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Wisconsin Depa a e oi�f d!' oElss; n__ t c-': 0 v of <br /> Division of Indust e es a` Page <br /> F. <br /> SI IL EVALUATION REPORT 5T-Q_D--1'7 9 <br /> ! SEP 1 4 2012D I )i County <br /> . '1 j n acco 4e vith SPS 385,Wis. Adm. Code �tfr r n G <br /> stiti— <br /> Attach complete site plan ori paper not less than 8 1/2 x 1 inchOs in size.Plan must include, <br /> •but not limited to:ve rcal an'd liorl7.RAAlza j®pmp oint :M),di[ection and percent slope, Parcel I.D. 3 ig_d 7_,S-/S:-.3.5-17L <br /> scale or dimensions,Porth aE�W'c�a �r1A Sop@ps r�l� *rest a to rest road. 07-04101-4- 8- <br /> 04100 <br /> L Please print all information. vre d bye „ip4A............pQat <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)), • � <br /> Property Owner Property Location ❑ <br /> 121 <br /> La k•c 7-1,a rise,, Govt.Lot '/4 1/4 S j 7 T 38 N R 18 E (or) W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> /, 6`+1 41j'Aere- 17r" ' 13,E /N <br /> City State Zip Code Phone Number ❑City 0 Village ©Town Nearest Road //V./9 <br /> orxedx 5wr5 I ti'''t 15z?.i'/D 1 ( ) i Wood /31trI V•Sher,e Dr tus <br /> 0 New Construction Use:©Residential/Numberof bedrooms 3 Code derived design flow rate 41. GPD <br /> fJ Replacement 0 Public or commercial-Describe: <br /> Parent material a4 o,+t. 1 Or;f e Flood Plan elevation if applicable /V//9 ft. <br /> General comments and recommendations: <br /> 5,vi. elev 9S' a <br /> / Boring# ❑Boring 96•S X‘ <br /> f- <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 -'5 75-'7il34 — /.S /7#1S5k /v,► GS 3rh ,7 / 4 <br /> J 8- '/`/ 7•Sy/ why /S .4.'6 le 1 s s 01F ' 7 /, 6 <br /> 7 '/y-sr 75-"04'4 /s amsdk ,•.. 1 63 — - 7 Ab <br /> - <br /> Boring# 0 Boring 6 7 <br /> Z Pit Ground surface elev. ft. Depth to limiting factor 6 0 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 /> / a- Id 7.s”I17 "14 /s IMS6/c r►, 1 c i 3ti, . 7 /.6 <br /> GI / . 3) 7.S'1R "1/,3 -- /S j ms 6 /c ,.,.1 1 6 S 3 Go .7 / 6 <br /> 3 34- 60 7•s'Z S i s 060- rv,1 ( 5 /F <br /> ,7 /. 6 <br /> Li r'60-04 7 7' 579 f- s <br /> /r. 'YR% S 056- <br /> /Y► I 7 /6 <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) SignaturCST Number <br /> Jt ies s /)4hs-els s� ot734/01.o <br /> Address ,1774 O )' :?-f Datevaluation Conducted Telephone Number <br /> iv•t b,.sf r r Lia- .St/ff 9.) 5- 1 - d 0 7'J e‘.0-eii/S7 <br /> SBD-8330(R04/15) <br />