HomeMy WebLinkAbout028-1041-50-000 (2)
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RECEIVED
Wisconsin Department of mmerce ° "~"ORT Page of
Division of Safety and Building{ 2
vl}i i GrVeccordai
County
Attach complete site plaSqh0j00 l QWJA-dn 8 1/2 x 11 inches in size. Plan must '~E> r
include, but not limita~ DEWk"MOffence point (BM'), direction and Parcel I.D.
percent slope, scald tmensions, north arrow, and location and distance to nearest road.
Please print all information. Re ed by Date Q
Personal information you provide may be used for secondary purposes (Privacy Law, s 15.04 (1) (m)).
Property Location
Property Owner
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Govt. Lot r= 1 /4 & 1 / S..~ T -I,
C. i"C Eck
Property Owner's Mailing Address Lot # Block # Subd. Na or C5M#
C;ty State Zip Code Phone Number El city ❑ village . own ~Nwrest Road
7 T j k,1 f 7
Ckzic~`~ (71-5)_'_' `I _7 7 / L-S t j < v
J 7
❑ New Construction lJse: Residential / Number of bedrooms- Code derived design flow rate GPP
-Replacement ❑ Public or commercial - Describe:
Parent material `~k20r '724 Flood Plain elevation if applicable ,/V ft
~ ~ c ss
Ganerai wrnmt;ntS e
and recommendations:
,
Boring # Boring
C°'
Pit Ground surface elev. T ft. Depth to limiting factor Soil A lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD/fl?
•Eff#1 `Bff#2 '
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
C L C. L ~L -S:- I If
S /c`` Y~
3 r v- -fi-D 7 y r is c' t- UC- Ssg (.1 4 r1 311.
,r
L- 11 q I
i ❑ Boring
Boring #
Soil Application Rate
11 I c~ r pit Ground surface elev. ft. Depth to limiting factor In,
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP,Difi?
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
C F Ct 1~^ u. - ~•.~.L ~,hs~it C
~ Cl 3c- to f c 1' V
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Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD11:51. 30 mg/L and TSS : 30 M19/1-
CST Name (Please Print) Signature CST Numb
Address , Date Evaluation Conducted Telephone Number
7
,A' ;7tl- Y /CZ /t 5 , 1-1.11.1
71
Property Owner ~ 4 'ret-ti C R r Parcel 1D #
Bo
Y/ ~ c., r C?c~c: Page ~
❑ Boring of
Boring # C
Pit Ground surface elev. -
ft• Depth to limiting factor In,
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Soil A llcation Rate
Boundary, Roots GPD/fe
in. Munsell Qu. Sz. Cont. Color Gr.,Sz. Sh.
Eff#1 Eff#2
J/ !9
r
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 GPDAF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. .El `Eff#2
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L
Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor In.
SoI A lifgtlon Rate
Horizon Depth Dominant Color Redox Description Texture Structure Cgnsistence Boundary Roots P /fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
*E 01 "E02
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Effluent #1 = BOD6 > 30 < 220 mg/Land TSS >30 < 150 mg/L ' Effluent #2 = BOD6. 5 30 mg/L and TSS < 30 mg/L
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SBD-8330 (R.07/00)
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