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IVCWisconsin Department of Sa' _i . , -. ,• .1. , (� o <br /> Division of Industry Services `7 a 5 o e�1 -2 —/1� Page ( of 2 <br /> �QY 2 2b9(l- E I TION REPORT �f <br /> fn accordance with S• 5 Wis. Adm. Code County <br /> Attach complete site plan on pape .t a than 8 1/2 x 11 in .- '• ' e.Pla must include, 8l�r„e f-� <br /> but not limited to:vertical and hori..ntal r- ` <br /> .ppp -17.v:i,fi ction and pe cent slope, Parcel I.D. <br /> scale or dimensions,north arrow,a' d locajio�o - - _ctep mamma. 07-0114.2-Mr/5- - OS 00S•0270°0 <br /> PI . in ormau i we y �' I�Da e <br /> �/?? <br /> purposes <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner 1 Property Location El <br /> C ,5 f- o� 1e5 Govt.Lot Y, V,, S T N R E (or) W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 7101 Mark Terface Dr <br /> City State Zip Code Phone Number 0 City ❑Village (Town Nearest Road <br /> Ecli na I N 15943`1 I (95z gs0-5/ "7 I I Ga-1*kK pax+ I?,c1 <br /> ❑ New Construction Use:[Residential/Numberofbedrooms 3 Code derived design flow rate 950 GPD <br /> [.Replacement 0 Public or commercial-Describe: <br /> Parent material Of>71-Lt.iA5k Flood Plan elevation if applicable ft. <br /> General comments and recommendations: <br /> sySi.ewt f£lfva}liWt q3,0 <br /> Boring# ®.Boring Q <br /> 0 Pit Ground surface elev. 17 Depth to limiting factor 90 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. <br /> *Eff#1 *Eff#2 <br /> I U-zo SYR 1-1-3 /lone L5 lwtSbK _ "-Fr C. I C • -i 1. 4, <br /> Z zo-50 SYR ÷L 404 c LS I v•vsblIN ru✓b,r C S 2.ve <br /> . 7 l • lo <br /> 3 -90 S1'R 4-LI one LS I msblL itk✓fr C S 2vC • '7 1 , to <br /> • <br /> ZBoring# Boring p <br /> ❑Pit Ground surface elev. 153 ft. Depth to limiting factor 55 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. <br /> *Eff#1 *Eff#2 <br /> I JO-1Lo 5Y29-3 rroKe LS luc bk µ.1.-cf CS lc •7 t• lv <br /> 2 [to-3q 5Yg. LI-b hone L 5 I wtsbY- A✓cr C5 Zi• * 7 I. (0 <br /> 3 3LI-85 5YR N- y 'lane L. 5 1 PA51)L i/-W4( CS 2Je- • 7 1. to <br /> *Effluent#1 =BOD,>30 5 220 mg/L and TSS>30 5 150 mg/L *Effluent#2=BOD,>30 s 220 mg/L and TSS>30<_150 mg/L <br /> CST Name(Please Print) Signature -', I` CST Number <br /> U el�..o las {-Lv3Lc.3 Ali"- 150 5-57 Z <br /> Address Date Evaluation Conducted <br /> 277(00 )- Pt 3S Telephone Number <br /> /(- �- z I 7/5-15LpIo- yl5-7 <br /> LL)e‘S+er INS 54%93 SBD-8330(R04/15) <br />