HomeMy WebLinkAbout026-1294-11-000 (2)
41
Wisconsin Department of Commerce EVALUATION REPORT Page of
Division of Safety and Buildings
irraccordance with Comm 85, Wis. Adm. Code
County St C t7
Attach complete site plan on paper not less than 8112 x 1 '
include, but not limited to: vertical and horizontal referenc point (dt l~ Parcel I.D.
percent slope, scale or dimensions, north arrow, and local on and n n a oad.
Please print all informati n. { eviewed Date
Personal information you provide may be used for secondary pur ses (PrivB~~ taw. ss. TS.O+tC I~Lp~)a). ~,{iliyt~ o~~ U
Property Owner ST. CR Xr 61%U Y do
Ge ral . S M l iL n ZONIN O 1/451/4 S~ a T30 N R E (or
Property Owner's Mailing Addre Lot # Block # Subd. Name or CSM#
11/100190 e• NU-) ( atoF -,c mooyb_ crc
city State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road
FIK R'.,V f tL M N K; 6N rn I S+
(a New Construction Use: 9~ Residential / Number of bedrooms Code derived design flow rate S D GPD
❑ Replacement ❑ Public or commercial - Describe: 'C' 1 n n L u 3Z-
Parent material "Y l.J_ Lr.s N i { M -Flood Plain elevation if applicable ft.
General comments S S US S c s t 3 -rt rY r~Lh ~ S V~ Fo / C 01 `
and recommendations: T.1 (99.9o') 7 y (97. /+a "I v W Ie h O W ~J
T.5 C9?.f9') 1 ; t i S lutie~
Boring 0-4.- ~T l °
Boring # ~ Pit qq~~ -
Ground surface elev. _L I n7 ft. Depth to limiting factor 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-to 10 Yk 3/ L aF k r aw F
ay_ MFv- e-W )VF • 7
q g5 .7
A- I
rd y
1
Boring # ❑ Boring mt- Lor""~~
❑ fA Pit Ground surface elev. _ ft. Depth to limiting factor 0 0 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
I-0-10 10 3Y L Qrs6k m v- au-) a F
s - I F s In 4t Fj cw G~
o~ ID - IS, 1 y b $4 v 1AA I, ie- r4 I=; e- vo uF '
44 a ,o y 5
7- 4-e dai 4-1--
Effluent #1 = BOD > 30 5 220 mg/L and TSS >30 150 mg/L ' Effluent #2 BOD < 30 mg/L and TSS < 30 mg/L
T Name (Please P Signature CST Number
-Add ,r Date Evaluation Conducted Telephone Number
-7 C t It -65 -7 6 -d VS -339'9
Property Owner Gera ldt 1, 5M'-11 Parcel ID # Page GK_ of A-
F,-31 Boring # ❑ Boring
Pit Ground surface elev. f71 • $ ft. Depth to limiting factor ' 0 0_ 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
- /OYP' 3 L I.Fs6k- m r - ~ y , 4P
10 -.1Q -1 - S 4/1, M Fi C w> - i
y/ r= GlL IMF /,10
3 an- 32 7,
-1u S 4 G L I M Fr
,S
7
Pot.
❑ 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/ff
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,
F-1 -
Soil A 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
Effluent #1 = BODE > 30 5 220 mg/L and TSS >30 5150 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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