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HomeMy WebLinkAbout040-1034-40-000 _K (D CD (D a G 3 3 co 2 2 N z o a) 2 H o o 3 W N N p (D p O co o• m CD o o a) w 00 Q d p_ N A m H B O A C 3 o~ao> > CJ x x o COD _ o o w G O o m CD CD a o 0 Q rj u' 3 0 FD 6 ° 0 ro o ro H y v ° o o = CD H w z a O H. N N CD CD (a E W ~ H rn O ~ r a p W o o a - cD crn In H <D m Z rn r y (~D ON o v H co cc) N r N ~4r b C~ c N E- K LTJ (nD z O O O • o a !J N d p 3 o 0 0. T o . o ? m h T v v. * (D o (D 90 R. T CD - CD a- FN (D o N rn a Ln 0~ N N z H z ° z oco pz 00 d O D a =1 Z o (D ro ~ -0 ; l0 U) C) ~ (D c (D 0) CD cc- G n w n CL H a 3 H o o N o CD 00 a A z z H 00 n W m w o d z A Z7 m m CD ~ w v I 0 CD c =r A 3 s m Q CD m o o 7 _Q O T 0 0 a 01 0 3 F O CD rn N ° CD v Ta l< o o y ~7 C A it D O C C (D H~ O 9.3 = O a N C Z cn O p I W ~3 N N .L O a A p 0 CD DO N f O ~O ~ yO O CD y Parcel 040-1034-40-000 10/03/2006 09:27 AM PAGE 1 OF 1 Alt. Parcel 8.28.19.111 D 040 - TOWN OF TROY 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 O - ANDERSON, JULIET HOFFMAN JULIET HOFFMAN ANDERSON 476 CTY RD FF HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' CTY RD SC 2611 HUDSON SP 1700 WITC Y L! Legal Description: Acres: 2.995 Plat: N/A-NOT AVA ABLE: SEC 8 T28N R19W 2.995AC NE NE COM NE COR Block/Condo Bldg: SEC 8 S 1326.8' TO SE COR W 1066' TO POB W 457'N 476'E 458.16'S 476' TO POB Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4) ASSESS WITH P1 12A 08-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 691/457 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/19/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.992 71,500 108,400 179,900 NO Totals for 2006: General Property 4.992 71,500 108,400 179,900 Woodland 0.000 0 0 Totals for 2005: General Property 4.992 71,500 108,400 179,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 140 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 i Parcel 040-1034-70-000 10/03/2006 09:19 AM PAGE 1 OF 1 Alt. Parcel 8.28.19.112A 040 -TOWN OF TROY Current X ( ST. CROIX COUNTY, WISCONSIN Creation Date Historical D to Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - HOFFMAN, MILTON A MILTON A HOFFMAN 1450 S WASSON LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 1.997 Plat: N/A-NOT AVAILABLE SEC 8 T28N R19W PT NW NE COM INT N R/W Block/Condo Bldg: HWY FF & E LN NW NE TH N 435.6 FT,TH W 200 FT TH S 435 F FT Tu €--200 FT TO Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) POB ASSESS WITH P111 D ~~~~~i ~ 08-28N-19W Notes: ~f Parcel History: Date Doc # age Type 07/23/1997 691/457 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 040-1034-40-000 Valuations: Last Changed: Description Class Acres Land mprove Total State Reason Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 0 0 0 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- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER JuLiG7 L^. jjr- j04.jgtj TOWNSHIP 1'/f 611-1 SEC. T N-R W ADDRESS K r. ,X I Crrf`>e; ya,. %rST. CROIX COUNTY, WISCONSIN 7 t- - - CP~ CA 1 SUBDIVISION /•rLOT LOT SIZE' M 4' w PLAN VIEW Distances and dimensions to meet requirements of 'MR, 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 7 / i _ 'y N Q (RID, ~ F N INDICATE NFL ARROW BENCHMARK: Describe the vertical reference point used fI [--QE. 4-r .Sal LaT erAw'v_ Elevation of vertical reference point: )V:V) Proposed slope at site: SEPTIC TANK: Manufacturer. `r Liquid Capacity: /rC"k 4,,{?< Number of rings used: Tank manhole cover elevation: 90.92 Tank Inlet Elevation: Tank Outlet Elevation: 91, 5 3 Number of feet from nearest Road: Front,O Side,O Rear, O 1471-C" feet From nearest property line : Front,0 Side,O Rear, O 45 - 0 " feet Number of feet from: well %w1wNVII, building: /X-40" (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: X Trench: Width: IL Length: 2 Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, © Rear, O Ft. 2-4'?) Number of feet from well: Mcue.Ew TKc,,,% kc~' Number of feet from building: 3y0-6 (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 0 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, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: 41 Dated: Plumber on job: 0 License Number: 2 7 3 3/84:mj D•=PARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WI 53707 BUREAU OF PLUMBING M CONVENTIONAL ❑ALTERNATIVE State Plan L D. Number. E] Holding Tank F:1 In-Ground Pressure ❑ Mound (if assigned NAME OF PERMIT HOLDER ~~A~DDRE F PE RMIT HO LDER. INSPECTION DATE Juliet L. Hoffman R3, Box 177, Hudson, WI BENCH MARK (Permanent reference P-0 DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.. NW NE, Section 8, T28N-R19W, Town of Troy Narne of Plumber. MP/MPRSW No. County Sanitary Permit Number: Paul R. Cudd 2739 St. Croix 69664 SEPTIC TANK/HOLDING TANK: MANUFACTURER . I LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED PROVIDED ❑YES ❑NO ❑YES ❑NO BEDDING. VENT DIA.. VENT MAT L. HIGH WATER NUMBER OF ROAD: PROPERTY WELL. BUILDING: VENT TO FRESH ALARM. FOM LIN AIR INL T'. YES ❑NO EET FR ❑YES ❑NO NEAREST DOSING CHAMBER: PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL JLOCKING COVER MANUFACTURER BEDDING =PPUM PROVIDED. PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: CONTROLS OPERATI ONAL NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) YES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing Nr;iH 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 WIDT` H LENGTH 7F~~ DISTR PIPE SPACING COVER NSIUE CIA -PITS LIQUID / MATERIAL' DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTRPIPF DISTRPIPE DISTR. PIPE MATERIAL. NO )TH NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH BELOW PIPES AHO VE CtOVER EL`E~V IN/LET ELEV. END PIP,Eg LINE FEET O . AIR LET l~lo~i V~ / v 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- ❑YES ❑ NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS. OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO IDEPTH OVER TR ENCH'BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL . SODDED SEEDED MULCHED CENTER EDGES ❑ YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO OF LATERAL SPACING JGRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. jD:STRPIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV.ELEVDIAELEV.PIPES DA.: DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO _ ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL. JBIJILDING. FEET FROM LINE: ❑YES ❑NO ❑YES ❑NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATU E TITLE DILHR SBD 6710 (R. 01/82) /a T t 11 Wisconsin APPLICATION FOR SANITARY PERMIT ~ DJILHR (PLB 67) St • CrOiX OUNTY lEnT I UNIFORM SANITARY PERMIT # nOUSTRYLR, LR90R 6 HUTgr'I gELRTlOr15 - rIOUS : >6 a" -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/Zx 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS Juliet i:. Hofftlatn Rt. 3, Box 177, Hudson, 41 54016 PROPERTY LOCATION (N= XaFX- 1y,Oar \ u1/4 T . 1/4, S T 2~N, R19 J&d W TOWN OF: LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER ~ • H • 111 li it TYPE OF BUILDING OR USE SERVED 1 Q X1 1 or 2 Family Number of Bedrooms. 3 Public Specify): (J THIS PERMIT IS FOR A: ❑ New System ❑ Tank Replacement ❑ Repair EX Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ZI 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 Capacity 1000 1 v iL Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: u' leser Concrete Products 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 ® 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): Signatu MP/MPRSW No.: Phone Number: Paul A. Cued 1+ PRSiT2739 (715) 425-2049 Plumber's Address: Name of Designer: Rt. 5, Box 364, River Falls, idJ1 54022 Arthur degerer (576) COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved Owner Given Initial 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 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. Fu rul - S T C 100 ownur ut Property Juliet L.Hoffman Location of Property r 1 - 4 ._.I~.__4 , S e c t i o n__ 8_, '1' 28 N R 19 W Township Troy Mailing Address_ Rt 3, Box 177 Hudson, WI 54016 Subdivision Name N/A Lot Number N/A Previous Owner of Property 't'otal Size of Parcel 2i7,&08 sr~aare feet (5 acres) Date Parcel Was Created Are all corners identifiable? Yes Include with this a)pli.caClou une Uf thu l011uwi.I1 .Certified Survey Map . Deed .Land Contract, or Other Legal Document which describu-s the prupurty PROPERTY OWNER CERTIFICATION (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 re~?rded in the Office of the County Register of Deeds as Document No. 93-4 t presently own the proposed site for the sewage disposal system (or I thaI (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. N/A SIGNATURE OF OWNER SIGNATURE OF CO-OWNER ( IF APPLICABLE) 9_16_&5 DATE SIGNED ni~A DA'T'E SIGNED H ~n Y S T C - 105 r y r; SEPTIC TANK MAINTENANCE AGREEMEN'T' St. Croix County ;y OWNER/BUYER Juliet L. Hoffman ROUTE/BOX NUMBER Rt. 3, Lox 177 Fire Number CITY/STATE Hudson, VJi ZIP 54016 PROPERTY LOCATION: NI ":T 1'4i sect icon F3 1 2,8 N, R 19 W' - - - ' Town of. TrO y St. Croix County, Subdivision_ P"1 A - Lot number \j I 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 umLer. 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 propUr 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. G I/WE, the undersigned, have read the above requirements and agree: to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- ment of Natural Resources. Certification form must be completed and returned to the St. Croix County zoning Office within 30 dayr; of the three year expiration date. SICNED_ zZ, DATE -~-1E-~ ; - - i 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 w r m ' 7D m CO) co 0 pi c y ~w~ m °w :7 W 2. K N a) a A A (D w~, < °<o :ow 3 c cn z c =r0scn ~ CD n ca °o~ o~~' CD S 13 to a 00 w o ID 0*ro°- m''mawA Ej* cQ ry : A E; ¢1 = Er CD n o i d O a)coa) W 0 CD ? _ w c 3 o c . o< c c o. m cn - - 1 3: _ A _ a v ~o C'. Err cn _ co = D j CD w Ci C A CD Ca 17 CD cn o ° D c cD A 0_ A A O A = o 0 w CL C- .m~ 0 - n 7 N C CD °w1v m wwN Z m 0 cn :3 (A cn CD CD D A 3 w w ?.a a D aC vIDi C ° ? :E A m waa ='--°~i~ Q° m ~0 > C > ~J O M Lw~OL m o - CL FA, In 0) ID C m v m a) C = ~O Q CD .S - CD 3 _ w Qw °oo cnpn=Mcii w ' S CCD co 0 ca °30. cQ°cF°% 'n 2)= W CCD C• l a w ci m m o m a cDL CC a 7 U.i C G -w <p 1M j CD I cn CD ° y n CD A C ~ cp :3 l< O N A CD o, ? C C w ° c0 -4 CD CD C a) m ~ =1 O CL ?C Sw A CL C:3 o=r c: 2-cD ° ° +w CD to 3 n ° < ' (D ( Z DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISON, WI 53707 P.O. BOX 76 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: OWNSHIP UNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: I,"~~ ,at 4 4 /T~ N/R ~9E (or, W COUNTY: OWNER'S UYER'S NAME: MAILING ADDRESS: ^ vLt~ 1t~p•`=t'•J L i ` USE DATES OBSERVATIONS MADE NO. BEDRMS.: ICOMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence A ❑ New LS~ Replace I Q 85 RATING: S= Site suitable for system U= Site unsuitable for system CONVEcNTIONAL: MOUND: IN-GROUNDPRES'SIURE:SYSTN-FI~LL HO5LDI~INGTANK:RECOMMENDEDSYSTEM:(optional) t OS FIV ~J ~V I LJd~~ 'X If Percolation Tests are NOT required DESIGN RATE: [~Ilain, portion of the tested area is in the 1~ under s.H63.09(5)(b), indicate: ~ indicate Floodplain elevation: N) - A- PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROU NUMBER DEPTH h8k NDWATER-IPoF~ CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) i r LTS ° o.I I 8 ' ~ n L_ ~ L 1 IIn S I y• 9 ~wte~.z J B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- 2. 38 S 3 Z Z is/!b Z P- 3 q - t4 l/• ly , P- Z cL `'i7•Z' 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. C YY C)' - ('1L.Stpctu.G(.L_y RBc~.GRuyF1 z. _ 3 _ - s z ~ 6-a';C'Q P~ .~fA 3 ' 20 l.5? A I 1 E )mac, ~PtT E E SY - I 41 4 C& ci, tz-- 'ST J_s 3 ZOO ~If TZTH Q>F7}t i CtR~.►tis~ t - pF Tl+~ lLAs V of TjY NE E 30 ejl R~ s 11'7 ~ZIStTgL PI E I ` [ ~°G e ~i' Ah- Tam + SCA Ce j Ir _ S SCC. 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. NAME (print): TESTS WERE COMPLETED ON: R`~)vl~ L, wE~~-~ ~ 9,-/_) - t~s ADDRESS: CERTIFICATION NUMBER: PHONE NUMB ER optional): BukZ'~i~ ~~w~i~-f~-1~~U1 CST SIGNATURE, DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - Tht- use 0", US tst_ ,c..t ~ iU; gIf vt 4c ! 3t,dt CFocn,- 0F } ( a t . r>.=~4, 5,O"}, t % gr t,7, lo:._~. -tig .rte f ~ no~ Q Ss r iis 'v; eS 5,_ ,~r C a4 n ti fIG.. V r W c t y d x a i t . . i P b~ F j-E E n i F2~ ti Y ~ I Lrr ~V I SOIL FILL D!5 I P1BUTIO►,-! - ;.F°FO ~L 54V fn 0 F°AGGREGATE~ ~L ! L PIPS TC B FT L1 0.5 I - i IUC LS 6~ C`. OF.i~1 v at_On t, id1z, _ - I Ca rp-.1 C -tea??}; d u11g- Q sC'i4er r- iuent S,'s1Cii.' E v' ell: a' C a Y. E: ° " i . CGl I. f t p I DE Gai. r r ii P,, ra- - op - b0}:, indi ca -1ng 1 teTi 15 511OC4Z1 O, D1G • ate t a: t ~ _Tk L 4 Pc~. y"C. V£ur~~ _ Ji I r { 1-'-.dip F L4 2~ PVC . PinE ` <F fL7, ~ ! J " i< L J ` p 'op rn. i r_•,y tr)a granting or approving Of the above nian, or up»n the event of a subsequent T- it P°ing ] ssl)ed,st .'^i 01X County and the St.I.I'O-XCounty Zoning Y,d imni nistrat Or, dc,,-`,E Ot assi:me or hold itself 14 able for any defects. in _ plans or sped' ica;-ion , _ _-lion, examination oversight, construction, or any damage that may recu t ?i ^'installation. - - - sae - o, j ~ [ ~ `7