HomeMy WebLinkAbout026-1121-12-000 (2)
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Wisconsin Department of Corn rce SO k EVALUATION REPORT Page of 3
Division or Safety and Building FEB 1 3 2004
ST. CR accordance with Crsmm 85, Wis. Adm. Code
OlX C County
Attach complete site plan on~iC 11 in hes in size. Plan must S~. cro t X
include, but not limited to: vertical and fence paint (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and l0 ca iiott"and distance to nearest road. o Oa 6 - Hal- 10k
Please print all information. R ed Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~C ' ,vN o~6 b
Property Owner ` Property Location
Ho.11-e 8U%, (►pe ~s Govt. Lot S k) 1/4 4j 1' 1/4 S te„ j' T30 N R J 'Z
E ( r) W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
M3 Awy 6q 1 Pa;'r;4 4Zvr
City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road
Aew R~~ and wr 5q 01,7 (-11,5 ) ay6-6 13 OVIVY,Gvss l o-7 t 6+
New Construction Use: & Residential / Number of bedrooms 3 Code derived design flow rate GPD
❑ Replacement ❑ Public or commercial -Describe:
Parent material Q Q. C. t - , Flood Plain elevation if applicable ft.
General comments `'S1~~ 0. . Y. 7S
and recommendations:
plat~ ~wc u/Le- ~ - 97.75
F 1-1 Boring # ❑ Boring
Pit Ground surface elev. 97.5! ft. Depth to limiting factor tot) in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-3 16yR3ia
cZ 3-10 JR 114 - ~ L PL Js CW I F ,4 . b
a1- 33 -1,sy>;4I6 d#158 ° ash CW .s
6 33-93 0,s V 4I6 a''s C Cavi
b 43-40 SIR 414 SL IF56k ds
Boring # ❑ Boring
C Pit Ground surface elev. ft. Depth to limiting factor _ 2 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
(3-10 10 Tg 31A - - L 1 d 5 CA5 A F
a b- 10 y 3h 1. ) F 8 S C 1 , y .
3 10-1% Io IR 414 L`~
LA M-39 15 4R 416 SCL 1 n1SAK d W -'4
~
3%- -),SyR 416 p1F=-7,S `gyp ~Ix SCL o-M 3 ►3
* Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) p~ Signat a CST Nu'm'ber
S-~ Cxr % c~ ~7"lO
Address Date Evaluation Conducted Telephone Number
`?(m oo r` s~ spar ~ w~ S14 W6 M-a0-01
'?IS-au8-35~$
SBD-8330 (R07/00)
Property Owner Halle AJAers Parcel ID # Page of
Boring # Boring Q~ 3 a in.
031 ❑
Pit Ground surface elev. Depth to limiting factor Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
I (3-y 10 SR 31a L I Fls l2 c) 51-1 6k a , t-I .
Li -q 0 IR31y 1FPL S CO IF •y
-30 t0jR 41q y`qL dm d5 CLA1 F •5 .9
44 3o-4a ,.5 4k yl 1:1 F , s v e sj_ 1 pS31C as a V . y .10
5 S4g 41q SL- ISM
❑ Boring
❑ Boring #
❑ 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/ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
❑
❑ Boring # Boring Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
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