approved Adverse Determination 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 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. AFt'lACA'C10N FOR SANITARY PLkMll S 'I' C - 100 Cl~i .-applic it lou loan to 1) couilileted in tu1.l and signed by the owner(s) of the property being; developed. Any inade.qur_acies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,("spec lumuse"), then a second form should be retained and completed when the property is gold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owuc'r of Property &A J L . ` r Location of Property ;4, Section 't'ownship ~ . ~ e 5 e _A 11 _ Mailing Address A,1 0,1 V'r\E~ 6 4flC_~►t N b crt ~GIr~C;`r✓< Subdivision Name Lot Number Previous Owner of Property (z r Total Size of Parcel Date' Parcel. was Created LZ Ar,~ all corners and lot lines identifiable? 0-I yes No is this property being developed for resale (spec house) ? Yes No ~ - Volwne i rind Page Number D ~ J as recorded with the Register of Deeds INCLUDE WITH THIS Al l L [CAT 10N ONE O TIFF FOLLOWING: 1. Warranty Deed 2. Land Contract 3. Other recordin+;r; filc-d with the R<,gi~ter u! M i_ice In addition, a certified survey, if available, would be hrlpiul. so as to avoid delay of the reviewing process. If the deed description refercitees to a Certified Survey Map, the the Certified Survey Map shall_ also be required. PROPbRTI OWNER CERTIFICATION I (We.) ee.nti.6y that aT 6-tatemen.t.6 on tka jonm arse thug to tile. best o6 my (cute) Lnowtedge; that I (we) am (arse) the owners (s) oA the pnope~l-ty d"CAibed iYl -tUz crt)onma ion 6onm, by v.iAtue o6 a wanhanty deed neeonded .irt the O, 6ice o6 the County Reg,i te-A o4 Deeda cts Document No. jf6(~ei ; and that 1 (we) prtesentey own .the pttopo~ed atite 4m the..aewage d~p'o6a2 6y6tem (OA I (we) have obtained an easement, to zun with the above desentled pnopenty, 6oh -the- c.Unstnue.ttion o6 .~a.id sy,,~tem, and the -5,viie has been doey neeonded tin the 06A' OT U~ Cite County Reg.u. toi U!, "Oec,4, cU5 Vocument No. ) . q h G v ~F SIGNATURE 0' OWNEk SIGNATU OF CO-OWNER (IF APPLICABLE') DATE SIGNED DATE SIGNED cn r S T C - 105. S1,.:Y`1'IC TANK MAINTENANCE A(;k E1?Mt'Xl' o St. Croix County c7 OWNER BUYER --.r~C•l~~ I\LIg ~C' ~f _ ROUTE/BOX NUMBER Fire Number !1 ~ - CITY / S T A `1' E _ S G ~1 t r 5 - - - > _3& _ Section 1 N, Kw PROPER'T'Y LOCATION: Town of '1o' r' St. Croix County, Lot n-umber/f Improper use and maintenance of your scl)tic 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 pumLet. What you put into the system can affect the function of the st2ptic tank as a treat- ment stage in the waste disposal system. St. Croix County residents maw be eIigi[,Ie to FCCeLVc a nt lur 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 systC ms 1)r0 Perly 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 ti three year expiration. ° G x OWE, the undersigned, have read the above requirements and agree U) to maintain the private sewage disposal. system in accordance with b the standards set forth, herein, as set by the Wisconsin Depart- meat 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. a S I G N E D ! - 4S ' - DATE' St . C roix County Zoning; 01' 1 i ce P.O. ox 9b llammoi d, WI 54015 715-7t6-2239 or 715-425-8363 Sign, date and return to above address. z° ° v~ `m O c N sr N O C `m O O E j 4 aiH j 0) 0 c o~ 7 C N 0` w 00 c CD C7 0 U o ce Loa)' :3 C L V U) ) Y cu C: L L- N 0 _ O .0 : 0 co c ca 'W ° >-0 D v Ec vl v cu U O` O C L I cno~p~= roc' ..Ocn 02 Q ai CM 'a0 co =aUi~'° t = cnCUo 0 Lim V sCaDCca - oa ~ Q F- cc ca " N O " t W m3~D- cu 3 v~v C cn m cn a N cc$ CC _ • L ='0 w CO ~ L Y C Q Q oLC~ai~E a~ivoi~c U. a) L U a) ` a) cd C ~ H ca N cC L N C3 F- Q Z U) CO co a L C p N O ; O a) a O ca v p ~I O 3: 2Oa p U U c~ - 0 0 to C9 0 c) -2 N >4)a~ O ' 0 oC c L~mvC a~ Qaa 0) cn~c L o o 0 ~ 0) - cn :3 ri) C13 O L ~ c C 3: c ~Z C :3 C C O C c V O C D) L C C i 0 0 0 O ' O O ~vj O> L r 0 E U N c+1 i u G C 0 N a> L (D a ca j h p C a) 00 3 i U D C 0 Q c 3cncn" o N 0a O«-a)a) a~= c ~13 E .0 a i N (a r- tr C Q) U U p Y Q) O a) 3 G 'MID 0 >1 ( ~ N O E N v=i cn co F- (D 3 N Q C I NGS DEPARTMENT , OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS P.O. BOX 76 INDUSTRY, PERCOLATION TESTS (115) MADIS ON W153707 LABOR AND '.HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOC TION' < SECTION:T I% TOWNSHIP/M "fG+P~1-TY: LOT,NO.:BwNO: SUBDIVISI N NAME: /•`2c) (or) L '4 L- '/4 3 / h.3o H R COUNTY: -P/BUYER'S NAME: MAILING DURESS: r- e c , 0 l_ lld -S USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence 3 44 Yvew ❑ Replace Il r RATING: S= Site suitable for system U= Site unsuitable for system CONVENT5_1 L: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) ©sou ❑u as u os u - , rH63 olation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the ..09(5 )(b), indicate: _ Floodplain, indicate Floodplain elevation: ~r PROFILE DESCRIPTIONS ti J BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER It+Ri, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK. ELEVATION 10 r7 C,2. Cam- 131,S f r / 7S (mil S~ ~ 1 Z ~l B- ~o G 4 > 131.5.x, . 1 u n , S L , L 733 ,yz 7S sg 08 0'7 1 B- 3 I C, ,a1 a iv S 13 B- C) 0 il) S o 00 ~ 7 ( 1 B- PERCOLATION TESTS `'BSI RIAj / T_ F DE PTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER VAIGI-hES AFTER SWELLING INTERVAL-MIN. PERIOD( 7ERI0 D2 PERIOD3 PER INCH P_ f 3 7- 5 A) 0 / 2 Y 3 P Z• 3 alit/ 3 n 1i Z L P_ g 1J 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 6-4 1 , ` - '220 S i Z E t4t~/z>✓S ~ 4_ 24,11L, _F1P-PE101 6 E S -,5 r ' 6 - _3Z' - P Z ' ~ I 10 : E ( 0 jyl 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. TESTS WERE COMPLETED ON: ANADMEDR(priESSnt): l ' CERTIFICATION NUMBER: PHONE NUMBER(optionall: cJ p _ r ✓ I Z_ ~ ~CJJ _ ~ ~ - ~ CST SIGNAT ~ i DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DI!_HR-SBD-6395 (R. 02182) -OVER f e L:, 1 ai.i s_ ° s,., :J 5 L . a~. _ i 1 € e :s _a,,. co r, i tzH';l ,a..L.=sF 1 E~tz; 31f € lir,€ r, ~t ?_r...,.i Cis .~:<wJ s r t ~ tc u rr ~ mr~ .Ett; . _-r, ~t~#7I r33r(7 .a+,. r.,. t .ci. , _ ~ a..E zlt I € 1 i r.€j~f: co .stt~:, rt t~_S4 3 " ~,I"i' s£;•3t7 ; c s ri ESfI E r ; E t l"v "l a~ . °a ~a n - - $ Vii, S Oi J 3, - crk Y l Ga `v .2- a1r I --7L LOP tie f