HomeMy WebLinkAbout018-1010-30-200 (3)} RECEIVED
Wisconsin Departmen;q Corn a �a' 7 JUIL tVALUA l IUN Ktl'JOA
Division of Safety and AmWni
in accordance with Comm 85, Wis. Adm. Code
ST. C OM CO11ty
Attach corn I ss than 8 112 x 11 inches in size. Plan must
include, 1 reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to near st road.
Please print all Information. S (/( Revi ed by
Personal information you provide may be used for secondary purposes (Privacy Law, S. 15.0/ (1) (m)).
>roperty Owner Property Location
rj 4 < Govt. Lot 1/4 114
'roperty Owner's ailing Address Lot # Block # S
State Zip
�Code
/ Phone Number ❑ city
'7/i uI� �. •. _r/ �. �/' 1 �%%ii T 1 Ih \ /1S!Ii /)r�l ll.� 9 NA..N417�
Page — of —
29 I y_
0 $- /Q/0 -
Date
Z
0T Z' N R12 E( W
"' 6 484 11 , 2 St-, 291057
New Construction Use;gQResidential / Number of bedrooms Code derived design flow rate _j� 74!) GPC
❑ Replacement Public or commercial - Describe:
Parent material r Flood Plain elevation if applicable N ' ft.
General comments ZG7t�-
and recommendation:
System Type %e4( System Elevation gel
a Boring # 0 Boring
Pit Ground surface elev. '0 ft. Depth to limiting factor , in.
Soil Application Rate
Horizon
Depth
in.
Dominant Color
MunseN
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPDO
'Eff#1
I •Eff#2
C
I. 5 14 /- 4 h 17,.5-L,r�//.,I 4$7/-f- S, ,V/Ga I5/ I —rn— I //'h, 1N/14- V J)./H I. *vl- � &� I
Ong # ❑ Boring Q Z ✓
® R Pit Ground surface slev. / S ' ft. Depth to limiting factor J (-) in.
Cnil Annliratinn Rat<
Horizon
Depth
in.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/fF
'Eff#1
'Eff#2
,r
Z
3-30
5(
, /
3
-�a
s
s
>�
r
M.
Auin.
Effluent #1 = BOD. > 30 < 220 mg/L and T55 >30 < 150 MW" Effluent 42 = 1:5UU. < 3U ngfL MCI I JJ < 3U M91L
CST Name (Please Print) S re CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address D to Evaluation Conducted Telephone Number
11
1432 120th St, New Richmond, WI 540 ! /--/ 715-246 4516
Property Owner
Boring #
❑ Boring
.3 R, Pit
9 Parcel 10 #
Ground surfaceelev. `� �� ft.
J Page
Depth to limiting factor �� in.
_ of
Horizon
Depth
in.
Dominant Color
Munsell
Redox Description
Cu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPDM
'Eff#1
I 'EfM#2
0-1
ZiaL
^
�l
J`I
i�
�
L
J Gam'
ElBoring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Sal Application Rate
off TIMPTI=
I
ElBoringBoring # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Soil Andiration Rate
Effluent #1 = GODS > 30 < 220 mglL and TSS >30 < 150 mglL ' Effluent #2 = BODS 130 mglL and TSS < 30 mg1L
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SB68330 (R.MDO)
Soil Test Plot Plan
Project Name Gail Dahlstrom Shau,
- Address 1118 170th St.
Hammond Wi 54015
Lot Subdivision
SE 1/4 SE 1/4S 5 T 29
N/R17 W
Boring Q Well PL Property Line
BM or VRP Assume Elevation 100 ft.
iTM #226900
4/21 /17
Township Hammond
County
Top of wood post
System Elevation TBD *HRpbame as Benchmark