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HomeMy WebLinkAbout040-1019-95-000 0040 E-u n o C7 LOP) v m 1 o A C • o m o oD o o Cl) _ m co 0 0 co w Q Z d ro w J p NO ~ CO CD CL N rti N m N o p OJ > io O °p c n 2 o p A~ cn 3 (D III O 7 N O N N N U y (D CD Us D a ~ m (n m N o, v N W N _0 (D 0 C cc CC) < r cn (n ch T a) -0 O n (n (n fn m v cr O p 0 cn O :(J CD m N N C7t R. 7 po (Q (1D = (O Q m D) N C N 3 d -;l 7 m d O OJ N Z O N Z Z c O v O D C-T Q N o CD m O O N W D (o d Q O O Z (D p N O O l0 A 2 CD Z O v o ~ o. 0 m N A W m a , tv Z 3 U) o m O co N CD I ~ w v n m N O_ O_ N O D ID ID 21- 0 CD o d N ? S N N N O O m d N ~ ~ TI O ZJ m `G p N C ' 7 ID m 0 O. ID Z (D c o m o o m 0 C, N j CD < OC O m I, (C X E;z C o m 80 C: -u 0 U) 5- m ~TJ S Oo .o~~ a CD -0 c) -omv~ N ~ N N ti O O m o O V C) :3 N v ti O S O ~ O 7c ~ 7-O O C p a O (O ~ A S ~ w b A A m 0'p b O O ~ N p C s Parcel 040-1019-95-000 12/14/2005 05:01 PM PAGE 1 OF 1 Alt. Parcel 04.28.19.64D 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 - HAUSER, GREGORY A GREGORY A HAUSER - 1328 BUSH AVE ST PAUL MN 55106 Districts: SC = School SP = Special Property Address(es): Primary \a !1 Type Dist # Description * 525 MARSON DR SC 2611 SCH D OF HUDSON SP 1700 WITC Y" Le - - 0.640 Plat: N/A-NOT AVAILABLE ' SEC 9W PT E 1/2 SE 1/4 COM 266 Block/Condo Bldg: 1 6 -FT j EOF WLNOF S OF S LN E & W TN RD, TH S 140 FT, E Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 200 FT N 140 FT, TH W TO POB INC 04-28N-19W~ 040-1020-50-002(64K)~~ Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 07/23/1997 (:803/559 07/23/1997 779/568 2005 SUMMARY Bill Fair Market Value: Assessed with: 102161 183,500 Valuations: Last Changed: 07/15/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.600 36,000 ( 140,600 176,600 NO Totals for 2005: ` General Property 0.600 36,000 140,600 176,600 Woodland 0.000 0 0 Totals for 2004: General Property 0.600 36,000 140,600 176,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Cs 1 -3?v7/ C S Cow IN jLwjN^ U ,i2 Nr MERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 C:!: a CROIX WUNTY REPORT UAT£t 10/03/91 COURTHOUSE DATE RECEIVED: 10/02/91 -10SON, WI 54016 1 julNERS Reuben Irene Fischer 7 D LOCATION: S25 Marson Dr.. Hudson COLLECTORS M. Jeth,ins JF S, INTERPRETATIONS Bacteriologically SAFE NITRATE-NS 9 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. 4oLiform Bacteria/100 aL Nitrate-Nitrogen, mg/L t. { IC k LAB TECHNICIANS Pam Gane WI Approved Lab No. 19 OF.\NDEVFNp f,Y O A =5 A Meares "LESS THAN" Detectable Level Approved by', o PROFESSIONAL LABORATORY SERVICES SINCE 1952 1 LA Ct ST ~ . CROIX COUNTY ZONING OFFICE v~ J 911 4th Street Hudson, WI 54016 Telephone - (715)386-4680 v The St. Croix Co. Zoning office offers the service of septic and water inspection to Lending Institution, Realty Firms, and private individuals. COMPLETION OF THIS FORM IS ESSENTIAL SO THAT THE PROPERTY CAN BE LOCATED. Please provide the following information, enclose appropriate fee made payable to ST. CROIX CO. ZONING, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING FEE:$ 25.00 y (For nitrates and coliform bacteria) WATER TESTING FEE:$175.00 (VOC'S) SEPTIC SYSTEM INSPECTION FEE:$ 25.00 PROPERTY OWNERS NAME Z, PROPERTY OWNERS ADDRESS CITY: Legal Description ~jC 1/4, 1/4, Sec., T N-R /i W, Town of Lot, No. v ,S bdivision FIRE NO. LOCK BOX NO. Color of houseT_` , 4t Realty sign?_'i .,,,,,Firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP, i.e., COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for 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 re sq, uest/ ing services._, : Telephone No. REPORT TO BE SENT TO: 64 Cz CLOSING DAVE : f+i Signature: i ST. CROIX COUNTY WISCONSIN ZONING OFFICE ~3isX ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 i Oct. 2, 1991 Reuben Fischer 525 Marson Dr. Hudson, WI 54016 Dear Mr. Fischer: An inspection of the septic system on the property of Reuben Fischer, located at 525 Marson Dr., Hudson, WI, was conducted on Oct. 1, 1991. 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. sinc rely, Mar ~enkinls Assistant Zoning Administrator cj Parcel 040-1019-95-000 11/03/2004 10:35 AM PAGE 1 OF 1 Alt. Parcel 04.28.19.64D 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 * GREGORY HAUSER, GREGORY A / A HAUSER 1328 BUSH AVE ST PAUL MN 55106 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 525 MARSON DR SC 2611 SCH D OF HUDSON SP 1700 W ITC Legal Description: Acres: 0.640 Plat: N/A-NOT AVAILABLE SEC 4 T28N R19W PT E 1/2 SE 1/4 COM 266 Block/Condo Bldg: FT E OF W LN OF E 1/2 SE 1/4 & 930.66 FT S OF S LN E & W TN RD, TH S 140 FT, E Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) TN-1A -Fq-,aHW TO POB INC 04-28N-19W 040-1020-50-002 (64 K) Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 919/541 07/23/1997 803/559 07/23/1997 779/568 2004 SUMMARY Bill Fair Market Value: Assessed with: 180,800 Valuations: Last Changed: 07/15/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.600 36,000 140,600 176,600 NO Totals for 2004: General Property 0.600 36,000 140,600 176,600 Woodland 0.000 0 0 Totals for 2003: General Property 0.600 44,000 130,000 174,000 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 Parcel 040-1020-50-002 11/03/2004 10:32 AM PAGE 1 OF 1 Alt. Parcel 04.28.19.64K 040 - TOWN OF TROY ST. CROIX COUNTY, WISCONSIN Current X Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): * = Current Owner HAUSER, GREGORY A GREGORY A HAUSER 1328 BUSH AVE ST PAUL MN 55106 Districts: SC = School SP = Special s es : Primary Property Type Dist # Description SC 2611 SCH D OF HUDSON SP 1700 WITC ~ (✓v~ ~~3 ~'la~-gin Legal Description: Acres: 1.819 Plat: N/A-NOT AVAILABLE SEC 4 T28N R19W_SE= SE 1.819A LOT-11-0 Block/Condo Bldg: CSM 5/1458 ASV'D W/040-1019-95(64D) Tract(s): (Sec-Twn-Rng 401/4 1601/4) a,(/J 04-28N-19W Notes: Q V J" Q Parcel History: Date Doc # Vol/Page Type 07/23/1997 919/541 07/23/1997 803/559 07/23/1997 698/168 2004 SUMMARY Bill M Fair Market Value: Assessed with: o Valuations: ms`s' Last Changed: 10/23/1995 Description Class Acres --wand __--Irhiprove Total State Reason Totals for 2004: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2003: 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 Computer 040-1019-95-000 Parcel 04.28.19.64D Municipality: Troy Township Address: 525 Marson Drive Hudson, WI 54016 1110312004 Hauser, Gregory Pam Quinn Owns both lot 1 of CSM 5/1458 and this parcel to the north. Original address assigned lot 1 was 523 Marson, but there are no improvements listed on it. i a E I/4 COR. 414.96' 426.50' SEC. 4 \ ~2C 61C OD 61A 61A10 $ , 61 G S n p M tt LOT I LOT 2 C. S. M. VOL. 8 PAGE 2213 62D - - - - 6.1 D _ - % 302.01' 3 250.03' 4 160.48 7 ?AGE I_I43_ v'-41=-7 11 = Y 8431 8 44 84 5a m 846 •61 F I M g N N I N N ti LOT 2 842 _ EIGH_ T It 62 J - - - - 182.2x' / / - 200 140.85' 6 22964' N 61 B 2 356.82 305.00' N f /4 SE l/4 - 61J o m 841 ( Q LOT N I I 611 61 M 61 E C. S. M. v_. 6, eQ 1628 200' y U 277' 77.40 840 B LOT I _ 61 H R' 840 61 K .61 L I . 200' , - - f I 2 74.44 539 d I 6 4 D C. M. \ ' Jam, i VO .5, PG. 1458 LOT 2 59971s5~ l 199.66 LOT -2 \ a ao.zs 64 J 64 T 1 N o m 90. 145 V; LOT ( M 1 1 ~3 J 8 64 B N 64 K - APPARENT OVERLAP L?- 0 ' M _ 10/ 2837_ N C. S. M l N 2 f. - -p~•O~_ ~___l~ L 64C N 6.4 F /\\6a G• 4 ~ pP ~ ~ z-r9 e4' 1 1 S\oi~~ 3 vo 64 G 1 6,4 H CD r- G~ 1 J 349.29 348.20 i 64 E F/•125. 9 E //4, SE //4 `:!:1.. ~,•f1PCi. t4•G ~ r 613/123 456.82' 64 A-10 456.06 1001/93 1001/95 1 63 D 64 A g E N 1139/03 SE COR. J 325 SEC. 4 .less' 750.76' • AS BUILT SANITARY SYSTEM REPORT DER TOWNSHIP r SEC. _ T z , N, R /X W 0, ADDRESS '71113 7~7~i „ ~ •,.1y , ST. CROIX COU Y, WISCONSIN. LDIVZSION LOT LOT SIZE PLAN VIEW -Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 0 i ~C I l,5 !f!i ! k I -ok -s tj I i 1~dicate lgorth Arrow :SCALE: TIC TANK(S) MFGR. CONCRETE STEEL u~~A~~`\ `l NO. of rings on cover Depth DRY WELL ; C~7 NO. of f width J" length /Je area f v We of lines width length area • depth to top of pipe REBATE RATE L. ~ AREA REQUIRED ' L AREA AS BUILT ~7 cialmer: The inspection of this system by St. Croix County does not imply complete liance with State Administrative Codes. There are other areas that it is not possible inspect at this point of construction. St. Croix County assumes no liability for tem operation. However, if failure is noted the County will make every effort to cermine cause of failure. ES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. `INSPECTOR DATED PLUMBER ON JOB ~,{,LvU LICENSE NUMBER 3 yr REPORT OF INSPECTION - I_NDIVIDUAI. SEWAGE SYSTEM ) Sanitary 11 erIII it a/ State Septic r NAME TOWNSHIP Croix County LOCATION SeCtiUn t,ot ~l Subc ivision SEPTIC 'L'ANK C" Sire r✓~ lions c bet- of compartments LJ-: slope - I)istance from: Wet' Bui Iding 127 t}ighwater PUMPING CHAMBER Size gallon, P mp.`Mtinufa,.lturer Muriel NumI)OF HOLDINC 'L'ANK p Size gallon Nube of oryatments _ Pumper A arm System Distance from: Well Bui]_d:ing 12% slope H -'>hwater ABSORPTION SITE Bed Trench jj Distance from: W e 11 B - u i l d - i n g g 7 C_ 12% slope Highwater_ ABSORPTION SITE DIMENSIONS Width of trench ft Required area__-Z _ ft. Length of each line ft Depth of rock below file in. Number of lines Depth of rock over tile- in. Total. length of lines "ft Depth of file below grade in. Distance between lines ft Slope of trench in. per 1.00 ft. Total absortption area s 1.t Type of Cover PIT DIMENSIONS Number of pits Gravel around pits yes. no Outside diameter ft Deptli below inlet ft Total absorption area,_ ft Area r. equi recce- --t 1 N S, P kfi T E D LlY APPROVED DATE' 198 REJ EC`I'E1) DA'Z'E 198 REASON FOR REJECTION " I 13EPAkTiMENT OF APPLICATION SAFETY & BUILDINGS INDUSTRY, FOR SANITARY 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. The owners copy or a legible reproduction of the soil test report must be included. Property Owner: Mailing Address: Property Location: City, Village or Township: County: a %Si~_%S /T,,-,4N/R E (or) W /c7J! Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake Landmark: State Plan I.D. Number: (if assigned) TYPE OF BUILDING Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: 1 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: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ❑ New 5~r Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit ❑ Alternative (specify) Seepage Trench C~/~ss ~~v Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): [Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name o umber: Signature: _ MP/MPRSW No.: Phone Number: Plumbe s dress: Name of Designer: COUNTY/DEPARTMENT USE ONLY ignat a of Issuing Agent: Fee: Date: APPROVED Sanitary Permit Number: ❑ DISAPPROVED eason 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 (N.03/81) SEPAR-C-MENT OF REPORT ON SOIL BORINGS /'q~ SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS ) ~~G o MADISOP.O. BOX N WI 7969 21 HUMAN RELATIONS o/ PAG~f ACT F/11cri LOCATI 1/fG ~j SECTIO~T ~N/R/? E (or 4 TOW MUNICIPALITY: NO.: 0 ,NY/G IVI NAME: COUNTY: OWNER' BUYER'S NAME: MAILING ADDRESS: ~AIX USE DA ~B A S MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROF TONS: ER LA ON TESTS: Residence 2 ❑New Replace a! LZ. If~ 1 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) ZS ou Z S au K]S ❑u EIS ©u a S ®u -7~°"cl-- If Percolation Tests are NOT required DESIGN RATE: SYSTEM EL If any portion of the lot is in the /ACT under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS SL$ y 5yD4vs A5 A-y~~y-- ~'v~~ BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) J^ B 7 > s B- ~ B- /07 y 16 ~ B- 3 ~0 H ,3 f r ~r .v, L~ ~1 „LY /5 ,1 SL Ly N "0 7!? 5 fft, w C L S B Q k,01, 3 >10f Za~ ESL /Y'' 10' L Q~r PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 PERIOD PERINCH P- P_ Si P_ Z 5 P- P_ `v P- PLAN VIEW: 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 slop. 13QTTONI o-' 7&__A1 V _$44GL Lim qr 5-',13,, iow Vt~2f. I e ' ,C3f}C~f/DE~ ~T S STEM ELEVATION OF ~ ' v = IgEeC DES G ~ uJELL - - - _ _ PcE /ins oure ~S I W { u% t. 70• its ~ !0 - I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin Admimistrative 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: jobE/RT" & - 2 Z / f P1 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional): Iff 3 D W11- 33 =o y,?Z 3, PC -14CJ's CST SS,I,G!N~AT,UUREEC DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. DI LHR-SB D-6395 (N. 03/81) , -i c~ i r\ i ,F j IV_ ~ EH 15 Rev. 9/78 REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 c LOCATION:'/4,56 '/4, Section / T N,RL E (or) W, Township or Municipality b~ v Lot No. , Block No. County Subdivision Name Owner',//Buyers Name: Mailing Address: R7. 3 0,.,, TYPE OF OCCUPANCY: Residence No. of Bedrooms J COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENTALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS SOIL MAP SHEET NAME OF SOIL MAP UNIT PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTE INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- P- P- P- P- P- SOIL BORING TESTS TEST TOTA DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, NUMBER I ES TEXTURE, MOTTLING AND DEPTH TO BEDROCK OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- Die' 1eU v f E /)/9 2Ee e(N 1%.4 T LIES B- Z it 5% o o f • B- B- 3mce -6A A otlEW AAEw 1,fCz5qE,J T 7APE e h 1-1 E v1,5~E B- 60 7 r14J s'®iL of 1O P,VElaE i G~eE4 ri td e T DR k0V to,,// B- NEED To I3F 7,,6E cam- - PiUE,ei/~1) 50,Pl uaAYt-2 A&JF) f',VOAA PLAN VIEW (Locate percolation tests, soil bore holes and suitab a soil areas.) Indicate on the plan the location and square feet of suitable areasVn Indicate number of square feet of absorption area needed for building type and occupancy Indicate scale or distance Give horizontal and vertical reference points. Indicate slope. /Uo /''F- . s l~ UA r/~~tl ~S /Op, Tl ew e»! X /EVgr~ovs CP~4~e ! Cie i,. &t,*r1oAv .~Oy ~ ~N FIms R t I IS O a € l• O(OM P'PE ~Ff . . S^ II' SOTTO„ _ Of TR1CW&4 11 _ I f r /Es 7 3 r FT /3.e/ow ca~ER ii R 0P rvP pxytvea PD , t I of Y toew T,Pc-vcA , t II I!~ ejEv, aue- Ta ot~iA,orrREAXh 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. Name (print) oh'ar Certification No.SS~DZ Address 12T 3 V1P,, / ~ 4ul S Name of installer if known .17 L ~TTI~'IM Copy A -Local Authority CST Signature'P6 /~h~