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HomeMy WebLinkAbout032-2174-08-000 (2) RECEIVE Wisconsin Department of , DEC 1 8 ' E Wi ALUATION REPORT Page / of -$ Division of Safety and Buildings ST.C•a#oewarni Cpmm 8 ,Wis. Adm. Code County j{ + �•`• OFFICE Attach complete site plan on paper not less than - 'g size.Plan must i�'X include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. 0 �." 7 —‘Agtizej percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Please print all information. eviewed Date l 71157/04"( Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). (,L!/YVy... I Property Owner Property Location ,/ 1 �,,,/1-S Govt.Lot L//r 1/4/1 1/4 S9 IT 2j/ N R/9 FOr 3 Property Owner's Mailing Address Lot# Br # S or CSM#' 9 ci/R- /9-- Ai'' ,),g 8 —,Vi )5-,1e/ Adw -K9Kie , ,aki Staff Zip Code Phone Number ❑City ❑Village Q9 Town Nearest Road /7 76 ,,,.r. SE7'1- I dv,E' I� 5 1 ( ) _ �lfiira.�LS'E I 7''i New Construction User Residential/Number of bedrooms " 1 Code derived design flow rate - de GPD ❑Replacement ❑ Public or commercial-Describe: Parent material Flood Plain elevation if applicable X ft. General comments a-� ', 14-114/A-4-e---0-1, 6`'m-iwk--°1- '//o f`6 -7 and recommendations: �--S ,,,N, - ok) cy,,, e 4*s'— Sb'1mfrx -Peav-e- ici A sys ,,.elev.°e-� • 6 .i_E d ri,,u,:ip 14,:s a)6D) f=rtxet 11'ifnnold a 1 ❑ Boring Boring# Pit Ground surface elev. 9f�,.3 ft. Depth to limiting factor £ ' in. soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg in. Munsell Qu.Sz. nt.Color Gr.Sz.Sh. •Eff#1 •Eff#2 / O-/D le5e3h j/ ...n"/ 1$JJ ii),r fs /iyr , �_ t sg--74,, /0)e?A z.4,44'., -fnlAoi 152m I lr-1 / 6 .-� 9114 - It. 52 Q Boris# 0 Boring Pit Ground surface elev. 9A7-5- ft. Depth to limiting factor ,<D in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fV in. Munsell Qu.Sz. nt.Color Gr.Sz.Sh. /7 •Eff#1 •Eff#2 C--2/ //P ei? /t/ ,s/ ,tit fro„ir as /,,-, , S , 9 - 'V-77 /11(e-c--4/ �, / .��1 ��,h - m14 � ig / sr- s5 3 r� 7 14 G� 1 ..-.��, in,,,� e.in! /c ,_5� . 9 s-fide /, y0?/� _ic,i, b /,.,a .,,,l — — 6 � 33 .i /�( q i Y' ” •Effluent#1=BODS>30<220 mg/L and TSS>30<150 mg/L •Effluent#2=BOD,<30 mg/L and TSS<30 mg/L CST (Please Print) 1 Sig ture CST Number Address Date Evaluation Conducted Telephone Number 3q�- /z 4 e 5c efse7i' z_ 1z-/y—v3 Ps--2VT X03 l - � Property Owner „,/,‘9i,/ ;1 /� 5 29� Parcel ID# Page g ef:::2of Boring# ID Boring La pit Ground surface elev. 97 7 ft. Depth to limiting factor `$'D in. S Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots al GP Rate /ff in. Munsell Qu.Sz. nt.Color Gr.Sz.Sh. -Eif#1 •Eff#2 /p+ 5('7 1V s �r�G ur as � r , 9 3 /' z, it ,ti sly/� �ti xd , �,.: J . 9 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/fW in. Munsell Qu.Sz. Cont Color Gr.Sz.Sh. *Eff#1 'Eif#2 Boring# El ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GOD/Fr in. Munsell 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 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.$330(R.sroo) , . OWNER ,,..;___ __;- . y Page 3 of 3 Name 4,, /. ,/,--5/4- Brian Parnell Address CST 231314 Date ...,, .•:,'-''.'.:L''' Benchmark 1 Olt /00,0 70/9 /VC 4074-(of/le/ .,. Benchmark 2 8/, /O2. / /174,i -,./ raj' fly' /t/.....40-i-c-0/4e,-- I I Soil Boring. , , t_J S citable 40' Scale , , -, , ; ; -7— i ■ i i , 1 i I ■ 1 1 1 ; 1 . . 1 1 ! , ! ! i I , 1 1 , ■ . : ■ . , t I ' j . ; , , ■ : 1 i , ! , I _ ■ ; I , ■ : , I ■ , ____,.._ I I i , t . ; 1 ! i .• I 1 , ; ■ ■ .' .....---.---.._---------c----- --, .7/ ....____4 i . , , . ! : . , _______ _ • . --4---i -5I--. -,- 1 -A' e.,____H_____,_ ._---r-- LI ■ I ; ± , i f vi -i---- ---i---7.----1-; , --7- , , , , 1 i I 1 : , 1 1 ; -1-- , I I I i I ___, I __ ______ I i i, . - . ............,,,, ........•,,I. ,,,, 7-----7-7- -t I 1‘0111 i , . i 1111 113 ; , ; . 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