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t-ZD <br />Wis. Dept. of Safety am',' Pro`e�sionai Semices 90"_ EVALUATION REPOFT Page _� of� <br />Division e safety and Buildings <br />in accordance truth SPS 385, I,,Vis. Adn,. Code <br />County ,r e <br />Attach compete site plan on paper not less than 8 ! 1 $ 5 l ust <br />include, but not limited to: vertical and horizontal r r i ( of d Parcel I.D. <br />percent slope, scale or dimensions. north arro+v, li rest road. Q 3 yj (s to <br />clo <br />PNease print all an f. Revie d Date <br />Personal information you provide may he used fc secondary ourposi,. acy a r . 15.04 (1) (m)). pC/p. "?f V7 <br />Property Owner Fropertty Location <br />1 ;TU A. Govt. Lot Sw 1/4F1/4 ST yp N R 7 E <br />Pro erty Cv , er's Mailing Address j I_oi Block # Subd. Name or CSM# <br />�;r, so <br />City State Zip Code Phone i'Juitber City 0 village WTown Nearest Road <br />+-os-►QT I 5YMI i t ? I5 > 7&0 ___ 9YIR �Pa.-t' ___ E t o C <br />C, R'c , <br />New Construction Uses Residential / Numher of bedroornsCode derived design flow rate GPD <br />J(g*Repiacemen; ❑ PubGc or con rrer: ial - DFsc.ri"% <br />I Parent material h k-)I+AlC,�� _._.. l l?od plain elevation if applicable <br />i General comments T,5vt I eas4 :3 G-S) Fa r —r .5 -rt- p1aIL e W'. d o4 . • . <br />and recommendations: <br />r-2 3 93-50 <br />1 BoringBoring <br />,: <br />pit Ground surface elev. _��,5C `t_ Depth to limiting factorQ•_ in. <br />Soil Application Rate <br />Horizon <br />Depth <br />Dominant Color; Redex Description Texture f Structure <br />7,orsistence <br />Boundary <br />Roots <br />GPD/ft <br />fft#1 <br />ff#2 <br />1 <br />in. <br />ifunsell Chu. Sz. Cont. Color Gr. Sz. Sh. <br />_ .......�_— <br />i <br />_ ` <br />o <br />aiY.`� <br />0 - 5 <br />vh <br />w.� r <br />mof/10 <br />3 <br />— _ -i- <br />5�f RS -- _F'S 0 " s <br />l <br />l <br />_ <br />a � Boring # <br />iC Boring <br />Pit Ground sut'iace elev. 7% So it. Depth to limiting factor /e n . in. <br />t Horizon <br />Depth <br />in. <br />Dominant Color Redox Descripiion i R xture Structure <br />Munsell Qu. S,-_. Cont. Color Gr. S,- Sir <br />onslstence <br />Boundary <br />Roots <br />GPD/ft <br />ff# "' <br />ff#2 <br />_ T <br />� <br />►o'+R ._ F:SL aFS16V, <br />- -- <br />�- <br />yFr- <br />a.w <br />c w <br />�m <br />►`�1 <br />._q <br />! . S <br />l___O <br />I <br />y 5yn <br />T <br />! <br />3 <br />►00 <br />Y�l ""•_.�.__ <br />F a v 5 <br />►rn <br />I <br />i l <br />cT-,iuenz ;T i = bUiJ = : u < zzt; ano l ,u _ i i,y/I Effluent #2 = ROE) 30 mg11- and TSS < 30 mg/L <br />CST Name ;Please Print) iilr ati CST Number <br />k -- _ a Q 11 Lf to <br />Ad Tess ( Date Evaluation ConductedTelephone Number <br />A �e boot' <br />s aw ��•• �:� ws S`i� 1�-------_ _- - 3-B-a�� — G5►-a38- g615 <br />CRT-I-QQIt) /R � 1 /11 <br />