|
• i...,',.. (.., 1117/ R NfAl . 01 (6c)Q
<br /> t- 19
<br /> Wisconsin Departn 210 Safety and Professional Sery s �f�5rj
<br /> c Page of
<br /> Division of Industry., -- es _ -a
<br /> 40
<br /> APR 05 2022 L EVALUATION_ REPORT
<br /> In accord oncew.h SPS 385,Wis. Adm. Code County ,-) �y
<br /> - Attach complete sitepl an on paper n , 31, "! r,
<br /> P P P 018'ttlje x 11 inches in size.Plan must include,
<br /> but not limited to:vertical and b.stiit$AFrottid, ltmoft4),dire;tion and percent slope, Parce I.D.
<br /> scale or dimensions,no tl, .�,a, oca-r Ol`yo_is'-.I y-.Ca -oo/ _0di, ?
<br /> J ItiLdtl❑n dn❑❑istance to nearest road. i -a - O 17 i O k
<br /> Please print all information, v'ee. by Date
<br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). tw.
<br /> , _,, - P� 4/ I I Vi.2-/1
<br /> Property Owner Property Location 0 ❑
<br /> J t k►'1 Li) r ids Govt.Lot 2 'A 'A S d g y p N R /L/ E (or) c
<br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# 3/.3/
<br /> 44?39s DA,e.in /?"-t .2, v,1y t / O 971O76
<br /> City State Zip Code Phone Number 0 City ❑Village ©Town Nearest Road A'3 i5
<br /> Web$ite I I' lit/5/3 I ( ) 1 I S'colf I i hein iz,;l
<br /> RINew Construction Use:®Residential/Numberof bedrooms -3 Code derived design flow rate 11)6' GPD
<br /> ❑ Replacement 0 Public or commercial-Describe:
<br /> Parent material 004IA-( Dr iT 7` Flood Plan elevation if applicable /ie)ft.
<br /> General comments and recommendations:
<br /> 5 y.'. e1 t',. 93:
<br /> ' Boring# [3 Boring 7`f
<br /> iv
<br /> 2 Pit Ground surface elev.Cit' 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 /> % A _y *Eff#1 *Eff#2
<br /> 7,5,1R 34 /5 /h1,56 1 ,,,,, I L j A -7 it 69
<br /> el LI- 3is 7,5 / `"/y r 1,1115.4K w. ] (:5 '3 co , 7 /,6
<br /> 3 S ) 3"'t/2 `'/to l- ://v s b K- jr I C- 5 Ill • -7 /, r✓
<br /> q Co -7 -75ylz s7ti — s os6, r^ I 7 /, 6
<br /> I Boring# 0 Boring clU 3 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 /> /
<br /> C _ 7, f?3/� . *Eff#1 *Eff#2
<br /> l-5 l dns h/4 is-. 1 c:5 1 ti , 7 /,
<br /> d q_ 30 7 S—r ?y/ _ /5 :>tim 3 6 g ,-,., 1 6-S 3co
<br /> 3 3sy- 7 fyR? '/� _ 7 /,6
<br /> .-/ 5.4-7) 7,-C i/?-'9 — s 1,-3 G- fit-, I , f
<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 mg/L
<br /> CST Name(Please Print) Sig ature `1 CST Number
<br /> �i:•-1ti,<5 S'a„,..,./.5 Ji. J v )7.3 so
<br /> Address A 77(c' /"/."^7 .5— D e Evaluation Conducted
<br /> �-Lh 5f c` 6YZ Telephone Number
<br /> 5�1g93 3 - 30 -).). 7/_5= yry6°- 4//5-7
<br /> SBD-8330(R04/15)
<br />
|