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HomeMy WebLinkAbout020-1448-29-000 (2) ` Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County ' I Attach complete site plan on paper not less then 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. Re ad D to Please print all fnfonnation. Personal inronnation you provide maybe used (or secondaty proposes (PrLraeY Law, s_ 15.04 (1) (m)). Property Owner Property Location ~QSf ~ i /~e~-s Govt. Lot AIE 1/43,,) 114 S 3 Z T 29 N R 1 cl E (or)(O Property Owners Mailing Address y Lint # Block # Subd. Name or CSM# n 703 Z'41 W (ndSor Fk, ~s /ST f1c~/ ~ Dr7 t-' . U ~ fJC) Ci(y State Zip Code i Phone Number City ❑ Village B Town Nearest Road 1'" 1 546(b 1 "U J-S 0,Y1 15- New Construction Use: 18 Residential / Number of bedrooms Code derived design flow rate y b GPD ❑ Replacement ❑ Public or commercial - Describe: - - Parent material _ Flood Plain elev ton If applicable ft. General comments ~,~Q, ,~Gi • 3a O 1 SI PIT recom endations: S5{~YV) e~ lOP gZ.d(0 L-0 Vic, kjlm Sal' ( re - F { g # ° Boring Boring Pit Ground surface elev. + 7,0 ft. Depth to limiting factor _ in. mi iq ate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft+ in. Munseii Qu. Sz..Cont. Color Gr. Sz. Sh. 'Eff#1 'Ef1#2 :f>;! 2 r~(r es I VE _ S Z $-30 10, ( - 5<d ms►~k CS _ 3 30-Co5 1 a 5 L k c ~s k Ln5-75 r S to - ra e S - NP KP Boring # n Boring t / a R Pit Ground surface elev. C~.2 , wit. Depth to limiting factor -70 in. Sol Application Rate Horizon Depth. Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDMF In. Mtmseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 C7 $-3 (0 y( - Sic b cS 3~sbK • 9 Ll i Sll9 ray P r - - N P /VP Effluent #1= BOD > 30:5 220 mg/1- and TSS >30 < 150 mg(L ' Effluent rig = BOD < 30 mg/Land TSS < 30 mg/L CST Name (Please Print) Signature - CST Number tAd&4-n ScHuYt,~l r 25330 Address Date Evaluation Conducted - Telephone Number 211 96T3 S~. ersei It Y ~54025 - o~ (7(5)7(,0 OZ-77 40 Property Owner Parcel ID Page _ 2 of E] Boring Borg # Ground surface elev. q3 8D J ft. Depth to limiting factor in. ® Pit Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDr112 in. Munsel Qu. Sz. Cont Color Gr. Sz Sh. •Eff#1 •Eff#2 6-10 to 3I2- 51 I 2,~, ► 5 S r) 14 Z 16--2,o f -3D- SL d l S~(o Fi' c I e 5 n e- rv ov ❑ Boring # ❑ Boring ❑ Pit Ground,surface elev. ft. Depth to limiting factor in. Sol Application Rate Hormon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfF In. Munsel Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 F-1 Boring # ❑ Boring - ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sol A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfF in. Munsell Qu. Sz. Cont. Color Gr. Sz- Sh. •Eff#1 'Eff#2 1 • Effluent #1 = BODS > 30:S 220 mg1L and TSS >30 150 mglL " 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 alternate format, please contact the department at 608-266-3151 or TTY 608-2648777. SBD-8330(8.01/00) OF~ PAGE _q,N,R,_L TE(me NAME: (a.k-eLOT# LEGAL DESCRIPTION:p 1/4, w 1/4,S TZ SCALE: ELEVATION: 100, d BM I DESCRIPTION: AOk i n Z" e ~ L BM 2 ELEVATION: -l P y,© G 3 Z BM 2 DESCRIPTION: m re f- SYSTEM ELEVATION: iOQ 4Z ,do 16QAr Ql. o d - SYSTEM TYPE: 00"<-y4c re~ I U Vic ~ f5 SIGNATURE: r DATE: 7-~ -off S4Nt/l a311VldWn- Min P• IOD ♦ I IPA f/L MN 3HL A0 i/ 3s 31HL ~Q 3f81 153M r/L Ms 3NL A f/L ~ ,LL L9 'A 3N 3u AD 3W is3M M 09.00 N -'ON 13VHDWWVO ,*0'66S! 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