HomeMy WebLinkAbout032-2167-39-000 (2) Wisconsin Department of Commerce L EVALUATION REPORT Page of
Division of Safety and Buildings -w
--,,rcfa-nce with Comm 85,Wis. Adm. Code
County
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must
include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. ?
percent slope,scale or dimensions,north arrow,and location and distance to nearest road. QJv2 _���j7--3���
Please print all information. Rey' wed by Date
Personal information you provide may be used for secon j urposes(Privacy Law,s.15.04(1)(m)). O
Propert wner .y� .,.4s Y'. Property Location
Govt.Lot ��J 1/4 1/4 S T N R E(or %
Prope Owner's Mailing Address w e �t {,l Lot# Block Subd. ame or C M-#,'
F Y •p
City State Zip Code Pban :NUmbnT' ❑City ❑Village Town Nearest Road
New Construction Use.0 Residential/Number of bedrooms Code derived design flow rate GPD
❑Replacement ❑ Public or commercial-Describe:
Parent material �iP&A c.✓ Flood Plain elevation if applicable X ft.
General comments /)
and recommendations
17 1 Boring# ❑ Boring
❑ Pit Ground surface elev. 2Z ft. Depth to limiting factor —,;;7 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 I *Eff#2
d ,l
1 /
rind
Boring# ❑ Boring
Pit Ground surface elev. ft. Depth to limiting factor 3 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2
- Q 11-4 s
3 / 6
- 6 s ,� 7
*
EJfluent#1 =BOD,>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BODS<30 mg/L and TSS<30 mg/L
CST Na a lease int)� - Signatur
O/V
CST Number
Address Da a Evaluation onducted Telephone Number
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-
SBD-8330(R07/00)
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e_
Property Owner S./� Parcel ID# Page , of
Boring It
❑ Boring �et 39
^-� Pit Ground surface elev. ft. Depth to limiting factor L in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 -Eff#2
7s -d ✓
❑ 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/ft2
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2
F-1 ❑❑ Boring
Boring# Ground surface elev. ft. Depth to limiting factor in.
Pit Moll Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2
*Effluent#1 =BODS>30<220 mg/L and TSS>30<150 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.
SBD-8330(R.07/00)
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