HomeMy WebLinkAbout032-2193-11-080RECE YED
06 - 4
JAB 0 3 2023. .
s Croix countynt SC�►IL EVALUATION REPORT Apv?!
of rg
V�li . '� of Safety p m e �
of Safety and60x17Z*,
Dnrrsi<`�n ety
in arcc o"iwxe with SPS 385, vltis. Adm. Cade
Cvu *
Attach complete site plan on paper not less than 81 i2 x 11 inches in size. Plan must
indude, but not limited to: vertk W and horizontal reference pant (BM), direction and Parcel I.D.perwin..0?0
t t road.
t slope,scale or dimensions north anew, and location and distance a nearest � l
Please print all Information. R by Date
Pwso" info nation you provide may be used for secon+dwry pugx es {Privacy Law, S. 15.04 (1) (m)). 213
Property Proper Lora
GovL Lot ._.. jV 1t , - 1/4 S T " N R E
Props Owner Maltg Address Lot Bbdc ## S►ubd. or
Z� (2
e Zp Code 'hone Number 0 Q vaage oVM Nearest
New Constn W use: a Residential f Number of beds ,3 Code derived design flow rate 47Z_'r � � GPD
0 RepWcesnent Q Public or commercial - Describe:
Parent material Flood Plain elevation If applicable ft.
General oonxxnents
and r
m re-
�X
&3fing
Boring
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r
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Boring ##
Pit Ground surface ew. ft. Depth to bmfflng factor. in.
Horizon Depth Dominant Color Redox Description Textt" Stnrrcture sistence
in. MunseD Ou. Sz. Cont. Color Gr. Sz. Sh.
tl'.5
VLBA_�
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AN
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* Effluent ' = B09 > 30 1220 mglL and TSS >30 < 150 nK;lL '' went #2 = BOD IS < 38 mWL and TSS 30 mrgA_
CST Nerve Print) ,, Sig CST der'
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Address Me Evaluation Conducted Number
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41 �,-
SBD-8330 (RI 111 I )
Property Owner-,.
n
Parcel ID #
ft. Depth to Urn" for
Pit Ground surface elev.
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pa, - �-3 of C--E
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BcKing #
pit Ground surface elev. fL Depth to firni" factor
Redox Descroon
Qu. Sz. Cont. Color
Structure
Gr. Sz. Sh
ij;
Boring # [:] BorirQ
0 pit Ground surface elev. ft.. Depth to limiting factor in.
I Sail Andication Rate
Redox Description
Qu. Sz. Cont. Color
Structure
Gr. Sz. Sh.
* Effluent #1 = BOD 6 > 30 < 220 mg/L. and TSS >30 < 150 nxYL * Effluent #2 = BOD :E30rngA-and TSS<30mom.
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 format, contact the department at 608-266-3151 or TTY through Relay,
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