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Wiscongin Department of CommeD R I G I N AL EVALUATION REPORT Page of <br /> Division of Safety and Buildings <br /> in accordance with Comm 85,Wis. Adm. Code <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must County so orn <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and r� t� <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. as o �irCh 1514�1d LA. <br /> Please print all information. Reviewed by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner Property Location <br /> 1�- ' 11 + G n c N ck.c K 0. Govt.Lot 1/4 1/4 Sig T lfv N R I y &Jer)W <br /> Property Owner's Mailing Aftess Lot# Block# 6W h-d--PJerReeFCSM# , <br /> H00 peer fOSS�r1 3 C 44Q0%j# vo1. 11 , ► ay <br /> City State Zip Code V Phone Number ❑City ❑Village j2 Town Nearest Road <br /> EI �nI SC 1 a9Oti51 I R;rCh 1 c. <br /> I] New Construction Use: Residential/Number of bedrooms .3 Code derived design flow rate ySC) GPD <br /> Replacement ❑ Public or commercial-Describe: <br /> Parent material 6 L A G t Pr L 'T I L L Flood Plain elevation if applicable N A ft. <br /> General comments <br /> and recommendations: <br /> Non-premdsu�•2ed In- e�s•o��d <br /> �ecomw.ensed SyStevn E►m'vaF on iZan9< 91, 60 7 - 91. 8r-1 <br /> Sa: l La4-6:rNG R4ic o. s /0 . 9 �pd <br /> F <br /> Boring# ❑ Boring <br /> ® pit Ground surface elev. 95• ft. Depth to limiting factor !(o in. <br /> Soil Application Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 'Eff#2 <br /> I 0-5 16YR y/3 1 o f 5V ev,.,•fir s o •s 0-9 <br /> 5- OYRY a�rS)0K 1-..11�r S aM O' s 0 -9 <br /> QS:55. 7.5 YR '1141 mr q w <br /> L./ SE-W. 7.5YR 9-44 m b *�1j�-c 0. S 0.9 <br /> 37,6'YRsX �A zusyfO1VWt'3bK -- <br /> 1" bay%6 o <br /> I^Iiia <br /> Boring# [-] Soil Application Rate <br /> Boring / <br /> FQ ® pit Ground surface elev. 3./7 ft. Depth to limiting factor b 8 in. <br /> Horizon DepthDominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 <br /> in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 I -Eff#2 <br /> 6-S v 4 ----- FS a f9bY. r.v�r s J O• s O .9 <br /> a say ti -- a�sb ��c s a� 0•s o. � <br /> 3 -G 7.242-4/4 I a'�m W « o S 0. 9 <br /> �l <br /> 46-48 7.5Y2 SX/ -- M b W W 0--5- 0.9 <br /> S (Z77 7-SYR SA I YR'/ 4 I �S bK <br /> oc�2on hag SGS *;..G1 SG a <br /> Effluent#1 =BOD5>30<220 mg/L and TSS>30<150 mg/L 'Effluent#2=BODS<30 mg/L and TSS<30 mg/L <br /> CST Name(Please Print) Si lure CST Number <br /> feo-* -3t C�Q6 <br /> Address &I Date E.vilfbation Conducted Telephone Number <br /> 4 IOSA! 5+cdc j�oacl ol7 Xa ward W1 5, y3 8J/S/o 1 C7is)-634-8a5� <br /> SBD-8330(R07/00) <br />