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HomeMy WebLinkAbout032-2174-03-000 (2) tx6:C,i r Wisconsin Department ofComniirce r.:-,- ,, ,Or,$OI EVALUATION REPORT Page / of .3 Division of Safety and Buildings -- in accordance with C• 85,Wis. Adm. Code ('H: ' County /% , Attach complete site plan on •=per not lest,than «�I inch=. in •size.Plan must Q. include,but not limited to:ve - • 1_i=�-,.,. .,.. t BM),direction and Parcel I.D. percent slope,scale or dimensions,north arrow,and location a •distance to nearest road. d 3_.)-f-7'f-03--0t, Please print all information. view y Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). I 02-//,/6 v Property Owner /� Property Location �3h7 A''1/S/� Govt.Lot `-� 1/41i4.- 1/4 S ? T 3,/ N R l9 E(orgf Property Owner's Mailing Address Lot# Block Subd.Name or City State Zip Code Phone Number ❑City ❑Vllage (.Town Nearest Road - /i/e7A:e I I air 15l,, c-I ( ) _ a;n 7a�se4 I _<Y ,d New Construction Use:gi Residential/Number of bedrooms 3 / Code derived design flow rate Ste- //7 GPD ❑Replacement ❑ Public or commercial-Describe: __ Parent material Flood Plain elevation if applicable ,1' 4 ft. General comments - 3 and recommendations: s�'�i� � ✓�3 G�t%'�'k-Ltirn // 1d - 4-u . Boring# (�p� � ❑ Boring pi Pit Ground surface elev. , , 9 ft. Depth to limiting factor Z-' in. Soil .t.ication 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 3 ifiri V1129111111111, IffieePlAIIIINIIIIIIJIIIIMIMIII • Boring# ❑ Boring Pit Ground surface elev. //V,j ft. Depth to limiting factor 7Q in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fW in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. `Eff#1 •Eff#2 40` 4 MIIPBM .1 _ ANEW 111MIMMIIIBEIMINIMA S IIMIA 3 i _ 7�i�1MPIA !r_!!?_ ! J 1� � ., AIM -- IiL,'' 1� !1 t , A - - Mil n •Effluent#1=BOD5>30<220 mg/L and TSS>30<150 mg/L •Effluent#2=BO;<30 mg/L and TSS<30 mg/L CST me(Please gignfrre) CST Number if a., t4e// �. •2 3131 Address Date Evaluation Conducted Telephone Number ?9 ?— /�2 a e 5 6 r i e s t ,--_ 2- 12-0 3 is-z r- os • .-/®t Property Owner /din 7)6/St Parcel ID# Page 1- of 3 ng# ❑!1 Boring Pit Ground surface elev. 9491/ ft. Depth to limiting factor in. Soft 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 C--"C9 RIMIPMITAIMWMINII=111- MN' - Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. l 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. Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munson 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 rng!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. seoasw(e.eroo) . . . . OWNER Page 3 of 3 --. Name .,/ext /DA- -1,- Brian Parnell Address CST 231314 Date /2- 1Z-3-? 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