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Wisconsin Depa 111-1jr.k:-.....E,(1..Va �1t0 D <br /> Division of Indust - , es C �' Page of <br /> /r IL EVALUATION REPORT <br /> FEB 14 20122 <br /> n acco ill i ith SPS 385,Wis. Adm. Code County pp <br /> Attach complete sit.plan o' ,-.- .. ess than 8 1/2 x 1 inc -s in size.Plan must include, JK0?IV <br /> but not limited to:v. ical and hor? , r.. poi :M), •rection and percent slope, Parcel I.D. �s dy_y chi- 000-01! o 0 <br /> scale or dimensions north.a 411 ice to ,earest road. o7.Ot�-d-'+�- *35615 <br /> Please print all informa ion. Reviewed y Date 7 <br /> Personal information you provide maybe used for secondary purposes(Privacy Law,s.15.04(1)(m)). 2 W M) <br /> Property Owner Property Location ❑ <br /> El <br /> -)01' vt 6h .(r4 Govt.Lot % % S <br /> Zip N R /mot' E (or) W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# Dot y`y/7d <br /> ?a c3 et' 1 `f 9 3$ atc.et'S <br /> City State Zip Code Phone Number 0 City <br /> WCbSf+°f �.✓,�' f4�i,�' 0 Village ®Town Nearest Road <br /> (- i ,.)0.4l4Son (Ali Idhayer RI <br /> ® New Construction Use:©Residential/Numberof bedrooms 3 Code derived design flow rate yt-o GPD <br /> ❑ Replacement 0 Public or commercial-Describe: <br /> Parent material a/AU'► Dr i-rY Flood Plan elevation if applicable NM ft. <br /> General comments and recommendations: _>j `o/-t' 3'3 , O 0,0 9d. O <br /> Boring# 0 Boring <br /> U Pit Ground surface elev. 937.eft. Depth to limiting factor 7 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 /> f 0 -1-1 1.1'itt 34 >1 A•'+ s6/6. M I 4 .5 3f . 7 / 6 <br /> ) y- S'/ 75`ig 4/4i — 1 F5 Amsble .... 1 G S 3 e0 , s I, fJ <br /> 3 5-1- 7 y 75111Z 37s - a s G ,,,.. f — a2 ni .-7 / 6 <br /> I I Boring# ❑Boring gH > 7� <br /> Pit Ground surface elev. ft. Depth to limiting factor 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 /> / o- y -g'11e 3/I. -- i S pZrn1.4/4 I G,s 3F . 7 /, 6 <br /> A zi- qo 7.5-HI?1'yy — /GS Amsbl4 mi G- 3 3C0 , 3- /. 0 <br /> 3 YB- -7) -7.c iR s%ti , 09‘ 0... 1 — A m . 'i /. 6 <br /> *Effluent#1 =BOD,>30 5 220 mg/L and TSS>30 5 150 mg/L *Effluent#2=BOD,>30<-220 mg/L and TSS>30"5 150 mg/L <br /> CST Name(Please Print) Signatur �p CST Number <br /> .Ja vh-es s Da i)t-elf seta-.--�`t ) 771/10 <br /> Address 4 77(pG /'"-Y 7.3- Date E luation Conducted Telephone Number <br /> +,-t 6.r i-r, wS fzi8'S 7 0,1 - S'- 02) -7y.5= tG6 - v/s 7 <br /> SBD-8330(R04/15) <br /> REVISED <br />