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wissvCoDerce aS~II EVALUATION REPORT Page 1 of 3
Division of Safety and Bui gs -in acc6rdanct°with Comm 85, Wis. Adm. Code
MAY 4 ~
County
Attach com Ian on paper not less than 8 '/2 x l I inches in size. Plan must St. Croix
ST, rtical and horizontal reference point (BM), direction and Parcel I.D.
OMMU I ensions, north arrow, and BM referenced to nearest road. O /O - 7Z -10 -oct
Please print all information Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m))
Property Owner Property Location
Susan Collis Govt. Lot SE t/. SE v. S 29 T 30 N R 16 w
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
250 Wilson Heights 1 CSm Z7, JP (o//~ to1L7IN
tKa:fispell State Zip Code Phone ❑ City ❑ Village 0 Town Nearest Road
MT 59901 406-257-7451 Emerald At 2774 130thAve
0 New Construction Use: 0 Residential / Number of Bedrooms Code derived design flow rate GPD
❑ Replacement ❑ Public or Commercial - Describe:
zaw-x
Parent Material Loess over Till Flood Plain elevation if applicable N/A ft.
General comments and recommendations:
1 Boring # ortng
0 Pit Ground Surface Elevation 100.0 ft. Depth to Limiting factor >40 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2
1 0-10 10YR3/3 - SIL 2-m-gr mfr as 3f-co 0.6 0.8
2 10-17 10YR4/6 - SIL 1-m-bk mfr gs 1 m 0.4 0.6
3 17-40+ 10YR4/4 - SL 2-co-bk mfr - 1 m 0.6 1.0
F2] Boring # ❑ Boring
OPit Ground Surface Elevation 100.0 ft. Depth to Limiting factor ZS in.
Soil ftolication 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
1 0-11 10YR3/3 - SIL 2-m-gr mfr cs 3f-co 0.6 0.8
2 11-16 10YR4/4 - SL 2-m-bk mfr gs 3f-co 0.6 1.0
3 16-25 5YR4/4 - SL 2-m-bk mfr gs - 0.6 1.0
4 25-36+ 5YR4/4 5YR4/6 & 4/2 f-2-f SL 2-m-bk mfr - - 0.6 1.0
" Effluent # 1 = BODs > 30:5 220 mg/L and TSS > 30s 150 mg/L • Effluent #2 = BOD5 < 30 mg/L and TSS :5 30 mg/L
CST Name (Please Pri nt) Signatur CST Number
Mark Iverson 7 46672
Address Date Evaluation Conducted Telephone Number
P.O. Box 155 Hammond, WI 54015 Aril 10, 2015 715-796-5664
L,-r- i
Property Owner Susan Collis Parcel ID# 6i0 - 107 Z- (D' CQ( Page --2 -of 3
❑ Boring L 0-r 1
Boring # ON Ground Surface Elevation 98.7 ft. Depth to Limiting factor 18 in.
Soil A tics ion Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Me
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-11 10YR3/4 - SIL 2-m-gr mfr Cs 3f-co 0.6 0.8
2 11-18 10YR4/4 - SCL 2-m-bk mfr
gs 1f-m 0.4 0.6
3 18-26 7.5YR4/6 7.5YR3/4 f-1-d SCL 1-m-bk mfr gs if 0.2 0.3
4 2640+ 5YR4/4 - SL 1-co-bk mfr - - 0.4 0.7
❑ Boring
4 Boring # Wit Ground Surface Elevation ft. Depth to Limiting factor in.
Soil A lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
in. Munsell u. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
Boring # 0 Boring
Wit Ground Surface Elevation ft. Depth to Limiting factor in.
Soil lication 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 # I = BODs> 30:s 220 mg/L and TSS > 30:s 150 mg/L * Effluent #2 = BOD3 30 mg/L and TSS S 30 mg/L
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Page 3 of 3 0 ft. 24 ft. 40 ft. 80 g,
N
The north property line is approximately
130 feet north of B-1.
13 - Top of 12"PVC Pipe
100.4'
B-1
100.0
B-3
98.7 p
nSX0 -
% fD
B-2
100.0
BM#2 - To of 12"P Pipe Adrl~
100.4' ' -IF
• = Ground Surface Elevation
BM# & Description = Bench Mark B-1
Elevation 1m, =Boring Location & Elevation
Owner: Susan Collis Site Information: Completed By: Mark Iverson, PSS #197
250 Wilson Heights SE1/4, SE1/4, S29, T30N, R16W 680 Larcom Street
Kalispell, MT 59901 Town of Emerald Hammond, WI 54015
St. Croix County 715-796-5664
Phone: 406-257-7451 CST# 46672