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Wisconsin Department of Com erce FEB 13 2004 S811- EVALUATION REPORT Page I of
DMaion``.n Safety and Building ST. C
ZO~FI~inrith mm 85, Wis. Adm. Code County
Attach complete site plan on paper not less tan x hes in size. Plan must S~
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 00'~ 16 - Ha 1- 13
Please print all information. Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). a (D
Property Owner Property Location
Halle &M ers Govt. Lot SW 114'C 1/4 Ste- T ,~j0 N R it E ( ) W
Subd. Name or CSM#
Property Owner's Mailing Address Lot # Block -W
1 4WA 4 of 1) K)
City State Zip Code Phone Number ❑ City ❑ Village K Town Nearest
RiCfnw►ov~ c Road w 1 54011 ~ IS ) ay6- 6%t3 7T S+ .
9 New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate `l SO GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material 41a ci ~'I In (f / Flood Plain elevation if applicable ft.
General comments 71 5 v5I r-6 + CL 'tit -75
I ~r • S G d 3, IM OA,~, and recommendations:
Boring # Boring
pit Ground surface elev. lop,o ft. Depth to limiting factor _ C o in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
in. Munsell Qu. Sz. Cont. Color G z. *Eff#1 *Eff#2
I a-li )olR3a as ap
d ~►-a3 ~.SVRl3 SL /~S~K ds C2J ! N
.3 3-41 2,544 "14 SL I)CSf K ul lv r .4 .16
HI-9b SyRy 4 SL eFSSK 6Skl\ •y .o
❑ Boring # ❑ Boring
Pit Ground surface elev. 1(:►f Q ft. Depth to limiting factor 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
I o-9 10 Y 3la APL d s a5 0? . y , b
q-16 /OSR sq SL 1,c5gk S Cvj 1F •q
a1 is 1K H14 " S L QMS6K d S vii
LA ~o?1-33 1,5 `~R y f6 S l rrfs6k' ~ C~ , q
33-8515 ~e q14 SL a 5 ASS avi .5 .9
5 -9 5 I g qW SL 1,C56k 15 - - .6
L 11
* Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L
C60vole, Name (Please Print) Signature CST Number
T 5 A f~ -2t~~ c~ !x'46
Address ate Evaluation Conducted Telephone Number
W% 5440alcl,
a-)6 C)0041 S+, S+Ck(- Rexicif )0-00-01
SBD-8330 (R07/00)
Ht//,e rte"
Property Owner Ht//e 911; M er.S Parcel ID # Page C~ of
F3-1 Boring # ❑ Boring Eff Pit Ground surface elev. -99,9 7 ft. Depth to limiting factor 30 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color *Eff#1 *Eff#2
0-9 10 R 3/a L.. FPL js~ as aF
a q-a 10 y2 yl acsaK ds', CW I F s .a
3 91-30 7,syR 414, s~ aFSB ds C%A) I.,F .5
y 30-ql 7,5yk FIF7.5 "it s~ rsaK Jst% taw ,y
5 qr 7s 5 y 41 b
F] 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/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
❑ 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/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BODS > 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.
SBD-8330 (R.07/00) '
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