Laserfiche WebLink
Wisconsin Depa Page of <br /> Division of Industry . . C" ,'-.D—.2 q12 <br /> SO <br /> ,IL EVALUATION REPORT <br /> i, ' t►4 bccorc Onoewith SPS 385,Wis. Adm. Code County <br /> Attach complete site plan on paper not less than 8112 x i fi6hies in size.Plan must include, 9U(Nep <br /> but not limited to:vertical and M),4rection and percent slope, Parcel I.D. D�(p <br /> scale or dimensions,north a .:,. ,� r i st�a9ce to clearest road. <br /> �—Please prim a1frrab YPi�tTt�tt:, Reviewed by A Date <br /> Personal information you Provide may be used for secondary purposes Pri Law,s.15.04 1 m -ly <br /> Property Owner Property Location El 0 <br /> �eoll r1111m-iye4A1 Govt Lot N E '/. /()F.'/. S Z 3 T 3 N R /'7 E (or) .W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> City State Zip Code Phone Number 0 City ❑Village 14Town Nearest Road <br /> @'New Constriction Use:(y Residential/Numberof bedrooms ZCode derived design flow rate 3 V GPD <br /> ❑Replacement / ❑Public menial—Describe: <br /> Parent material 6!'�C�b!/ �i�7' Flood Plan elevation if applicable <br /> General comments and recommendations: <br /> I Boring# ❑Boring <br /> [1a Pit Ground surface elev.17 A Depth to limiting factor J in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. -Eff#1 •Eff#2 <br /> 0- 7 7 3 — ZS mti" IV 1- E F . 7 66 <br /> 7 3"7 7SN,e / F9 '14,L <br /> SO <br /> v <br /> FilBoring# aBoring <br /> ❑Pit Ground surface elev..7 ft. Depth to limiting factor in. <br /> Soil Application 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. -Eff#1 -Eff#2 <br /> 6 -59 X5YA/y <br /> *Effluent#1 =BOD,>30 5 220 and TSS>30 515 L 'Effluent#2=BOD,>30 5 220 L and TSS>30 5150 m <br /> gfL <br /> CST Name(Pri / Signature ��` CST Number <br /> Address Date Eva nation Conducted _ Telephone Number <br /> MR//4/N 1k,e/&k69r)j �Z-3 za l5-566�azoz. <br /> SBD-8330(R04/15) <br />