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HomeMy WebLinkAbout036-1058-90-000 (2) ,DECEIVED JUN d 2 201 6 ~p Wis. Dept. of Safe! and Professional Services 'f A ~o~M' REPOR Page _-of ST, GROK nd Buildings COMMUNITY DEVELO MENT in accordance with SPS 385, ths, Adm. Code County s~ Attach comolete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must I aclude, but not 1?rnited to: vertical and horizontal reference point 113M), direction and Parcel LID. percent slope, scale or dimensions, north arrow, and Incation sand distance to nearest road. © 3 .,.bev Please pr/E?t all information, Rev' ed by . Date Personal infrrmaticn you provide may be rise:,' for secondary pu,pc,es (Privacy I_avi, s. 15.04 (1) (m))- Piocerty Ollrjr~~~r Property Location -So~-- ~f (1 Govt. Lot 1/4 W114 S T N R 17 E (or W P; ;perty Owner's Mailing Address Lot # i3lock # Subd. Name o SM# City State Zip Code Phone Number ~ ❑ City ❑ Village ®Town Nearest Road 9- (71 S 117_5 190 S~$" . ❑ Ne ~ truction Use: Residential / Number of bedrooms Code derived design flow rate..._30t GPD General ❑ Public or comlr~errial - Descrihe _ weplaceZ"t- " ~ aierli (nNi if oppi,cabic 'k, comments e and recommendations C P 1 0. Ce- 151 l 9 Boring pcJC~~$C. Boring4~ n u pit Ground surface elev. Depth to limiting factor__ ~Q in- - Soil Application Rate Horizon Depth Dominant Color Redox Description Tpy'.ure Structure onsistence Boundary Roots GPD/ft Ill Munsell Q.. Sz. Coni- Color 9 Gr. Sz. Sh. * ff#1 ff#2 slz ra r A to a tri IA- C V") Iftl 75 S rn7.<b-fA~ I JVF . tv C-R m 7. 51f Boring # ~ Boring IF "o Pit Ground Surface eleir „ li 7 - tin ; factoi n - - - Soil Application Rate_ HOrrZnn Depth Dominant Color P.edox Description exb.ue Structure onsistence Boundary Roots GPD/ft in. Munsell Ou. SZ. Coni. Color ter. Sz. Sh. ff#1 ff#2 F I ~ 1 i i - L Effluent #1 = n 0 D > 30 ; 220 me/I_ and TSS = ;30 _ TO mail " Effluent _ (30D 30 mg/L and TSS < 30 mo/L CST Name (Please Print) Signah~re CSTAamber Ac Tess a ey) '1 Do-r ^N S4 to Evaluation Conducted Telephone Number SIM4330 (R11/11) to N W i Se 3 (tJ, R 1743 ~ ah r1 IQr C S 'f' •~a~ 1'a4 ~ ~ ~~r~ lat • '"Not t o sc~^l L - gPPt-c~c~ 6orGlno\ e. ~8h+1 G. SdaP:r•s o G~~ ilaJ Ohl x i Q \P°°~ a Al As u ` ~ryw its ~'T'anlz ~pw5e ~ ~S l975 w x~,rc ~Qrass