HomeMy WebLinkAbout020-1464-11-000 (2)
Page of
Wisconsin Department of Commerce ''-OIL EVA' UA T ION REPORT
Division of Safety and Buildings
in accordance wilh Comm 85, Wis. Adm. Code
County Q
Attach complete stte plan on paper not less than 8 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (SM), dlreciion and Parcel I.D. G
percent siope, scale or dimensions, north arrow, and location and distance to nearest road.
Rev Date
Personal information you provide ay be °R '.l,YS...,. Wises (P acy Law, s. 15.04 (1) (n'O). Z G~
Property Owner Property Location
t 2 3 1 I Govt Lot .51 /4,br- 114 S T Z N R E(or)40
Property Owners Mailing Addles" Lot # Block # Subd. Name or CSM#
000 C ~K0 J~vvU.'4 ( Moo VIW e
City St to C er City ❑ Village Town Nearest Road
H81)nd VI
d i ( ) 1-~ ud5a
New Construction Use: Residential! Number of bedrooms Code derived design flow rate _S~~Q GPD
❑ Replacement ❑ Public or commercial - Describe: _
Parent material Flood Plain elevation if applicable _-_--/_L~---_--_ fl•
General comments ~Ysf em e /GAL
and recommendations: y'
uQ.~ ray crrt~G,
i
F-)] Boring # F] Boring q
pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
l j2 10 _ sir 2►~Sbk m_ c5 lv
y
2 12 2 - 4 - ' ~I 2m1< mfr C5
3 2-tl~s I yl(~ - S U m I - - .ri I.~
fr
d u S,ifG _ o S.%s Sr' t rl
Boring # ❑ Boring
❑ [9 pit Ground surface elev. ft. Depth to limiting factor in.
Rate
_ Soil Application
Horizon Depth Dominant Color Redox Descripli'on Texture Structure Consistence Boundary Roots GPDKf
in. Munsell Qu. Sz. Cont. Cr1br Gr. Sz. Sh. 'Eff#1 "Eff#2
~i 2m >r G5 y _ $
C) V,
0-10
2- :30 l 4-I4 5 f ~I 2mS bK C5 9h e s,' e- l 3 w6byN r oC l c - Lt (v
m
ti
I
Effluent #1 = BOD 30 220 rng/L and T >30 < 150 my/L ' Effluent #2 = 1300 5:< 30 mg/L and TSS < 30 mg/L
T Name (Pie Print) Signature CST Number
Wa~er 2533017
Address Date Evaluation Conducted Telephone Number
2-1 t3 MTh 3 o m 64o2s '-f -l14 --o - 7/~ -fie -,OZ.-7
Page -_2 of
p / Property Owner Parcel ID # - - - - - -
~!~-~1--------
F3_1 Boring J
Boring # ~vQ, ~f Depth to limiting factor I in.
Pit Ground surface elev _ g Sod Application Rate
HorizADepth ominant Color Redox Description Texture Structure Consistence Boundary Roots `Eff#GPDlft2Eff#2
Munsell Cu. Sz. Cont. Color Gr. Sz. Sh.
2m5b C 5, 2 r m -
3 I /(o C3P 1,5 rye S~c~ 9irn3b~ MIL
7 1.2
17d
E Boring # Boring ft. Depth to limiting factor in.
Pit Ground,surfaceelev. SoilA licationRate
Consistence Boundary Roots
•Eff#l ~Eff#2
Horizon Depth Dominant Color Redox Description Texture Structure
in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh.
'
❑ Boring # Boring Ground surface elev. ft. Depth to limiting factor in-
Pit Soil A lication Rate
Horizon Depth Dominant Color RedoxDescription Texture Structure Consistence Boundary Roots 'E GPDfftzEff#2
in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh.
Effluent #1 = BODS > 30 < 220 mglL and TSS >30:S 150 mg1L ` Effluent #2 = 80 D, < 30 mglL and TSS < 30 mglL
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sAn-8370 (a.07100)
PAGE_OF
NAME: L e ( LOT#__L~_LEGAL DESCRIPTION:5E 1144tC 1/0 TltN,R,L~_E(orQ
SCALE: 1"= go
B~ ELEVATION: /(7 0 • d
BM 1 DESCRIPTION:, u ~UG~ f~P
BM 2 ELEVATION: 4-1' FIBG l `
PM 2 DESCRIPTION: P fC-
SYSTEM ELEVATION: f y, U d
=s
SYSTEM TYPE: CO djUe n~ kYl I CA.( 50
oo
z
SIGNATURE: DATE: -d
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