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nPrivate Onsite Wastewater County:
<br /> industrysew Treatment Systems ( POWTS)Division C.'-5).
<br /> 1 t y,p$% PDBax7162,
<br /> ' E Madison.WI Soil Saturation Determination Report Parcel Tax No:
<br /> `��`% 53707-7162 Pursuant to SPS 385.60(3),Wis.Adm.Code
<br /> General Information " Jam/- 137- ` l
<br /> Personal information you provide may be used for secondary purposes f Privacy Law,s.15.04(I)(m)]
<br /> Property Owner's Name: Owner's Address:
<br /> C /g...r or,4A,72_ c,� S P t4«.E;--- )4:it/ .4%7, , ,/4' i/) 3- 3
<br /> Lot Number. Block Number.
<br /> / ❑City ❑Village 4S1 Town of: /..0."74t:-..�-,r./
<br /> Subdivision I CSM Name:
<br /> C Sir!, yam/02 Govt.Lot , /i`✓ 1/4,"WC- 1/4, S 3a ,T 7 N, R rr___E/v'-
<br /> Monitoring Zone: BM Elevation(ft): BM Description:
<br /> lA a 13 a C �,�,. 1 v v-c' 6..5.4..7{, ..S1.,o."it
<br /> Observed Water Elevations(FT) Observation Pipe Elevation Data(FT)
<br /> OBSERVATION OBSERVATION OBSERVATION OBSERVATION OBS. TOP OF GRADE BOTTOM GRADE EL
<br /> DATE PIPE N0: f PIPE NO: 07. PISS N0: V PIPE PIPE AT PIPE OF PIPE MINUS BOT
<br /> NUMBER OF PIPE EL
<br /> -2-• )J /6 /✓vo✓tr /vA ni./JE N✓h!E t.✓- l 5'c,• / 9`f-- 5k'.,2 3. F
<br /> ..:4-��< /4 w-vt, 9S / 9...3 i " 2 V/.c
<br /> g 9-/6 w- 3 / /• 92..-3 fl.s 2. 7
<br /> _3,."7 ..i6 Comments/Conclusions
<br /> /V / 1 ,J.- 5/ ! 2/ . ? Is =3 { 7c'- S/1 s . 5'
<br /> 3-/7-/4
<br /> 7. ? 5//L
<br /> 3-zf-/6
<br /> y;-/l- it _
<br /> SI6-- , C. I( Monthly Data
<br /> Station(s)Precipitation
<br /> Data Obtained From: c/"..4.4.3-0.0-• F ..-.0 - /v,...4/1.,14 '°v'"' AL-7,i /AA-J-7- " '7/-i0"`/
<br /> Monthly Precipitation Amounts(in)
<br /> Sept Oct Nov Dec Jan Feb Mar Apr May
<br /> ti. c,/ 2172 _.s-3 F 5y'a3 v. 6. 0,...1-3 __3 .75- /-.2y .7:c. 6
<br /> Total Amount Sept-Feb (Need 8.5 inches):d v: /. inches Total Amount Mar-May(Need 7.6 inches): 0...5:5- inches
<br /> CST Name(Print): , CST Address: CST Telephone:
<br /> ,;7"•94.--,L. "9. /y,92 e,T 72.2 6 -ti a a.2„✓9 ,PX., V %.,s,✓ Goy,)'f� /cr.c '
<br /> Date of Signature: CST Signature: yy ", CST Credential Number
<br /> G- Z--ii_. / /
<br /> "4 _ o2.2539K
<br /> This form is required to be submitted pursuant to SPS 385.80(3)(J),Wis.Adm. Code. Failure to complete this form may result in denial of the approval
<br /> request. Information to be submitted In addition to this form includes,but is not limited to: Data on artificial drainage,a completed Soll and Site Evaluation
<br /> Report(SBD 8330), regional water table Information,daily precipitation totals for February through May,any previous site specific observation results,
<br /> governmental unit or department reports on observation pipe construction or water levels,and a site plan showing observation pipe locations. All information
<br /> must be submitted within 60 days of the completion of observations. When more than three(3)observation pipes are installed,use Page 2 of this form to
<br /> report observation data,results,and commentslconclusions.
<br /> SBD-6412 (R03113) Page / of
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