Loading...
HomeMy WebLinkAbout020-1464-19-000 i - A ~ Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of _ Division of Safety and Buildings in accordarxs with Comm 85, 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 limited to: vertical and horizontal reference point (BM), direction and parcel I.D. 0 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. b Date Please print all fnfotrotatlon. Reviewed~ ~j Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner R E G I Property Location 2~c\(AcxfC~ Govt Lat _ 114/UW 114 S T Z ~ N R f q E (oE Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# l ~ + 14 <CT P R A;A 3 OO~C 19 _ Mo tAd to E -dudes 1 State 7il Cody, _ .P Amber,, ❑ City ❑ Village © Town Nearest Road City >l C{ GN ~UwT; XNING IFFICE R vC~ S0 b IIJ ® New Construction Use:2 Residential / Number of bedrooms Code derived design flow rate _1SZ~ j! GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material --n L) Fbod Plain elevation if applicable h• General comments and recommendations: S m Ek-v• Boring # E) Boring p D Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I 10 'j 21'VI ( 2 m-<&, C 5 I V l . 5 25 2 2I-3g 1 y/ - - Si Z n--k'r C5 - `l 4.V jt-~ 3 5 C ~.5 r y/ ~c1 3ML, k ryjC, cw - ( Co 4 -i30 b s m) - - 1 12 5 YZL~f ~~f Z Utz Boring # E Boring pit Ground surface elev. !Qg, Z o_ ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I D-I IU SO 2m5i* rot- CS I v~ Z I - 2 Io LA/ - s• d 2 r cS - -3 2 c 1P -7.5 / S~cI cw - y -Y-) ( - -7 • Z b-(3 (d 4 - 5 Dsp Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODz < 30 mg/L and TSS < 30 mg/L CST Nam (Please Print) Si nature CST Number Address Date valuation Conducted Telephone Number Property Owner Parcel ID Page of ❑ Boring Boring # Ground surface elev. _ c~ ft• Dept to It9 factor in. Sod Application Rate Pit L~• z Hono n De th Dominant Color Redox Description Texture SWdure Consistence Boundary Roots GPDIft2Eff#2 p ff#1 in. Munsell Qu. Sz. Cont Color Gr. Sz- Sh. •E Sit 2m5b A04 I ' Sicl 2msb r c S 2 39 0 ~~~sbk l \rV - r y 3 GP -I,rL-) 5 I s t y y 5 Ds YYl1 - - t,2 ❑ Boring ❑ Boring # Ground.surface elev. ft. Depth to limiting factor in. Pit Soil Application Rate ❑ Horizon Depth Dominant color Redox Descr tion Texture 5trudure Consistence Boundary Roots .Eff#1 t2Eff#2 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. ❑ Boring F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ pit M#1 Rate Horizon Depth Dominant Color Redox Description Texture SWdure Consistence Boundary Roots fff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Effluent #1 = BODS> 30 <220 mg/L and TSS >30 < 150 m(lL ` Effluent #2 = BODS < 30 mglL and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. if you need assistance to access services or need material in an altemate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-83301 R.07/00) PAGE_,OFa NAME: ISG LOT#I q LEGAL DESCRIPTION:,iff1/4 0J/4,S ~I Tzg,N,R,_LLE(ar)10 r SCALE: 1"= G/( f,,,Y1\ ELEVATION: 1((? C) BM 1 DESCRIPTION: L) 0,'o e BM 2 ELEVATION: Q C( 0 I C BM 2 DESCRIPTION: SYSTEM ELEVATION: q Z, 0 O SYSTEM TYPE: o It tl e ,n o a I 21y' nc,V~c~ V ©U, v"ll b~ ~ ~z 1 0~ SIGNATURE: D TE: - o