HomeMy WebLinkAbout026-1294-09-000 (2)
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Wisconsin Department of Commerce Q EVALUATION REPORT Page __L of
Division of Safety and Buildings
ra J with Comm 85, Wis. Adm. Code
County 5. { . C 1
Attach complete site plan on paper not less than 8 1/2 x 11 nch s ~J 1
include, but not limited to: vertical and horizontal reference int Parcel I.D.
percent slope, scale or dimensions, north arrow, and locatf and distance to nearest road.
Please print all informati f 2 05 Re ewad b Date 11
Personal information you provide maybe used for secondary purp as (Privacy Law, s. 15.04 (1) (m)). r/l a o
Property Owner b 1. R FiEd jfVLbVaon 5 E
Gera .l ck 'S • SM f ` n ZONI O Ff E t" 1/4 SE 1/4 S aq T30 N R E(or
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
I 00 1 90 e. NW afi o F "c M a r., (IL C-rc
city State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road
~IK R~ ER KIN 30 ( ) - $ piGhrn 133r Rve,
New Construction Use: I& Residential / Number of bedrooms Code derived design flow rate GPD
❑ Replacement _t ❑ Public or commercial - Describe: _
Parent material W." - Flood Plain elevation if applicable ft.
General comments stass• t S'} 4 . -ors ~-~•~S , M ~D f' a G.C -1-. s ~-rt
and recommendations: ?.S C 95.39' rv h D,N 1 F
T.► (96.2a) n
• T 3 l4 f;.oo'~ . T•!. 95,1 Y'~ ~G e S) t-.S i
T.3 (95.'14') 5 ate a . -t.7 (9Y• 4~') I S
7. 4s.571 e9.-W)
Boring ~0~''
a Boring # Pit Depth
r and surface elev. ! to limiting factor _ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f?
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2
3121 L - L a w E Q
47-4 S YPI 4 _ . L 1 - mEv- c w I vF . `f . 7
3rd _ - S Yh, I -S
-414+b V L D tM c. K e. }
Boring # Boring/
® 1A Pit Ground surface elev. ft. Depth to limiting factor / OS in. Soil Application Rate
Horizon Depth Dominant Color Redox De9cription Texture Structure Consistence Boundary Roots GPD/fF
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2
3 L I- k ft r aw a E , y
0-11 10 1 - 5 s - t_ b 1 rat C t,o I-
y H to v ~ , M b T = • c-t-o IvE .2
I-SI W tM c
D r c
• E Mg/L u = BOD < 30 mg/L and TSS < 30 mg/L Vb
T Name (Please P Signature CST Number
,'Di>60 (L~to-
01 drr . -t .S"~ Date Evaluation Conducted Telephone Number
y(ka.,i6r-1111 wZ -a 3 -b s 7 15 a ya 3598
SYVai.
~v
Property Owner Gera Ids Sm Ak Parcel ID # Page c~_ of
F--31 Boring # ❑ Boring
Pit Ground surface elev. _ n~~ ft. Depth to limiting factor a 0 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
o-tI ►oY 3 L 6 s ►MFv- ato o?
I I -a9 y/ SL b rn F,r c"2
3 a9-y7 -7-5 glle 5 o- mL c~ 1,1F 1.
Boring # ❑ Boring -
❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Boring # ❑ Boring
El Pit Ground surface elev. _ ft. Depth to limiting factor in.
F-1
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
i
Effluent #1 = BOD6 > 30 5 220 mg/L and TSS >30 5150 mg/L ' Effluent #2 = BODS < 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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