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1984 c 104
.--1 IDN/ G
Uff/[f t AS BUILT SANITARY SYSTEM REPORT It /I TOWNSHIP SaM e r S, f SEC. 9 T N-R W
ADDRESS 1 ST. CROIX COUNTY, WISCONSIN
[6 h/1 OJ U
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of H 63
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
4) ro p Osa J We A 4 r <=c-A-
I~
~rez 5 4 k~ Me r
j by
C~'- / V
~3 M /W. v
INDICATE NORTH ARROW
bid
BENCHMARK: Describe the ver--ical reference point used
Elevation of vertical reference point: Proposed slope at site:
D
SEPTIC TANK: Manufacturer: Liquid Capacity:
Number of rings used: Tank manhole cover elevation: -
Tank Inlet Elevation: Tank Outlet Elevation: 7
Number of feet from nearest Road: Front, Side, Rear, -0o feet
From nearest property line Front, 0Side ,(~,,)'Rear,o feet
Number of feet from: well / building: ~t%d~p uS e-
(Include this information of the above plot plan)( 2 reference dimensions to septic tank)
SEE NFVCRSI? _ I hl'
t ,
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. T
Number of feet from well:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM
Bed: Trench:
c9~
Width: Length:_ n-~5-0 Number of Lines: Area Built: Fill depth to top of pipe: '
Number of feet from nearest property line: Front, O Side, Rear, O Ft
,P
Number of feet from well:
i
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 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:
( ~ Rear, O Ft.
Number of feet f,,)m nearest: property line: Front, O Side,
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Nanufacturer:
Inspector:. LyelsoA--
Dated: Plumber on job: Ile e- 0t;"-
License Number:
3/84:mj
•CNMERCIAL TESTING LABORATORY, INC.
514 Whin Street, P.O. Box 526 I
Colfax, Wisconsin 54730
715-962-3121
800 - 962 - 5227
a CROIX COUNTY REPORT DATE** 5/18/9;: i
WRTNOUSE
I
VZ~l Z
CATIOM 467-222 ve., )Somerev
'ELECTOR! M. Jenkins
TE COLLECTED: 5-12-92
AE COLLECTED: 2.00pm
JRCE OF SAWLE: Outside faucet
;'E ANALYZED:5-14-92
1E ANALYZED'+2.00pm
LIFORM: 0 /10("
'TERPRETATION2 Ractei
5 pp
e Vi
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Ys9oOFA ADEPENO
Z.` ~m r3Fl+Y :t1+~~} ,
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o PROFESSIONAL LABORATORY SERVICES SINCE 1952
ST. CROIX COUNTY ZONING OFFICE
St. Croix County Courthouse
911 4th Street
Hudson, WI 54016
Telephone - (715)386-4680
The St. Croix County Zoning Office offers the service of septic:
and water inspections to Lending Institutions, Realty Firms, and
private individuals.
completion of this form ja essential a2 that tbjq property can 12~?_
located.
Please provide the following information, enclose appropriate
fee made payable to St. Croix County Zoning Office, and mail,,
along with form to the above addrYss. Tasting will be done as
soon as possible after fee and form are received.
WATER TESTING----------------------------FEE: $ 35.00 XXX _
(For nitrates and coliform bacteria)
WATER TESTING FEE: $185.00 _
(For VOC'S)
SEPTIC SYSTEM INSPECTION-----------------FEE:, $25.00 XXX _
(Determines if system is properly functioning at.,time of
inspection)
PROPERTY OWNER'S NAME : Kenneth E. Kimberly
PROP. ADDRESS:- 467 - 222nd Avenue, CITY Somerset,
Legal Description sW 1/4 of the SE 1/4 of Section 9 , T 3=L_N-R 19
Town of Lot Number Subdivision:
FIRE NUMBER 467 LOCK BOX NU74BER L~ Z ~ li L ' r,✓/
Color of house Realty sign by house? If so, list firm:
PLEASE INCLUDE, IF AT ALL POSSIBLE, A XAP j.e,COPY OF PLAT BOOK„
WITH LOCATION SHOWN, AND A COPY OFoTHE LISTING SHEET.
Testing of residential water requires a sample that is fresh. If
the home is vacant, and has been soTfcr some time, the water line
must be purged by running the water for several hours before the
test can be conducted.
WINTER TESTING: Many times water lines are turned off, or sill
cocks are turned off, making access to the home necessary. If
this is the case, please make proper arrangements with this
office to ensure time when entry may be gained.
Firm or individual requesting services: Bank of Somerset -
Telephone Number (715) 247-3348 -
REPORT TO BE SENT TO: Bank of Somerset, ATTN: Kristen Dixon, P.O. Box 220, _
110 Spring Street, Somerset, WI 54025 _
CLOSING DATE: 5-15792
Signature Ot t 4. Z7 -
ST. CROIX COUNT`h(
k
WISCONSIN
ZONING OFFICE
ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON, WI 54016
(715) 386-4680
May 12, 1992
Kristen Dixon
Bank of Somerset
110 Spring St.
Somerset, WI 54025
Dear Ms. Dixon:
An inspection of the septic system on the property of Kenneth
Kimberly, located at 467 - 222nd Ave., Somerset, WI was conducted
on May 12, 1992. At the same time a water sample was obtained for
testing. The results of that testing will be sent to you as soon
as we receive them back from the laboratory.
At the time of inspection, the sanitary system appeared to be
functioning properly. The inspection of this sewage disposal
system was based upon a surface inspection of said system, and did
not involve any excavating or chemical analysis. Accordingly,
there is the possibility of hidden defects in the system not
discoverable by this inspection. This does not in any way warrant
or guarantee the continued proper functioning or operation of this
system. It is recommended that the system should be pumped once
every three years. Therefore, the prolonged life of this system
may be dependent upon proper maintenance of the system.
Sincerely,
3
u
A 1W
Mar J . J,6iikins
Assistant Zoning Administrator
cj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 53707
CONVENTIONAL ❑ALTERNATIVE State Plan l.D. Number
(
El Holding Tank El In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER. INSPECTION DATE.
Kenneth KimbeAiy R. R. 1, Hammond, W1 3.11304-:00
BENCH MARK (Permanent reference pond DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF. PT ELEV.
SW SE, Section 9, T31N-R19W, Town o6 Somenaet
Name of Plumber. MP/MPRSW N,, County Sanitary Permit Number.
Bennie Hetgaon 3215 St. Cttoix 49497
SEPTIC TANK/HOLDING TANK:
MANUFACTURER LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOC NG
P O DED PRO td) O YES ❑NO
p O
N
BEDDING: VENT iA.. VENT MATL.. IHIGH WATER NUMBER OF RO PROPERTY WJBU
ILDI GAVIER N ITNLTOETFRESH
ALARM FEET FRIJMLINE❑YES NO ❑YES ❑REST DOSING CHAMBER:
MANUFACTURER 7INGS LIQUID CdPITV PMP MODEL UMP/SI ON MAN FA'T fR WARING LABEL LOCKING C ER
PROVDEDPROVIDE
E❑ ❑YES ❑Y NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NU BER OF PROPERTY WELL BUILDI ENT TO FRESH
(DIFFERENCE BETWEEN FE FROM NE AIR"LET
PUMP ON AND OFF) ❑YES ❑N N Al REST
SOIL ABSORPTION SYSTEM. heck esoil oistureatthedepth ofplowing ILI I;TEI DIAMETER IMAJTERIA AND (/ING
or excavation. (If soil can be (led into a wi e, construction shall cease until I'ORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
WI
T LE
BED/TRENCH D NGTH No. of DISTR PIPE SPACING. COVER INSIDE DIA. tt PITS LIQUID
THE, ES M N IAL DEPTH
DIMENSIONS PIT
GRAVEL DEPTH FILL PTH DIS i PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTR NUMBER OF PROPERTY WELL BUILDIJ?G. VENT TO FRESH
BELOW PIPE ABOV OVER. E E INLE F ELEV. END '7 4 PIPES(' FEET FROM 1 LINE AIR INLET.
l y,1.C ~yJ C I 1 (Z ! NEAREST-----m-1 MOUND SYSTEM: 7~, _
Mound site plowed erpendicular to slope Check the texture of the fill material for PROVIDE A DI RAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVER DE. SHOW ELEVA-
meets the criteria for medium san T10NS AS RED.
❑YES ❑NO
SOIL COVER TEXTURE PERM ENT MARKERS SERVATION WELLS
_ ❑YES NO /❑YES ❑NO
DEPTH OVER TRENCH TEED DEPTH OVER THE
NCH BED DEPTH OF TOPSOIL 'ODDED SE ED MULCHED
C ENTER EDGES
❑Y S ❑NO ❑YE ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM: / III
WIDTH. LENGTH. NO. OF LATERAL A G. GRAVEL DE TH BELOW PIPE. FILL DEPTH ABOVE COVER.
BED/TRENCH TRENCHES.
DIMENSIONS
MANIFOLD PUMP MANIFOLD DIS EVE MANIFOLD ATERIAL. O. DISTR. DISTR IPE DISTRIBUTION PIPE MATERIA_ & MARKING
ELEVATION AND F LE V. ELEV. DIA. EL V.' IPES DIA:
DISTRIBU710N
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRE TL COVE MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS
❑Y ❑NO ❑YES ❑NO
COMMENTS: PERMANENT MARKERS: OBSERVATIO LLS: NUMBER OF PROPERTY WELL: BUILDING.
p FEET FROM LINE.
~f 1 1 ❑YES ❑ O ❑Y'ES ❑NO NEAREST
LC~
Sketch System on ( ;~etain in county file for au It.
Reverse Side. /
-FE
DILHR SBD 6710 (R. 01/82)
wlsconsln APPLICATION FOR ;SANITARY PERMIT
0~+- ,~,f,~__COUNTY
~DILHR (PLB 67) "
oEVRATmenTOF UNIFORM SANITARY PERMIT #
InDUSTRY, LABOR 6 HUMRn RELRTIOnS
Y& !z
-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
PROPERTY OWNER MAILING ADDRESS o C r V~~_~LlVh4 /YJ rl ~7 rA 6&
PROPERTY LOCATION CITE
L AGE:
1,1) 114 1/4, S VI
, T,/ , N, R / -L jQr) VV TOWN 1 0 -e rs
LOT NUMBER BLOCK UMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
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 Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
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):
-teA, t Wd l, i el
~y
/Cp5 0~ ~o0 Z7 XI Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Namge~of Plumber (Print) Signature: MP/MPRSW No.: Phone Number:
Plumber's Address: Name of esigner:
COUNTII'/DEPARTME=NT USE ONLY
Signature of Issuing Agent: Fee: Date: _ ❑ Disapproved
r-
J P L l Owner Given Initial
4Approved 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.
T Ali
APPLICATION FOR SANITARY PERMIT
STC - :100 e
e fi
This application form is to be completed in full and signed by the owner(s) of the 7
property being developed. Any inadequacies will only result in delays of the
peri
issuance. Should this development be intended for resale by owner/contract0=,("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.
- - - - - - - - - - - - - - - - - -
uwr. e r u f
Property
Location of Property -~Iwly, section, T N- R W
Township
Ma I I ing Address ,s/ / ✓
C ~i
:_;ubdiv i:,ion Name
;,ot Number
orcvioub (Amer of Property z~-~~-~~~Ol"i
~ `.i i z 4 U t tea, P'4,1,-(-`A was Created ter: /f 7"
Art~• aii corners acid lot lines identifiable? yes N,
Is this property being developed for resale (spec house) ? Yes L-- Nu
Voluu~c ' and Page Number s as recorded with the R~bister crt omit--pis
INCLUDE WITH THIS APPLICATION ONE OF THE Fof,IAWING.
i, WarrattCy Deck;
2. Land Coz,truct
3. Other recording., tiled With ttte itegi,iter of Leeds Office
In addition, a certified survey, if available, would be helpful so as zo avoid delays
of the reviewing process. If the deed description references to a C,+rtifil(2. Slu,vey
Map, the the Certified Survey Map shall also be required.
PROPERTY OWNER CUTIFICATIl
I ((fie) eenti% y tJLat a.et statements on this 6onm sae tAue to tice Ill ob Illy ;nun;
rznowr,edge; that I (we) am (cute) the ownerls) o6 .the pn.openty de,acAi,bed in -this
i.n6o4mation 6o4m, by v-uctu.e o6 a warranty deed recorded in the 066iee o6 the
1'ounty Reg-i.b'ten o6 Deeds as Document No.p,,! and that I (we)
pn.eseni awn the proposed site. bon the sewage pos system (on I (we) have
obtained an tgsement, to nun with the above deac4ibed pn.opehty, bon the
eonst4uc Lion o6 said system, and the same had been duty teco tded in the 0 6 6ice
o6 the County Reg.iateA o6 Deeds, as Document No. )
. ,...Z,44 7
SIGNATURN Of OWNEi
DA SIl DAI'rs b1iv; Ey
t,
VNI
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S T C - 105 r
• y
ti
SEPTIC TANK MAINTENANCE AGREEMENT o
St. Croix County z
_ d
OWNER/BUYER
ROUTE/ BOX NUMBER~~py~~ Number
CITY / S `T' A `I' E7~~
PROPER'T'Y LOCATION: S(,U %a, Section I_3~ N, R--~~
Town of~Q-nlew $to 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 SuIlLiC tank Rump r. 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 ma_xim_um 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 Cho requirement that
owners of a_1_1_ new __ystems agree to keep their systems properly
Iilailltained.
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 scam.
Certification form will oe sent approximately 30 days prior to
three year expiration. H
E
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- w
ment of Natural. Resources. Certification form must be completed
and returned to the St. Croix County Zoning Office within 30 days
of the three your expiration date.
SIGNED
A?e
DATE St. C uix County Zoning Oft ice ~
P.O. iox 96
Uammo id, WI 54015
7 15 - 7) 6 -112 3 9 or 715-425-8363
Sign, date and return to above address.
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY DIVISION
LABOR AND PERCOLATION 'TESTS (115) MADISON W 7969
HUMAN RELATIONS
(1463.090) & Chapter 145.045)
LOCATION: SECTION: f W TOWNSHIP/M4,, +64RA1~:FW. LOT NO.:BLK. NO.: SUBDIVISION NAME:
W '/564 j~ NjR/ ~Gpr) n n. k" e
COUNTY: O ER'S/B ELR/~W,4P/IE: MAILI ADUHLSS:
,Stcklox I ~l r e / 7'a .rv s~ ~ 0.
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS:
Residence New ❑ Re lace
l i/ 1 p C~ Ia
RATING: S= Site suitable for system U= Site unsuitable for system 41 .C r~ %-e
/
CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FI LHOLDING TANK: RECOMMENDED SYSTEM:(optional)
~S [:]U KS ❑U ®S ❑U ❑S ®U IS20 C6 UeH a SaG
If Percolation Tests are NOT required DESIGN RATE: I If an
L y portion of the tested area is in the
under s.H63.09(5)(b), indicate:/¢s Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
b/ 1 S s, y 0 45S 3.3 ' n ~h S
Bj 16.C) ' >6 `
16.61 B- d
B-3 p' << > ll~,0/ I$i L, r5 PIS-' n 4-5 3j' n A4,5.
> 4 rs -2.5 -A, 45 44 4/ 6?, IAJ
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 PERIOD3 PERINCH
P-
P- Q,
P-
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. Upp{,- '77-en-4 00
SYSTEM ELEVATION ncly~~F
3
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- - - - - - - - - -
A
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is
. Qibd / C~/4cn+rarf SpI Ke A'~~r tpib6o~~ ~c5cc~ Iorn
J 1 / / ~jv rea- f n ®a k 1r c~
1, 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 (pant): TESTS WERE COMPLETED ON:
C' o-C A~es-o,? o? e(-
ADDRESS: I CERTIFI ATION rAJMBER: PHONE NUMBER(optional):
1209
CST SIGNATURE:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R 021182) -OVER
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