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Wis. Dept. of Sad I� QIT SLil&U-ces S014 EPORT Page of 3
Division of SafeBuildingsSt. Croix Countyn actorance with SPS 385, Wis. Adm. Code County
Attach complunity Develo ms n an 1/2 z 11 inches in size. Plan must �
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Q.30-.Z 33
Please print all information.
• .R ' by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
1
Property Owner / y Property Location
(or)�V
IQItrCflAt L.� evi Gov. Lot 5tiG 11456 1/4 S23 T�0 N R2� i
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 4tq
18 - l y�,►�P �4ve
City State Zip Code Phone Number [I city ❑ Village ®Town rest Road
o�.lte� (,vs
Y O
�t New Construction Use: ❑ Residential / Number of bedrooms Code derived design flow rate GPD
❑ Replacement ❑ Public or commercial - Describe: ( AParent material GhQ�cK 0-4't t- ' aL Co C.Z Sca.�, L•.wt Flood Plain elevation if applicable _%a Ana x` ft.
General comments Sf.s y-eM �� 7 �. ��t /n�r�l- Q �e �' W Q L' Ds ��al R��� �' -� FfF r
and recommendations:
U Boring
Boring #®0•
Pit Ground
surface elev. 3 ft. Depth
to limiting factor
P g
9'
/d !
in.
Soil A lication
Rate
Redox Description
Qu. Sz. Cont Color
111A
IVA
Texture
$L
s G�
rns
Structure
Gr. Sz. Sh.
m �
o s
6s
onsistence
S
L
�
Boundary
as
c w
Roots
/�'
w�
Horizon
Depth
in.
Dominant Color
Munsell
ff#1
O r
ar 7
ff#GPD/f2
/(
l t�
o-q
loy z
2
q- 63,
to yR s�
3
6s �o
/oyRs�
FZ-1
Boring
Boring #
19 Pit Ground
Q p
surface elev. qU . O
ft.
Redox Description
Qu. Sz. Cont. Color
Texture
Horizon
Depth
in.
Dominant Color
Munsell
[
v-1
PA _
A/A
/U,41,4
SG
L
2.
12.23
Foy /y
3
234Y
7,sY9 y/`AIA
y
y /o1
7 OR %
Depth to limiting factor (� i in. Soil Application Rate
Structure
Gr. Sz. Sh.
Donsistence
Boundary
Roots
GPD/ft z
ff#1
ff#2
0 m
0.0
11O
ams6k
ol/l�l6k
s
s�
a s
c
��'
10,4
0, 6
0,
0,7
0� 8
1.0
om f�
s
' Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent #2 = BOD 5 < 30 mg/L and TSS < 30 mg/L
CST NaT Number
a eS
P�f a.� arse l(.�� y
Address Date Evaluation Conducted Telephone Number
a cue SoMer-ser- AU2 5YWr /0 -026 c26.2Z 7X 7,0 6 8s"
Property Owner Part/, cAn4C � ey e/ y Parcel I D #
Boring # ❑Boring ^ _ L
® Pit Ground surface elev. ' ft. Depth to limitina factor /d 8
Page 2 of 3
Horizon
Depth
in.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
onsistence
Boundary
Roots
3
0= q
•71. 7d
/dYR %Z�
/4
/l�'/t<
SC
2m
a /Vs6.4.
s
c c.,
C 4-,
t
/ u ld
Soil Application Rate
GPD/ft 2
ff#1 * ff#2 _
0 � 6 1., o
016 .01.g
0,-7Q 19,6�
d, -7 << 6
Boring # U Boring
u ❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Eonsistence Boundary Roots GPD/ft I
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 * ff#2
----------------
------------------ T
F-1
Boring #
❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in
Horizon
Depth
in.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
onsistence
Boundary
Roots
*
Soil A lication Rate
GPD/ft 2
ff#1 *
ff#2
k
* Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD 5 < 30 mg/L and TSS < 30 mg/L
The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to
access services or need material in an alternate fonnat, contact the department at 608-266-3151 or TTY through Relay.
SBD-8330 (R1 V 11)
OWNER Name Mar(eanne Zeverty
Address -Zi a' /Vn j 4ye
wr. ST0, 80-
Benchmark 1 TOP I!/Z//PJc f"?e 15�, /00. 0
O Benchmark 2 %bjl /yz" f
❑_ Soil Boring
_ i Suitable Area
1" = 40' Scale
Page 3 of 3
Brian Parnell
CST 231314
Date
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