HomeMy WebLinkAbout032-2174-16-000 RECEt ' 1� .,_
Wisconsin Department ofComme DEC 1 8 COIL EVALUATION REPORT Page / of S
Division of Safety and Buildings
gin Ecffickentis with Comm 85,Wis. Adm. Code County
Attach complete site plan on pa_ -- - ii•' 8 25k Ill inches in size.Plan must C
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include,but not limited to:vertical and horizontal re eiiinerrlotnt(BM),direction and Parcel I.D.
percent slope,scale or dimensions,north arrow,and location and distance to nearest road. 3_2 -„/../ 7 �7(p f-6
Please print all information. eview y Date
Personal information you provide may be used for secondary purposes(Privacy law,s.15.04(1)(m)). G( - I i1/Q k
Property Owner /� Property Locatio
.e// / Govt.Lot j` 1/4, 1/4 2.27 T,5� N R /9/(or)W
Property Owner's ailing Address Lot# Block, Subd. or CS ,/
- / /F 'k'''Address
// A/4 _t w -11:9G.e
City State Zip Code Phone Number ❑City ❑Village O Town Nearest Road L
i s I u n-./2-? ( ) _ 3i.9n, r°;sz I 7 57
I New Construction Use Residential/Number of bedrooms 1i/ Code derived design flow rate - 6---e--6 e GPD
❑Replacement ❑ Public or commercial-Describe: ____ __
Parent material Flood Plain elevation if applicable ,/i/ — ft.
General comments S� A-, 9‘,6 / '—
and recommendations:1 6/ q s q !0 ea.—S pr -,4- -, -ea t - f3/g//�2 �,., 9 .60
it i U 14/l.. 4A 3 q e 1' - C�# t `e7o Shia-e_
/ ❑ Borings
# Pit Ground surface elev. 111, ft. Depth to limiting factor 4'-f' in.
Sail Application Rate
Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots GPD/fr
in. Mansell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2
iiimpm ar- , ii Aimmlisumv-mmowimpilmwzrim
.3 WINIMEMINIPPYAMININAIWwt.:0AINFAIIMIESIEZIPM
INEMPAIIMMEHEMMINIMIMIIIMMERIMIIIMI - -7 MI
MI MI INN!
Boring# 0 Boring
,LI f Pit Ground surface elev. 4 N ft. Depth to limiting factor � 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. •Etf#1 •Eff#2
/ C./y /6>rd _.,/ A LZA , ,J( eh.) I, , 7 /-7
.. /:
INIFILIMMIIIIPMENEWAIMPIRDIMMEMINSIMMIM
MI "!. I !'lira -- MIMPEI
MIL .o. VB NIB e , IPINIMIA --- MIMI
•Effluent#1=BODs> r<220 mg/L and TSS>30<150 mg/L Effluent#2=BOD < I mg/L and TSS<30 mglL
CST Name 1 Signature ' CST Number
�,rfAr4.7.1),P"l/ ,� — 07°25(-;, ,,
Address Da Evaluation • • . • Telephone Number
: ` _?Yj4,- �s--(10, .f)r s :-Z / -/.s-o 7 7"6—...5'--—?//r
e � ���Z
Property Owner s /S�
Parcel ID# Page - of 3
Boring# ❑ Boring /
DO Pit Ground surface elev.M')° / ft. Depth to limiting factor 4.51 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
1161111EMPBEFAIIIIMMIIIII. 111E1111' "matmommimm•-
rirmirmriiummatummem
Bori
Boring# ❑ ng
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rood GPD/ff
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2
Boring# El 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
•
•Effluent#1=BOD,>30<220 mg/I_and TSS>30<150 mg/L •Effluent#2=BOD,<30 mg/L and TSS<30 mg/L
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OWNER
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Name /8 >�%,_�,��
Address
Date
Benchmark 1 L,/OD,o 76p // Hof co/fie.,- // - / j, S
r..,'m Benchmark 14. /CV-/ / ► e / .4/1 past- g,v /Vt/ c�`f4 C- 06 3
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