HomeMy WebLinkAbout030-1066-10-010 (2)FEBDaMC�FMWJFEEO ilk
o s 2024 ��
Wis. Dept. of Safety and Professional ALUATION REPORT Page 1 of
Division of Safety and Buildings
in accordance with SPS 385, Wis. Adm, Code
County
Attach complete site plan on paper not less than 8 1 /2 x 11 inches in size. Plan must
include, but not IiniRed to: vertical and horizontal reference point (BM), direction and per{ I.p
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. "
Please print all information. Re by -1 Date
Personal Information you provide may be used for secondary purposes ('Privacy Law, s. 15.U4 (1) (m)).
Property Owner Property Location
Govt. Lot 1/4 j -, 14 3 `)r' T "�' N R G E (or,&
Property Owner's Mailing Address L # Block # Subd. Name
City State Zip Code Phone Number t3 City ❑ Village joTown Nearest Road .
New Construction Use: ® Residential / Number of bedrooms Code derived design flow rate GPO
❑ Replacement ❑ Public or commercial - Describe:
Parent material r'+f �,_ 5�i Flood Plain elevation if applicable ft,
General comments
and recommendations:-�J�`�,f� �� .- -. , •. �S �,%u, r/,'
1:1Boring # Boring
® pit Ground surface elev. _+ •/ ft. Depth to limiting factory in.
Snit Anrillr�tirut Rafw
Horizon
Depth
in.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
onsistence
ff#2
rt-
E[IGPD/ft
y`
7
.(
.l
171 Boring # ❑ Boring r
® pit Ground surface elev.ft Depth to limifing factor �..-_. in. Snit Anntiratirxt Rata
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
onsistence
Boundary
Roots
GPD/ft
ff#1
1f#2
'S
t
-
`l '
/.
v
<
` Effluent #1 = BOD > 30 < 220 mg1L and TSS >30 150 L ' E ent #2 = BOD < 30 nA and TSS < 30 mg/t-
,ST Na Please S' aloe CST Number
LILL
/+ 3
Address Date Evaluation ConductedTelephone Number
5
Property Owner ,� .;, ti t fi / Parcel ID #
Boring #❑11 Boring
I^� Pit Ground surface elev. ft. Depth to limiting factor G in
Page -- Of
Sni] Annliration Rala
Horizon
Depth
in.
Dominant Color
Munseli
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
onsistence
Boundary
Roots
GPD/ft
ff#1
ff#2
/""
Al
r. i s
ill
7 Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Redox Description
Qu. Sz. Corit. Color
W
W M, ".1 M
Boring # ❑ Boring
pit Ground surface elev. ft. Depth to limiting factor in.
Soil ADoiication Rate
Horizon
Depth
in.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
onsistence
Boundary
Roots
GPD/ft 2
fW1
ff#2
Effluent #1 = BOD , > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 W BOD s < 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 format, contact the department at 608-266-3151 or TTY through Relay.
5641-8330 {Rt F!l.t)
IS3 ?-o 14�
ZaSCA)
-f;tJ -ZA:!-a- r-56,V-Xl� K/
44.
-t&6
M.,
CERTIFIED SURVEY MAP
LOCATED IN PART OF THE NW 114 OF THE SW 114 OF SECTION 25, T30N, R19W,
TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN.
v