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Wisconsin Dep; (y { l v� <br /> Division of Indu. : � ' - _ Lam/ V Page of <br /> c.*IL EVALUATION REPORT 0-S`—_ _91 <br /> JUN D n ac., ._, .-with SPS 385,Wis. Adm. Code County <br /> - Attach complete si •lai 'n pap r not le s tan 1/2 ,c es in size.Plan must include, 7A.~h e <br /> but not limited to: -rtical nd horizontal reference poin, :•), I irection and percent slope, Parcel 1.D. <br /> scale or dimension nort _ _ . ce to Barest road. 07-0440-,2-Y0-14-0 S-/,�,yr e^),670C <br /> =urne owly <br /> Land SeelieepriDbpditrfmaration evi w1ey / <br /> ,r/ Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). •, I ‘(�)/2 D <br /> Property Owner Property Location / <br /> 14`''\'rt't i/i/, A j Govt.Lot +/, + <br /> Property Owner's Owner's Mailing Address S c� T yG N R �(� E (or) W <br /> e� Lot�� I Block# I Subd.Name or CSM# <br /> City State Zip Code Phone Number <br /> / /� I M� I,5�� I ( ) 0 City 0 VillageI ®Town Neares;oar!a 5 /r S <br /> `-l'c'� RL� jct �I <br /> �c lUw.,�( I f%CN1 Al Ak, 4Ant_ <br /> NewConstruction Use:®Residential/Numberof bedrooms 3 Code derived design flow rate SI_rG GPD i <br /> ❑ Replacement / 0 Public or ommercial-Describe: / <br /> Parent material Lr('6Gl a �� i h Flood Plan elevation if applicable�!fift. <br /> General comments and recommendations: <br /> s y.t �l,e v 93, C �1.1 ,5 c7 0 <br /> I ) <br /> I Boring# 0 Boring <br /> ®Pit Ground surface elev.9 ft. Depth to limiting factor , ')In. <br /> • <br /> Horizon Depth Dominant Color Redox Description . Texture Structure Consistence BoundaryRoots Soil Application Rate <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. GPD/FYI <br /> / • /mil Jt . • / s 3 M . -7 /, d <br /> [1,5" c.s•6, >''^ I — , - 46 <br /> IBoring# 0 Boring Q Pit Ground surface elev.96 I ft. Depth to limiting factor 7 7 iy <br /> n, <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bounda Roots Soil Application Rate <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. ry GPD/Ftz <br /> C• _y ,S yl� 3/� /S l /C *Eff#1 *Eff#2 <br /> s , l �s 3.v, * � /, 6 07 le- 3C 7,Stile % s es <br /> IS esG .�, I — — , 7 /, E <br /> *Effluent#1 =BOD,>30 5 220 mg/L and TSS>30 5 150 mg/L *Effluent#2=BOD,>30 5 220 mg/L and TSS>30 5 150 m /L <br /> ST Name(Please Print) Signature g <br /> �o-HH•e S/f )6h/Y /5 /At CST Number r <br /> idress 7-7¢0 /ywy 3-5 - Date Ev ation Conducted <br /> il''"c-SS�r'.'1,�� s'� 93 Telephone Number <br /> SBD-8330(R04/15) <br />