Laserfiche WebLink
010 0y <br /> Wisconsin DepartIndustry <br /> o a(�ak-%p L5fis �r1V'tW �% Page of <br /> Division oflndustryS is (�C�C ll�Vi LG �LfI ��ff n ST- a ( — j-7� <br /> AUGI VALUATION REPORT l• <br /> A �- 9 IrQq2jrdar SPS 385,Wis. Adm. Code County <br /> Attach complete site pla n er not less than 8 1/2 x 11 i I size.Plan must include, <br /> but not limited to:vertical and h rizontal reference point BM direct n and percent slope, Parcel I.D. HO�t4�1f� S'aS-CJGiI�03c oqe <br /> scale or dimensions,no arro nce o near t road. G 7Y-01S4 <br /> l�@�eS tNif9#Rt46 Reviewed by Date <br /> Personal information you provide maybe used for secondary purposes(Privacy Law,s.15.04 1 m • '. 2 <br /> Property Owner Property Location <br /> -)Of- 6 c- e,m bps Govt.Lot '% Y< S y T 4G N R /Lf E (or) W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> City State Zip Code Phone Number El city El village [�Town Nearest Road <br /> 5 o�h�V- t S'H S©I Sce�/f J 1�i7 C��/ea L7 <br /> ❑New Construction Use:®Residential/Number of bedrooms 3 Code derived design flow rate L/3'r'GPD <br /> ® Replacement ❑Public or commercial-Describe: <br /> Parent material I'cc c ie-f /)r i iLt Flood Plan elevation if applicable `"Alft. <br /> General comments and recommendations: <br /> Boring# ❑Boring51 q6.a©Pit Ground surface elev. ft. Depth to limiting factor in. <br /> Soil A [!cation Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ftz <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. <br /> *Eff *Eff#2 <br /> -7 <br /> q -3 "A 6 k <br /> 3 3d-S'a 7Sy/7y/4� s 3/ , S /� ca <br /> �S 561t v',� f G S i/-- .S 40 <br /> � Boring# ❑Baring f� <br /> J [�Pit Ground surface elev. Depth to limiting factor in. <br /> Soil A lication Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Fe <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. <br /> *Eff#1 *Eff#2 <br /> l a-'I �,sti�� 3/J. 1S /M561C /,► 1 c5 -7 /. 6 <br /> y- 36 ,5 tifz a -- 1t=5 r✓��6 J� 1 (i S 3co . s— 1, O <br /> 36-5-6 7•S"II? y b 9J�S m y b k l (> 5 A M , 5- 40 <br /> S6-6. 7 5'M S/q 15 Ac r►, 1 ,? 6 <br /> *Effluent#1 =BDD,>30 s 220 m /L and TSS>30 s 150 m /L *Effluent#2=BOD,>30 s 220 m /L and TSS>30 s 150 m 1L <br /> %ST Name(Please Print) Signatur CST Number <br /> /S , _Sr 0 4%1� -73`fit 6 <br /> Adress �J76d /"Y '�s" Date E aluation Conducted Telephone Number <br /> SBD-8330(R04/15) <br />