HomeMy WebLinkAbout032-2193-11-120is
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JAN.'O 3 2023�
f
,S EVALUATION REPORT : P of ..�
Wis. Dept. Q# end � ;Senrt�ce age
Division of � ' vela ment f 77Z;,PV
nce with SPS 385, Wis. Adm. Code ,
County
Attach complete site plan on peeper ro less than 8112 x 11 it *M in size. Plan must
Include, but not limited to: vertu and horizontal reference point (BM), direction and Parcel I.D.
erpnt slope, Scale or di1enSiaisnDharraW and lTCiti4iad distance to nearest road.
Please print all information. R wed by Date
Pew intwnaWn You pmvkie nay be umsd far secmdwy WWws (Privacy Law, s. 15.04 (1 ) (m)l.
Property Property Location
Govt Lot 7 114 114 S - T �' ; N R E (or) W
P Owner's Mailing Address tot # Bk x* # Subd. or C.SM#
/,—,) h d, V, - .
�Ak,
CA ty e zip Ph" Number [] Cky ❑Visage ElTown Nearest Road
�V-
H a2
ry �f
New Construction Use: Residential 1 Nurr er of bedrooms Code derived design flow rate � GPD
0 RepWoement [] Pubfc or rm - Describe:
7Parent rnateirlai 42ry Flood PW n elevation if applicable tL
General comments
�e- -
and r endations•
Lz
7PS A)&
r1 Lt � C Owr y�c t.
Boxing
BBoring#
Pit Ground surface elev. ft. Depth to limiting factor in.
Snit Ann�icatic�wn ate
I ) I
Bodng # BCOM
pit Ground surface elev. ft.
Horizon Depth Dominant Color Redox Description Texture
In. Nlunse Qu. Sz. Copt. Color
Zia
7 7v r
+. + .. %
WEN,
Depth to limiting factor in.
Structure FnsistenGe Fundary I Roots
Gr. Sz. Sh.
Soil t%n Rate
GPD/ft x
ff#2
4-
f
1
�
r
* Effluent P11 = 1309 > 30 < 220 mgA.. and TSS >30 < 150 El ent #2..= BOQ < 30 - and TSS < 30 i ng1L.
CST Print) Signat r CST Number
Address INii6 EvMuadon CxxxWed T6� Number
Z/ <)
Lt�n 47Zf1 !i) 1 1 /1 Z ►
kma
!0
-14
Property Owner
� �� �� Parcel ID # tr
Boring # Boring 02, q
I r.-._) I pit Ground surface eWv..-- / /0 ft. Depth to UmIfing bctor In.
Page of
It ZrVZ�flf%n Bata,
Redox Description
Qu. Sz. Cont. C.olor
C*"
!,-Gr. Sz. Sh.
�40
M'.
MO
MMMM
MMO
lo®rlinpil
ME Mx-bol IMM
or
row
WARM
# BoCing
pit Ground swface elev. ft. Depth to "ting factor in.
I Sod ArmUcation Rate i
Redox Description
Qu. Sz. Cont. Color
Boring # NxiM
0 pit Ground sWace elev. ft. Depth to lWfing factor In. I Soil AmUmfim Rato
iL
IL
EffluwA #1 = BOD > 30 < 220 m9k and TSS >30 < 150 mg/L. Effluent #2 = BOD 5:5 30 mg/L. and TSS < 30 rrQ/L
The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to
access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay.
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