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HomeMy WebLinkAbout042-1087-30-000 o y c"1 o m ~r1 3 0 r. c w H. CD 3 - ~ m CD i " Q 0 r=n O ° 0WD pI ° 3" 3 N N FH CD ?7 ro z( N ccn 7 N C ~p co Oo Oft A C] r 00 n ~ h 7 O O < CO ° p CA) S ` 1\ o W G m e tD 3 m b ~01 cn F*-' 3 N N A O ( b O O d c:T o w ~ o W a N~ < r Q "r m c ~"'t V F..{ _0 3 N CD N E r c n CD c o o 0 O D _ t a = m m W (D p W 41, a CD p p ~ C) r a cn co Wco WN O c U-1 CD (D ET ;z -0 T "a E O O O O !r. 0 ~ c N cu N D d n CD 3 o m ( O O p N 1 3 < y cn p N N J I O j 7 (DD W W 0. 1 n W CD C• z W w 0 z co O d O D a 3 H H d CD (n t7 Z m c O rb c CD CD N. t7 ~ co cD 0- 00 U) a 3 5 rr z CD -i cn :3 Z (D O O .a K b C') a a O o O rt z -i w U W M 1 O d z °o cn z C A W D CL Q ~ o - 3 T SV C z c 0 m A, rl O CJ A n ' a I ~ t ' N N O O R v 0 ti CD A w Efl ~ ti O a Parcel 042-1087-30-000 10/03/2005 09:01 AM PAGE 1 OF 1 Alt. Parcel M 31.29.18.485E 042 - TOWN OF WARREN 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 MATTHEW P & KAREN A BRUMMER O - BRUMMER, MATTHEW P & KAREN A 907 64TH AVE ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): * = Primary 0~ ► b~~ Type Dist # Description * 907 64TH AVE + 7i SC 2422 ST CROIX CENTRAL i 3 z1v SP 1700 WITC Legal Description: Acres: 7.630 Plat: N/A-NOT AVAILABLE SEC 31 T29N R18W 7.63A IN NW SW LOT 1 Block/Condo Bldg: CSM VOL 3/723 ORD Tract(s): (Sec-Twn-Rng 401/4 1601/4) 31-29N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 847/364 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/22/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 7.630 56,500 172,000 228,500 NO Totals for 2005: General Property 7.630 56,500 172,000 228,500 Woodland 0.000 0 0 Totals for 2004: General Property 7.630 56,500 172,000 228,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 124 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 8378 (WI) 800 - 962 - 5227 =T. CROIX COUNTY REPORT DATE* 7/14%85 ;OLtTHOUSE - 7 7 falSON, WI 5401E STN! THOMAS C NEi-SON W. Cin G g: :k - / 2 .GCATION: Rt. 2, Box 120A, Roberts, WT "OLLECTOR: Mary Jenkins - St. Ci-,qix !_ountj C;oltl~csas_U~ -18td f~. ,OURCE OF SWLE. Kiir..h.'._ ':,!-n 7: rzr Pr~vad Labb No. 15' x 4 ~ OF.\NDEDfNOpH P V 01 ei lia E&1 ' HA ie+ec ab i,e ~.r': v:~ 3 aFF1 4v d t~;='. PROFESSIONAL LABORATORY SERVICES SINCE 1952 ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 July 13, 1989 William G. Cook Route 2 Box 120A Roberts, WI 54023 Dear Mr. Cook, An on site investigation of the septic system on your property located at Route 2, Box 120A, Roberts, WI 54016, was conducted on July 12, 1989. At the same time I also obtained a water sample and submitted the sample to the laboratory for testing. The results of that testing will be sent to you after we receive them back from the laboratory. At the time of the inspection, the sanitary system appeared to be functioning properly for the existing use. 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 is totally dependent upon proper maintenance of this system. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, `I- Mary J. a inS Assistant Zoning Administrator MJJ/sa D I(s t Oc~} ~S IJ ► ~ ~7 ~1 `-x--31 ~ft }~.a" cr~ R15 E i 1 ~ltvr'~c k¢~ 'g L. { T } 4 C ct, 4z U", cz~ J V e n C 'F- 5 1 y L4,) ~I Parcel 042-1087-30-000 12i28i2005 11:03 AM PAGE 1 OF 1 Alt. Parcel 31.29.18.485E 042 - TOWN OF WARREN 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 - BRUMMER, MATTHEW P & KAREN A MATTHEW P & KAREN A BRUMMER 907 64TH AVE ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 907 64TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 7.630 Pla : N/A-NOT AVAILABLE SEC 31 T29N R18W 7.63A IN NW SW LOT 1 BI ck/Condo Bldg: CSM VOL 3/723 ORD Tract(s): (Sec-Twn-Rng 401/4 1601/4) 31-29N-18W Notes: Parcel History: Date Doc # Vol/Pag Type 07/23/1997 847/364 2005 SUMMARY Bill Fair Market Value: Assessed with: 79703 282,900 Valuations: Last Changed: 10/22/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 7.630 56,500 172,000 228,500 NO Totals for 2005: General Property 7.630 56,500 172,000 228,500 Woodland 0.000 0 0 Totals for 2004: General Property 7.630 56,500 172,000 228,5000 Woodland 0.000 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 124 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 15.00 Special Assessments Special Charges Delinquent Charges 00 Total 15.00 0.00 Parcel 042-1087-40-000 12/28/2005 11:03 AM PAGE 1 OF 1 Alt. Parcel 31.29.18.485F 042 - TOWN OF WARREN 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 - LAKOSKY, LINDA M LINDA M LAKOSKY 626 91 ST ST HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 626 91 ST ST SC 2422 ST CROIX CENTRAL SP 1700 WITC ~A r Legal Description: Acres: 3.332 lat: N/A-NOT AVAILABLE SEC 31 T29N R18W 3.332A IN W 1/2 SW1/4 Block/Condo Bldg: LOT 1 CSM 6/1553 FORMERLY KNOWN AS PART T 2 CSM 3/723 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 31-29N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1123/439 QC 07/23/1997 795/397 07/23/1997 786/79 2005 SUMMARY Bill Fair Market Value: Assessed with: 79704 236,700 Valuations: Last Changed: 07/14/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.332 43,400 147,800 191,200 NO Totals for 2005: General Property 3.332 43,400 147,800 191,200 Woodland 0.000 0 0 Totals for 2004: General Property 3.332 43,400 147,800 191,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 105 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 15.00 Special Assessments Special Charges Delinquent Charges Total 15.00 0.00 0.00 AS BUILT SANITARY SYSTEM REPORT R OWNER Ol TOWNSHIP 461a Vr« SEC. T_N-R__W ADDRESS y` S1'. CROIX COUNTY, WISCONSIN. SUBDIVISION LOT _ LOT SIZE _ PLAN VIEW Distances and dimensions to meet requirements of H63 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM CCr G 'V A 'W a r/6 5 4/ X-1 5-T3 17 4s rd ' 3 B y e 7 rr f h re 44~' vej A Indicate N r h rrc w BENCHMARK (Perm vent r erence Point) Descr'be: S~ea~ Sf<~e dZ~ G l X470 1i !w wi t 1X44• Elevation of vertical reference point: rp it Slope at site: ~b SEPTIC TANK: Manufacturer: 44lee 10~S Liquid Capacity: me Number of rings on cover Tank manhole cover elevation:/ 's'ue Tank Inlet Elevation: 'l'ank Outlet Elevation: /,+•,t PUMP CHAMBER U" Manufacturer: Number of gallons Number of gal. pump set for a cycle gallons; Total capacity of distribution lines gallon: size of pump head; gallon per minute horsepower ;brand name of pump and model number ; Type of warning device_ HOLDING TANK: Manufacturer 1V14 Number of gallons Elevation of manhole cover- Type of warning device SEEPAGE PIT SIZE;-/V ¢ _ Number of pits feet diameter feet liquid depth___ seepage pit inlet pipe-elevation bottom of seepage pit elevation feet. SEEPAGE BED SIZE: number of lines__3_ width length..74,/ tile depth p~ y 8 EEPAGE TRENCH: width Iength_ PERCOLATI'JN RATE AREA REQUIRED~~ AREA AS BUILT INSPECTOR - llA'1'Ell PLUMBER ON JOB___) lso~A LICENSE NUMBER .Z~ DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING. LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 796 BUREAU OF PLUMBING MADISON, WI 53707 XXCONVENTIONAL ❑ALTERNATIVE State Plan l)D.Numbec L1 Holding Tank ❑ In-Ground Pressure ❑ Mound L, assigned NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Bill Cook 811 Orange, Hudson, WI X~ '14140 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.. NW SW, Section 31, T29N-R18W, Town of Warren Name of Plumber. MP/MPRSW No. County. Sanitary Permit Number: David B. Fogerty 3561 St. Croix 38485 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. =INLE V T ANK OUTLET ELEV WARNING LABEL LOCKING COVER I / PROVIDED PROVIDED !Q~- O/ -]YES ❑NO ❑YES ❑NO UMBER OF ROAD: PROPERTY WELL. BUILDING. VENT TO FRESH BEDDING: VENT DI A.. VENT MATL. HIGH MAT [NEAREST=77::!d ALARM EET FROM AIR ❑YES NO - S ❑NO ' DOSING C AMBER: MANUFACTURER. BEDDING. 11-11111ID CAPACEANDCONTROLS EL PAN FA IRER. WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: OPERA oNA UMBER OF PROPERTY WE LL BUILDINGI VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM NF AIR INLET PUMP ON AND OFF) ❑N NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LFN(,TH 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 WIDTH LENGTH NO OF DISTR PIP SPACING C R INSIDE f)IA -PITS LIQUID 1 7 ~j TRENS: MA RI,AL: PIT DEPTH. DIMENSIONS /l G GRAVEL DE TIi FILL DEPTH UISTR PIPE DISTR. PIPE_- DISTR. PIPE 17ATERIAL / o rR. NUMBER OF PROPERTY ELL BUILDING. PVETT FRESH IN T BELOW PIP ABO covER ELEVINLET ELE _9' PIFEET FROM LF 'Aq / NEAREST i 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 sa TIONS MEASURED. ❑YES ❑NO SOIL COVER TEXTURE ERMA ENT MARKERS OBSERVATION WELLS YE NO ❑YES ❑NO IDEPTH OVER TRENCH BED DEPTH OVER TRENCH BID T=~ D D SE ED MULCHED CENTER EDGES ❑Y S NO ❑YE ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH __~LENGTH NO. OF LATERAL SPACIN'. AVEL /DT FI LL DEPTH ABOVE COVER BED/TRENCH rRENCH ES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE f, MANIFOLD AT IAL NO. D TR DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV.'. ELEV.'. DIA. ELEV.'. PIPE DIA.: 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. BUILDING. FEET FROM LI"E. ❑YES ❑NO ❑YES ❑I\ NEAREST Sketch System on Retain in c t file for audit. Reverse Side. SIGNATURE. ITLE Ile DILHR SBD 6710 IR. 01/82) DEPARTMENT OF APPLICATION INDUSTRY, FOR SANITARY SAFETY & BUILDINGS DIVISION LABOR AND' PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8'/2 x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be included. Property Owner: Mailing Address: -aP Fi( Property Location: City, Village or To ship: County: A W '/4 `l '/4S-T/ /T.Z f NCR E (or 4/ - _9 e' Lot Number: Blk No.: Subdivision Name: ip,~PA 4YI-A~_s Nearest Road, Lake or Landmark: State Plan I.D. Number: f (If assigned) TYPE OF BUILDING Number of El Public* ❑ Variance* ❑ Other (specify)* Bedrooms: V, or 2 Family *State Approval Required. TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: 46i. 'E EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): New ❑ Replacement ❑ Experimental LS Seepage Bed ❑ Seepage Pit ❑ Alternative (specify) ❑ Seepage Trench 3 WatterrSS `pply: Owner's Name as Listed on Soil Test Report (If other than present owner): Ltd Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber: ^ ign MP/MPRSW No.: Phone Number: _!C37-6 1 1 )-,/Plumber's Address: Name of Desig COUNTY/DEPARTMENT USE ONLY Signat re of Issuing A ent: Fee: © 02) Date: APPROVED Sanitary Permit Number: 1 ❑ DISAPPROVED Reason for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber DILHR-SBD-6398 (R.07/81) I out et C' Form - '1' C 1 00 of S IT to co , or_ ce.. Owner of Property COyni1 ~ .Location of Property jQ Z Section3(-~`~-LET lY N R t~'; W Township Mailing Address rte, ; r cr yC' J Lf C-) Subdivision Name Lot Number Previous Owner of Property i~~) f`\g V'. j:Lc~~ a V' Total Size of Parcel _ ( ; r< C-r ;,r < Date Parcel Was Created Are all corners identifiable? Yes No Include with this application one of the following: l'Certified Survey Map ft r _ o Deed .Land Contract, or .Other I:egal Document which describes the property PROPERTY OWNER CERTIFICATION I (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 recorded in the Office of the County Register of Deeds as Document No. E ; and that I (we) presently own the proposed site for the sewage disposal system (or I (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. 31 SIGNATURE OF OWNER SIGNATURE OF CO-0W ER (IF APPLICABLE) rl DATE SIGNED DATE SIGNED LL.i&l J. RAD0SEVICH A ET{ RNEY AU • S?'Ord 5!i...Pl • Nu1',un, :'hscnnc,•: .`i4J77 • 111$ .t;U_r,~;..: - STA i EMIEN October o, 1981 N'r. Q,-4 Mrs. William G. Cook c/o Currell Realty 300 Second Street Vidson, Wisconsin 54075 Examioataon of Abstract of line N ether 15,544 of tna St. Croix County Abstract Company, v'ritten Title Opinion thereto. Legal fees $ 60.00 y Telephones: Offices At: E,32 Secund Streit Hudson, Wiscons;n 1-4016 715-386-5583 Hudson h' L Wetro no toll) 612-436-74136 Hudson 145 Mill Sireei 715-247.3392 - Somerset Somerset, u,,scunsin nzv:5 SIT I. 71,5-263-3123 Cibor Lake r^4t Third With Vision to See And Courage to Do Code KK-69 r I Lots of acreage at a reasonable price! f 7.56 acres fo $13,900! 4 * 7.63 Land contract terms available. Suitable for conventional or earth-sheltered horm. I I Located approi.iz:lately 6 rules ~ East of Hudson on Comty Road N. (Section 31 of Warren uAn- ship) 1. C I ~ia~f i'' Tho 5 f" S r_ /i Fj J_j ' ~ ~ f ~ .rrryJ U ~ ,P. do { T,T I 94 lr { _ R / ,J'~n> > f•.,~ ~ , 72'rrzrr"_FTr.~ rr-- ~ n L r~9 SLE PAC, r~ounty Road N _t. .t 1 k HOGFR HFTCHLER KAPROLL L. CRAiC 1hfYNE K,4CZWA.RSrl (715) 3Ku 197 (716) 395-x624 1715) 263 2` ` t•:AP,OLD WHRMORE ALICE DUVAL GENE WKLIAN ~ r.~.e+ (e12) 4b5 1IQ (715) 247-5249 JOANNE tlELSOr; R'tdL10R j FREr) W. KOTTKE CHARLES WHEELER I ~ ti C71b1 3kt4-7<,j5 (715) 245-3 ()lE+i 771~`::J L;` EH 115 Rev. 9/78 REPORT • ON SOIL BORIINGS D PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 ~I VFrt r,, ~cT a (J ~QL ION,'Nf 193 1 LOCATION'/4~ Y4, Section.2rL,T~N,RA?_Q (or)(VTownship or Municipality Lot No. , Block No. County S11, C~ off Subdivision Name a Owner's%BuyersName : Mailing Address: r,441 'e- A1k4Q(.e10Ac0 4L) s, Q/ TYPE OF OCCUPANCY: Residence No. of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW- REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS 7 ,A I--P PERCOLATION TESTS fnA 9& 1.4 SOIL MAP SHEET (G? 7 NAME OF SOIL MAP UNIT SA C a ~~-rA."A/ " ~"Z _ PERCOLATION TESTS ~ TEST i HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES NUM- DES CHARACTER SOIL SINCE HOLE HOLE AFTE INTERVAL RATE MIN; IN BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P-- e Y Ala -3 P-„Z 10 « /a,K is /e„ G SZO 1/0 3 6 6 P- S it See &&-e- Ala -3 P- P- P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- / 411 e 7 ,r a,~ w S4 r 10-S B- L de. -4 AA%d B /O" . / 14- B- y /1&Ke- 7 K K/ k SIC B- PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy CZVT"'.Indicate scale or distances. Give horizontal and vertical reference points. Indicate slo~e.1 S~;'t ~.~o S,~2. - !/'sT q.rt ce.r /~.S ..~ir ~ ~•y~~r~ Bores ~ ~ ~ ? I ~ vex E 3 F.t cA,,L g~ l c, eds O -Per" ` . ~ A4 _._4 1A Am. F-4. = /00 ` 22-0 A, &A (l$'.4 Yd' eha RC. = /°©•S' N E Sl~~r:~.#<y ~o N1arr~~~c +~~-~F.~co / /{e~.~+a 8~"' = ~ ' ! ~ _ 6Z, 77 Q A J ` v 03 SO Sled 5 *he- J; CAA` UrivA-60 I, the undersigend, 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 location of test holes are correct to the best of my knowledge and belief. c Name (print) 4-1p fia". ° • Certification o. d g d _ Address t- Name of installer if known CST Signatu re mss.. Y_4-1a40 Copy A - Local Autho -~a 03 = 1- i 4~ - r y i ~ s s a a i fz> O ~j cn Ili 1~ N t