HomeMy WebLinkAbout040-1312-12-000 (2) Wisconsin Department of Commerce RECEI & LUATION REPORT Page / of 3
Division of Safety and Buildings
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. Attach complete site plan on paper f less than 8112 x 11 inches in ze. n /1
include,but not limited to:vertical a d horbrlfeFd�efk# pqi {BM) direction (J Panel J.D.
percent slope,scale or dimensions north add*g f send dis rice to neares d. p 4 b
Please print all information. Revie y Date
Personal information you provide may be used for secondary purposes(Privacy Law.s.15.04(1)(m)). /'b//z A
Property Owner Property Location
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Property �s0 i�AN�C� Lot t#- Block# Subd.!Name or CsM#
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Cfly State Zip Code Phone Number
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I"l ✓V I ( > -TROY S0L18 610-4 /Z915
New Construction Use:® Residential/Number of bedrooms 3'S Code derived design flow rate 45 d- -750 GPD
❑Replacement ❑ Public or commercial-Describe: _
Parent material 45 A0 T>'f LO�.� 10L '/W AS 1-} Flood plain elevation if applicable 1/� v ft
General comments
and recommendations:
Am X spot Tested wbbie for S� �d-- �S. For s s�
a comlentbnW ingrourid system(RO.WTS.) 3
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F-1 Boring# ❑ �� Q /
® Pit Ground surface elev. g_ Depth to l��g factor )95 in.
Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu.Sz. Cont.Color Gr.Sm Sh. 'Eff#1 'Eff#2
0-14 !u Yle 2/ - 3 m 5 blc i»-fr C 5 3,4 l� g
5e,l 2 M5b'k 1'►')fr I a W 2✓� 9 .!o
3 A-95 ►v R 5l4 _ - 059 dl - .7
FlBoring# ❑ Boring G�
64 Pit Ground surface e(ev. •q'9�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. 'Etf#1 'Eff#2
l 0-18 10 2-m5bx mfr 9 S 3vf 1, 18
Z 1$-38 IvYR4/4 - 512,l 3m5bK mf1 aW 24 -4 b
3 38-94 10 YR'1/4 /i fI S D 5 Oil - - --7 1- G
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'Effluent#1=BOD >30 1220 mglL and TSS>30<150 mg& •Effluent#2=WD <30� <and TSS 30 mg/L
CST N�(Please Print? Signature - -
Address Date Evaluation Conducted Telephone Number
2�IZ /v?NJ� SPRIiJq 1��}11�7-r►Jt M.AY—l0- 200E
For issuance of permits and designing
Contact: Ulbricht&Associates Ulhricht &Associates
Registered private wastewater consultant and pI1Y1ho Private Sewage Consultants
2812 10th Ave. 2812 10th Ave.
Spring Valley,WI 54767 Spnnq Valley, IM 54767
715-772-3442
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For issuance of permits and designing
Contact:Ulbricht&Associates
Registered private wastewater cones gW plumber-:
Ulbr'icht &/associates 2812 10th Ave.
Private Sewage Consultants Spring Valley,WI 54767
2812 10th Ave. 715-772-3442
Spring Valley, ti'll 54767
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