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Wisconsin Dep M. t ' f r" i (y ,�n 8a <br /> Division of Indu S VVG ( `1 a 1 Page of <br /> IL EVALUATION REPORT <br /> JU y 2 2 2022acc a with SPS 385,Wis. Adm, Code County �2 u <br /> Attach complete sit la paper not less than 8 112 x sin size.Plan must include, <br /> but not limited to:v ical a d horizon taf reference point BM), On <br /> and percent slope, Parcel LD, <br /> scale or dimensions north ce joearest road. `7_a _ v tio vl wed 61`f CCt <br /> / <br /> Personal information you.provide may be used for secondary purposes Privac Law,s.15.04 1 m). D <br /> Property Owner Property Location t <br /> ErrG �rrC Sort Govt.Lot y, y, <br /> C T `-/G N R 16 E (or) W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> /3�b yj"th 141,c NE `f <br /> City} State Zip Code Phone Number ❑city <br /> `-C/k4nb - �S MA/ 5 � ❑ViIlage �w0 Town Nearest Road <br /> Cck k 14:, <br /> FGeneral <br /> uction Use:O Residential/Numberofbedrooms_�Code derived design flow rate `l-^GPD <br /> nt ❑Public or commercial—Describe: <br /> 1 s C r E 1 D,-i{'A Flood Plan elevation if applicable/'//,ft, <br /> ts and recommendations: <br /> 93, G <br /> Boring# ❑Boring <br /> ©Pit Ground surface elev. 9S' Cft, Depth to limiting factor 7 in. <br /> Soil Ap lication Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Fe <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. <br /> l `0- `y 7,,5`1/7 34 /S /M bIt 1 C S 3 `Eff#1 Eff#2 <br /> '., ,7 h <br /> 3 '>o-5S 7,5'1R + G s' oS� . 7 116 <br /> 1 I Boring# ❑Boring <br /> _�J ®Pit Ground surface elev. s yft. Depth to limiting factor 7 in. <br /> Soil A lication Rate <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Fe <br /> In. Munsell Qu.Az.Cont.Color Gr.Sz.Sh. <br /> � y- y 3 7 5-`!/7"A �� -7 <br /> 75`7 R <br /> / J �4° rY� 1 -� 1. 6 <br /> 'Effluent#1 =SOD,>30 5 220 m /L and TSS>30 5 150 m iL `Effluent#2=BOD,>30 5 220 mg/L and TSS>30 5 150 m /L <br /> 3T Name(Please Print) Signat e CST Number <br /> (dress A 774 G Jy+-y 3S Dat. valuation Conducted <br /> � Sri 3 1- _ Telephone Number <br /> -` 71S- 5Ee-_ '//f7 <br /> SBD-8330(R04/15) <br />