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HomeMy WebLinkAbout030-2131-40-000 (2) ` Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of -3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County _ Cro 11 Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 3 ~6 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Date Rev' e y Please print all i orm fq w u 3 /3 0 3 Personal information you provide may be used for seC ndary purposes (Privacy Law, s. 15. (1) (m)). (.~i~1^^-- n~ Prop rty Location Property Owner I f ,sa i~ 2 0 C~rY \ ``V~i Y1~ Govi, Lot W 1/4 w 1/4 S T 36 N R z E (or) /7 2, Property Owners Mailing Add s Lot Blodt # Subd. Name or CSM# , r _ ~~7~~'3 Cc%G 2© ' / City State Zip Code Phone Number ~ ~ ❑ City Village own Nearest Road nil 'MN 212- 65t ) 3 Code derived design flow rate D 000 GPD New Construction Use: Ej~ Residential / Number of bedrooms 0 Replacement I ❑ Public or commercial - Describe: ft Parent material 0 U t- h _ Flood Plain elevation if applicable General comments Y , ,_,e m -e /-2 • ~G U - 410 /Vlo~ and recommendations: C Ur1-aU e- -e .e U l f- r70 ❑ ❑ Boring # Boring pit Ground surface elev. /0 U. D fL Depth to limiting factory _ in. Soil Application Rate Texture Structure Consistence Boundary Roots GPD/ft2 Horizon Depth Dominant Color Redox Description in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~ l 3 2 s 2 ~g 1 I 1-0 2 5i-cl rr,-Se~ _ 44 C-2-0 2. s s ~i ZmS~k 3 514 ❑ in. Soil Application Rate Boring # Boring Pit Ground surface elev. 1-7 ft. Depth to limiting factor Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •E GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. m C 8 Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODs < 30 mg/L and TSS < 30 mg/L Signature CST Number CST ~Name (Please Print) ~ 2S 3 3 C~~j Lam' ` ' U m ~ - 1 Date Evaluation Conducted TelgphloLne Number p Address Property Owner ~4e . _LL Parcel ID # Boring ❑ B Page of Pit Ground surface. elev. yQ ft Depth to limiting factor Horizon In. Depth Dominant Color Redox Description Texture Structure Soil Application Ra In. Mansell Ou. Sz. Cont Color Consistence Boundary Roots GPD/flV Gr. Sz. Sh. V-I co) ~Z •Eff#1 .Eff#2 Z iy -45 i p . _ r rr c I .5 g Si ik~ 1 S CZP c l 2 _ Boring # ❑ Boring F-1 ❑ Pit Ground surface elev. R. Depth to fimiting factor in. Horizon Depth Dominant Color Redox Desaipfion.._ Texture Structure Soil Application Rai In. Munsell - Consistence Boundary Roots GPD/ft2 Qu. Sz. ConL Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring # ❑ Boring ❑ Pit ' Ground surface elev. fL Depth to Gmitfng factor In. Horizon Depth Dominant Color Redox Description Texture . Structure Consistence Bounda Roots Soil Application Rats in. Munsell Ou. Sz. ConL Color ry GPQ/ft Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent ft2 =GODS < 30 mg/t4 and TSS < 30 mg/I. 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. SOME] 30 (807/00) J PAGE 3 OF 3 Z~s T 3 y N R 2 NAMF a r i, a s g LOT# ~/Q LEGAL DESCRIPTION JJU I X SiJ4 S' SCALE: I"= BM I ELEVATION 100O BM I DESCRIPTION 4p a 1 ! Ocr~ BM 2 ELEVATION 79, i aOT c C` z----- BM 2 DESCRIPTION SYSTEM ELEVATION /6 0 q O SYSTEM TYPES /~,.Q Q r CON'T'OUR ELEVATION 9I 96 9,7, F6 SIGNATURE a_ DATE l y ° Z