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HomeMy WebLinkAbout040-1020-50-001 N O -0 0 O r c y o t7 Lo~ 0' 3 A. l~ 7 3 n C W • 3 O W G y U m z 0 = H 0 0 a 3 _m Iv N 0 w o a a CD O a m 3 < K) ° F-. m (D E: 0 0 (D 5i 0 fD o m W° m o 1 N) CL :3 0) in H. o -0 Q O N r~r H p cn m O -0 0 A' w 0 ` I-' d1 Z N N 7 ~ N OI w _ (y m CL C:) m (n CL (D ~I F N I T ON -u 3 g co: r p 0 N z ° cn N ~ (D O COOm ~ r- (n co co t o N cn cn N a Q H• 00 c v v w m d z o O O ° - 1 H4 H c 0' a c ti ai ti 0 N D Oo O Iv C~ CL M In 00 0 (6D (D O O ° :3 cn CD I Z tcns1 ' ~ °1• m rn I co fb o y N _ Ul F h I-- N 3 W CD Ln 00 H " (D O_ 7 n n z C H z O O O p ° m j N p \ m N m m (O Q N W ~p CD 0 (D 1 LJ z CD U) O O_ _Z fD m O K 0 -1 c Z O a Q A z 3 O (n H A 00 W m r) co o zt z 0 3 a X O 3 m co r„ z (D rv y CL CD n 7 O O - N 601 CC cn Z P - CM O rn m O N ,a o e i ~ ti 0 0 I A O pq O o p " }V O O O CL ~ Parcel 040-1020-50-001 11/03/2004 10:20 AM PAGE 1 OF 1 Alt. Parcel 04.28.19.64J 040 - TOWN OF TROY Current X_, ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): Current Owner MARK & CHERYL KLANDERMAN ` KLANDERMAN, MARK & CHERYL 520 FRANCES AVE HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 520 FRANCES AVE SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.620 Plat: N/A-NOT AVAILABLE SEC 4 T28N R19W 2.620 AC SE SE LOT 2 OF Block/Condo Bldg: CSM 5/1458 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 04-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 02/11/1998 572825 1295/336 WD 07/23/1997 719/155 2004 SUMMARY Bill Fair Market Value: Assessed with: 220,300 Valuations: Last Changed: 07/15/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.620 56,000 177,000 233,000 NO Totals for 2004: General Property 2.620 56,000 177,000 233,000 Woodland 0.000 0 0 Totals for 2003: General Property 2.620 48,400 163,600 212,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 101 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 Uc^t .E ~ ty4 nN TOWNSHIP "'CLC E SEC. 4 T Z-6 N-R I~ W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION N LOT" 1 ]LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of ILIIR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM D r-3nst s k I I~ •,O Z~^Q. .4 p0L A W ' W~[ 1. INDICATE NOJTH ARROW BENCHMARK: Describe the vertical reference point used 1c'F C,4 -1-F- .-c o t4, K- hc~ Elevation of vertical reference point: 10I_12 Proposed slope at site: C SEPTIC TANK: Manufacturer: WE[ ,i_ Liquid Capacity: IZ50 =->r., r Number of rings used: Tank manhole cover elevation: /t?l.l/ Tank Inlet Elevation: 98_€7- Tank Outlet Elevation: c{ Number of feet from nearest Road: Front,Q Side,o Rear, o 100 "Ofeet From nearest property line Front, 0Side, 0 Rear, 0 12 0~-O " feet Number of feet from: well 7510" building: 30'_.0" (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, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: X + n ~ Q Length: ~p~Cr -G Number of Lines: tE~3ta1 Area Built: 330 rC~ Width: 5 - Fill depth to top of pipe: 4?r-mcv% ` Number of feet from nearest property line: Front, O Side, O Rear,0 P't Number of feet from well: OdErz- Icx~'-C~" Number of feet from building: "(`:0~JCN 2 `Z5`-,o" 4r-xx140Z- (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 © 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, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: f Dated: Plumber on job~• ~~7 ( 2 License Number: 3/84:mj 1 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOO` MADI►301V, Wl I 53707 BUREAU OF PLUMBING KXCONVENTIONAL ❑ ALTERNATIVE s1:1 Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER. INSPEC O DATE. Don Harmon 905 Coulee Road, Hudson, WI 54016 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.'. CSTREF. PT. ELEV SE SE, Section 4, T28N-R19W, Town of Troy, Lot#1 Name of Plum Ber. MP,MPRSW No Cnu v Sani,ary Per,iii Nu ether. Paul Cudd 2739 St. Croix 69637 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY TANK INLET ELEV TANK OUT LET ELEV WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. / L EYES ❑NO ❑YES ❑NO BEDDING'. VENT D IA ft VENT MAT I _ HI(;H HWATER NUMBER OF ROAD. PROPERTY JVVILL. BUILDING VEIN TO FRESH A LAM1? - - LINE IIA1R TN LET t I FEET FROM YES ❑NO ❑YES ❑NO NEAREST u6s"ING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPnCI II PUMP M(TUL %IP SIPIInN MANtIf AC ll1REl4 WARNING LABEL LOCKING COVER PROVIDED PROVIDED. ❑ YES ❑ NO ❑ YES ONO ❑-YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PHOPERTY WELL JBIJII~DING LVENT TO FRESH (DIFFERENCE BETWEEN FEET FROM `.INF~ A1R INLET PUMP ON AND OFF) L_JYES L_JNO NEAREST--- 0 SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing 1[ I - UTAMF TEI+ IMAL HIA( AND MAHKIN(, or excavation. (If soil can rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: < 11111TH LENGTH- NO (lF DIS'ft PIPE SPn( IN (7VtII INtilltE IT I:. =P~7S LIQUID BED/TRENCH RFNC"LL ~l QIaL PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH DI 11 P PE , O IP j/ DISTR PIPE MATERIAL NO 171 H NUMBER OF PROPER Y WELL BUILDING VENTTO FRESH BELOW PIPES ABOVE COV ER EE~,Nf ELVN y~ PIPE' LINE ,..7 AIfi INL ET,, FEET FROM f / _L 1 - NEAREST MOUND SYSTEM: 4 'd 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. ❑YES ❑NO SOIL COVER TEXTUHE iTnNINIMnwk_IHS 1011s111VATIW, v',, Ls _TPj ❑ Y ES ❑NO DEPTH OVER TRENCfI BED DEPTH OVFH THENCII BF _I YES ❑NO D IJf PTrt ()F TI)PS(IIL ti(11)OF I) :iE L IJF I] E~ULCHED KENT EN EDGES ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO. OF LATERAL SPACING; (;HA VEL D E P T H BF I AV PIPE FILL DEPTH ABOVE COVEH BED/TRENCH TRENCHES I DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATEHIAL. ]NO DISTR D'STH PIPE DISTViIBUtION PIPE MATERIAL & MARKING ELEVATION AND ELEV. ELEV DIA ELEV. PIPLS D IA. DISTRIBUTION INFORMATION HOLESIZe HOLE SPACING DRILLE D COHHECT L Y COVER MATE HIAL VERTICAL LIFT COHRESPON DS TO APPROV ED PLnNs ❑YES ❑NO _ ❑YES ❑NO COMMENTS: PERMANENT MARKERS JOBSERVATION WELLS tNF UM BER OF PROPERTY WELL JBUILDING EET LINE ❑YES ❑NO ❑YES CINOEAREST- t '7 , P Sketch System on Retain in county file for audit. Reverse Side. SIGNATU F TITLE DILHR SBD 6710 (R. 01/82). L 11111~ wlsconsln APPLICATION FOR SANITARY PERMIT ~ DILHR St. Croix COUNTY ~a• OEPggTR1EnT OF (PLB 67) InOUSTRV, LRBOR S HUmRn RELFITIOnS UNIFORM SANIyT~ARY PERMIT -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 81/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS Don Harmon 905 Coulee Rd., Hudson, Wl 54016 PROPERTY LOCATION XDTX: SE 1/4 SE 1/4, S 4 , T28 N, R 19 E UPM VQX0~: TOWN OF: Troy LOT NUMBER BNAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER 1 C • S •NIT • Francis tlvenue TYPE OF BUILDING OR USE SERVED CJZ7J ,.y~j~_ /C/-Jl:v _ a 1 or 2 Family Number of Bedrooms. 4 Specify): w THIS PERMIT IS FOR A: Y 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 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 1200 1 X 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): Class 1 660 660 Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for ' tallation of the private sewage system shown on the attached plans. Name of Plumber (Print): gnatu e: MP/MPRSW No.: Phone Number: Paul R. Cudd 2739 (?15 )425-2049 Plumber's Address: Name of Designer: Rt. 5, Box 364, River Falls, WI 54022 Arthur Wegerer (536) COUNTY/DEPARTMENT USE ONLY Signatur of Issuing Agent: Fee: Date: ❑ Disapproved 0❑ Owner Given Initial 0 Approved Adverse Determination Reaso 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 r 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. f S t ' 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 inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractoK,("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 06~ V~ (/i~• /mil ~t~~~l/ l-~C~~ Location of Property S L , Section T N- R W Township Ciz)~i x Mailing Address ~(1 2-~_~_ Subdivision Name Lot Number Previous Owner of Property (-JQ Total Size of Parcel z . (o Z Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for r.esal.e. (spec house) ? ~ Yes ~ No Volume and Page, Number ( as recorded with the Register of Dcreds INCLUDE.WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Officc: In addition, a certified survey, if available, would be helpful ~;fl .i~, lo avo t l cl+ I<,, , of the reviewing process. If the deed description references to ,A C;ertiiied 5u,vk?y Map, the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (Glee eWi4y .that a l .6 tatementz on th ,6 Konm a,ne. tAue to the. best o6 my (~n know edge; VLa t I p am (~a&ej the owneA (s) o6 .the pl.open.ty de a cAibe.d i thiz in4oAmati..on Aonm, by vi&tue o6 a wa,4Aan.ty deed n.ecotded in the 06{ice. 0 .the.. County Regiz teA o6 Deeds as Document No. 3cl - Uri ; and that I pnee entt y own the pnopos ed .6.i to ion the sewage c M po.e alb yo -tem (on I have obtained an eab emen.t, to fua.n with the above dacAi be.d pnopen ty, 4oh..the, con.6tnucti.on oA 6aid sys,te.m, and the same. has been duty A.eeonded in the O{44,ce oh the County RegizteA o~ Deeds, a.6 Document No. i ogLf . SIGNATURE OF OWNER SIGNATURE OF OWNER (IF APPLICABLE) 2 DATE SIGNED DATE SIGNED G cn STC - 105 r y SEPTIC TANK MAINTENANCE AGREEMENT U St. Croix County G d r (t Y OWNER/BUYER (JC`!3C V ZG1 VKit I'7L ROUTE/BOX NUMBER10CUt~~ lC~ C_ Fire Number • CITY/STATE HC ~11~~U(~l _ FLIP Section T N x w PROPERTY LOCATION: ~4, )E __L Town of (I'Z St. Croix County, Lot number Subdivision , 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 ne_w_ systems agree to keep their systems properly maintained •rhe 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 nee-' 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. C; I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal. system in accordance with H 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 D ATE (I LA Cl C -2 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 _ S m S m N F G c (d cD ° cD p ==0 0 ID CL CR cc 0 Q 0 c o can =r 2. 3 m co co o ~ - m -0 a (D CD ° 0 D~ CD (n ' to O a 00 w 0 cD :3 CD n (D m ;K- w w M ' W -0 CD m (D cn a N 1 co (CD S 0 = M tD n 0 3 a 0---n n ° w tp O CD H co O w O 0 CC 3° C C w n O C o a ZS o O c s m p~ w v_°i ° w° O(D p a In 7 CCD CO '0 -0 n 0 CD A fD C to 4 o _DC cc a- 0 .m C C 0 w a^ w°w ~mCD0 p 06 CD 0 CL 0- S* CD Cl) CD w Z S w to o 0 m 2 ~CDo mw0s-+CD (1 p 3CDDfDM?a D D 1 N CD, 0 =rf ° °n w=.o~p ~T1 wa=: =r-_~ Cw vwa CD, M, aco°i N ~v 3=r -M10 -aCD5-= C ITI m lco jaicCDD u°,oCD~W~ 0 a ca 0 CD (D O In p ,0~-Ctp a w CD ~ co 0 (n ao * (nn c C 0.w0, ~ w 3 w m a a (aD N 3 fl1 - CL . a 0 CD F CL c° G) 0) -111 • cr cQ w - (D (n o G)° C 0 m° 3 m 0 CD o C N a 00"000 T 3 e a ° ocn w c m ~m c o ~f~m a ° C. 0 C=r w rz o CL C CD 0 -4 0 -3 1. w 9L CD *e N 7' 0. O CD . . - CD co . o 0 0 DEPA'TMENT Of REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS ,INDUSTRY, DIVISION P.O. BOX 76 LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/iFAl1GtRAL1TY: T570 .:BLK. NO.: DINAME 'yy-- 1/ 1/4 `1 /TzA- /R).9E(or _ COUNTY: OWN ER'S/ - ~ NAME: MAILING ADDRESS: _1 V. 'Y USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILE DESCRIPTIONS: PERCOLATION TESTS: i ew ❑Replace Il - Q.Residence N ;v RATING: S= Site suitable for system U= Site unsuitable for system CONVENTION'AIL: MOUNC D: 'I IN-G~(R~O~~UNCDPRESSURE: SYSTECM-IN-FILL HOLDINGTANK: RECOMMENDED SYSTEM: (optional) V A` [ I V V ~Y IC-~ V ~U V "U EIS EU If Percolation Tests are NOT required Dunder s.H63.09(5)(b) RATE: I If any portion of the tested area is in the ,indicate: Floodplain indicate Floodplain elevation: 1\3 .,/A PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-t~ CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH t'id, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) i T IS ~h S ff GL- vim, B 13- > B- 3 • > ~t - 73 i ~ 5 - ~h _,i- LL/' ,ter ; 14 - .12k l 1 B i PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATER INCH ES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD t PERIOD 2 PERIOD 3 P P- r P_ _7 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 `t of ~t:. of land slope. S I SYSTEM EL„~VATION µt6 a ~~.~.tF9 aAH L~. max V-1 OtL E [ ~ r 'SM Pv COtiI)~i c ' U bSo~f fyJ SST ' _.2F ? o r~ 4-I Z-. S~k bbd I' i[ _ -,,z Pv>NCa'"I , ~ //V 18°~°_~t it, . (I~,y ~o'wrtQ ctt~ . Lo N-A -g at - $ V t 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. 1 NAME (print): - TESTS WERE COMPLETED ON: R_744 (3R L ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): T °a 11 = CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, yOwner a ester. DILHR-SBD-6395 (R. 02/82) G R - Use . 1 e t. T C;= ff naAS~s F- E A i 8_` !S ,;£„P;. E s C 3, 4:=E"i JN "s`- 6 a.e ! ~3E, a 3 a~....sa _ I{? ? t =rd}Y t ..,I p; 0 7'S us'i€_; i on, p, C', Eii?1'.tty .➢i 0i g=~; locating, D },3ff`7 to a":al€:'t - Sc prelot a tF. . 1.. a, ~;.6, L€ ~2~i..a3a2f~alt "old, t wli j.~df°n a %.G all 3Sp olp; la kcs as tCt £.!t, E a, I t 1 CV, .b._;.. sand 1._."GI VY i t j l! kG . ~ .F _a ]Fain a ,,n a a w, .F IP~i .nul v ' x. , (/p F a:~.$E „p I -,1 v ~ ! 2 r P` 2cGrc L=RroR p;~~ - _ _ - S-71 e0o Z~~ - C= -cl Lic tan}: Building sewer O - li r z - , SYstem eleva Lion is b We 11 vc s ~zem ~_ea Property 1~nes w/ LA C' _ --5--_~',~tiO. t V Ga p 1•._r. - - c . ;nar}; 1n appropriate bo~_, indi ca ~ in 9 1 em is sno • r; O_. ter, Li V AT S 0 2' l i. y'PvC PER'=oRATE'L II QQ L ~ l~~S;S~\~U'Z1NJ AI?E I' NRP- ~O Zt L~ i i 1s' o'= ~l "PV b C H~ ~ q g 2 ` f TA~k ' t I ' \ yo r ,i11~ d ~ --u LJ i B}l the erantinc Or aUZ, ino Of =ltr,_t inC SSll°Gl~~l•.~rC~ XC7,1 t}?P above plan, O ll %Jn the event of a _ y and SLL_. llen e O hold 1tS 1f u7t}' t}12 St.1-,ro1JrcOi~,ty Zoning tidrlnnistrat ~AOr defects 1 SS-071, in or ;D eX IP1Tia i 3 On Over-,, n}iL CO* SLJ UCtl on, "Ci ri Ca t1 On 5, O1 Lri E installation. _ or - any ~c--aqe that i;,d rest - ~ e ~l Y/J 1"