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HomeMy WebLinkAbout026-1121-11-000 (2) RECEIVE QEj Wisconsin Department of Comm rce r. EVALUATION REPORT Page of D isision f'Safety and Buildings Z~ in accordancem 85, Wis. Adm. Code CROIX C County s~- Attach complete site plan on ntr,~ qF$s in size. Plan mustVo t include, but not limited to: vertical and ii kBM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and lodistance to nearest road. o a6 - I' Please print all information. viewe Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). G-~ ~j b G Property Owner Property Location Ha Govt. Lot SW 1/4 SC- 1/4 S S T30 N R E (o W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 11 Ijw by ! Peer+,'+a a Qq City State Zip Code Phone Number ❑ City Village 9Town Nearest Roid 5+. New RiA tai ,5g017 (1(5) ayb -16213 Richwto►,) 10 10 T 'N New Construction Use: Residential / Number of bedrooms -3 Code derived design flow rate q50 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material C( Q C-; Flood Plain eelevatio~ ,iff appl ft. General comments~~ S ~loQC rble ble n e and recommendations: Y 75 g„ <A--7t 101, d o -/U1 A4~telt L -7 Boring F-)] Boring # Pit Ground surface elev. 7, l ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 E 10101A L- 1 F&R OS~ a5 a y ,b a G- I 3 0'tR a - L ~ s v\ C W . y . 6 41 F 6 lF`►.5 y R b g HSL /esek 8s~ ~V3 qq-W 5 yR 4141 I D,s \1R 61% SL )Fs6K y , Boring # ❑ Boring F&-1 Pit Ground surface elev. 99, 67 ft. Depth to limiting factor toQ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 o-s 1018 "la Gs a F .y .b a IoyR~a t± s Cw I E ,y .b 3 ~r54K CW VF ►IQ .3 y a 1-33 679 q c)ay ,3 MSGK $ C W .01 .3 10 44-~D 5 SIR q SL ` I:SK3X 3S y * Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number %v) 0. yb Address Date Evaluation Conducted Telephone Number c ~(0 s+ +cxr P,ra;,C),f, w1 s~©ab io- ~-ot "~I s -ay$-35,5 SBD-8330 (R07/00) I 6 ~ Property Owner f iQ u&,1Ucif S Parcel ID # Page of ❑ Boring 3 Boring # Pit Ground surface elev. O D , ft. Depth to limiting factor ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I o-5 loy ala L 1 F~ ~s as ap y a s-~ ioyR 3/;k L 3SV% cW F .y 3 is-19 IOyR "ly HeLy 1m58K 65~ CW 1vF y y 19-36 -15y yI("-- Hest 1tK AW v y 30-~o S \4K 'lq SC- I FSQK d s~, q . b ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # F1 El Pit Boring Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 < 30 mg/L 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 608-264-8777. SBD-8330 (R.07/00) 1 e- 3 C- 4? 13 I< Qc)q,S ~h `t Lo+ i►'' 11r' , a ! ql .vac t, S /3+1'1 -h o / tk a o a P r:7 bac c d F :,43 -t, vsrt;VM rr ~ 30 _ 1 oo.ou ~i 4 i 3 SovTh gyp-} ;nr TA Ave