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HomeMy WebLinkAbout020-1464-26-000 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page _ of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 112 x 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. C _I (`r - c U Re awed by~ Date Zoo . Please print air Tnf > IV E C Personal information you provide may be used fo secondary purposes (Privacy -Law, s. 1 .04 (1) (m)). Property Owner Prdperty Location . 91 e ~Ol) Goj t 1/4 (/,.J 114 Sl T Z N R E (or (0 r r Ina e Property Owner's Mailing Address o # Block # Subd. Name or CSM# - Il S~ CA ;,Fr ~o twlav~d 0("- S P City State Zip Code 1-rhon9'MOmber City ❑ Village R Town Nearest Road cQ Q~ W l 5yol(o ( ) ud.S~ ~ e .p ~our1~ New Construction Use: Residential / Number of bedrooms _3-'_`r/ Code derived design flow rate _ `1Sa 16 O O GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material _ dU-c~a_Sl~ Flood Plain elevation if appl' General comments s ys c eA e v./ Hy o d C~C11 S and recommendations: Boring Boring DO q4 # ! © pit Ground surface elev. _ r ft. Depth to limiting factor-/ Oin. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsetl Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 o-(~ to F3/Z ~ SI' m !C Ian-~~- C S 1u~ , s~ . S, 3 zo-loo i - s os I - , I i Boring # F1 Boring Pit Ground surface elev. fe ov ft. Depth to limiting factor 1Q~_ in. Soo Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsetl Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 I 'Eff#2 2 a /vo ~d, / os v- - - 1. z i I i i I Effluent N1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mgiL CST Name (Please Print) r _11, ignature CST Number ~a w. ~ lam, ~ I~ ~ 3-~0 9' ~ Address Date Evatuaticn Conducted, Telephone Number Co-/-off 7511G1 _00 i Parcel ID # 1 0 _ Page of __3~_ Property owner -~-q- ❑ Boring ft. Depth to limiting factor lL in. Boring # Ground surface elev. Sod A ica6on Rate ®Pit GPDIf1= Texture Structure Consistence Boundary Roots 'F#t •Etf#2 Horizon Depth Dominant Color Redox Description Gr. Sz. Sh. in. Munsell Qu. Sz. Cent Cobr - / SL IM L W\_4 f ~S l Vf 6 "b 3/3 5 aS ~ ~ - (n -!o is r yl 2- ❑ Boring a Boring # Ground surface elev. Depth to limiting factor in ❑ Fit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Gr. S ush Consistence Boundary Roots •E GPDtft'Eff#2 in. Munsell Qu. Sz. Cent Color Boring # Boring Ground surface elev. ft. Depth to limiting factor in pit Sod A lica5on Rate ❑ Des:.ription Texture SWdure Consistence Boundary Roots GPDKf dox Horizon Depth Dominant Color Gr. Sz Sh. 'Eff#1 'Eff#2 in. Munsell Sz. CorL Co'•or I I i Effuent #1 = BODS> K < 220 mg1L and TSS >30 < 130 my'L ` Effluent c = BODS < 30 mglL and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 603-264-8777. SBD4330 (a.mroa) i PAGE -?OF-5- am- NAME: 16- e►' LOT# Co LEGAL DESCRIPTION:-SC 1/4,0w1/4,SN TZ~( R,jE(m')SO SCALE: 1 t7+ ti>.. 6w, w, ELEVATION: (()U Y` r BM 1 DESCRIPTION: BM 2 ELEVATION: eI e' BM 2 DESCRIPTION: Id P 6 l ~u~ SYSTEM ELEVATION: SYSTEM TYPE: ~o n U e ✓1 +r" " = ` W V ~dk C'us ek pn' o X oc) 6' Z g Z ~ -Zl - ~ DATE. SIGNATURE: s J t Wisconsin Department of Commerce SOIL EVALUATION REPORT Page _ l of Qiv~ision of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County C I~b 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. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all infomtation. Reviewed by Date Personal information you provide m y be u " y s (P ' cy Law, s. 15.04 (1) (m)). Property Owner " Property Location Govt tot 1l4 (,U 114 Std T z N R E (or)e Subd. Name or CSM# C. Property Owner's Mailing Address A LU}-- Lot # Block # t -c C. L CP City State p C ' 'ONI , r ❑ ❑ Village W own Nearest Road New Construction Use: ® Residential /Number of bedrooms C e derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material --0--0 t~ ` ~~-(1--------- Flood in elev 'errif p~ Ic b(e - - ft. General comments and recommendations: ~~s~e m ` 7 Q d citA O V~ V Z 7 l-7 o Boring IT Boring # ch Pit `s~ I - qzy Ground surface elev. _ ft. Depth to limiting factor _ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0`9 k fr3 3 - SL 5 C -C - 2 A5 1 / z f 72- Boring # Boring l Zd 14 pit Ground surface elev. ft. Depth to limiting factor _ 09 in. Soil Application Rate Horizon Depth. Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDH in. Munsell Qu. Sz. Con', Color Gr. Sz. Sh. 'Eff#1 'Eff#2 D- l SL I bl r C5 t - Li Effluent #1 = BODS> 30:_<220 mg/L and TSS >30 < 150 ffVL ° Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (P Print) Signature CST Number Date Evaluation Conducted Telephone Number Address I t > G `7 f of Page Property Owner Parcel ID ❑ Boring Boring # ft. Depth to limiting factor -in. ~Plt Ground surface elev. Sod A cation Rate Horizon Depth Dominant color Redox Description Texture Structure Consistence Boundary Roots "E GPDtff in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 1 D-(4 16 X 13 S L 1 rn5b~< CS 1 v 2 _ S~ c l 2m ~'r Cw - 3 3 ` l ❑ Boring Boring ft. Depth to limiting factor in. Soil A lication Rate ❑ Pit Ground.surface elev. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots "EGPDIft'Eff#2 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. ❑ Boring ❑ Boring # Ground surface eiev. ft. Depth to limiting factor in. ❑ Pit Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots "E GPDIft2Eff#2 in. Munsell Qu. Sz. Cont Cobr Gr. Sz. Sh. Effluent #1 = BODY > 30 < 220 mg1L and TSS >30 < 150 mg1L " Effluent #2 = BODS < 30 mg ,L and TSS < 30 mg1L fhe Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact die department at 608-266-3151 or "TTY 608-264-8777. SB U. 8310 (R.07/00) PAGEaOF 3 -e LOT# Z Co LEGAL DESCRIPTIONSF I/4§ 1/4,S I TT-Z-q-,N,R, aE(or)l ~ NAME:-f)-e- SCALE: 1, - U {3m ( ELEVATION: ,/O U G BM I DESCRIPTION: BM 2 ELEVATION: 9r O = ~zcBM 2 DESCRIPTION: 4,,p o-l 1 pvc 0<°Ot SYSTEM ELEVATION: SYSTEM TYPE: 0 0 ti a7 ~ SIGNATURE: