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HomeMy WebLinkAbout042-1040-30-026 RECEIVES ~ Srt - ~~16 y D VJs. Dept. of Safety and Professio `$e(iyirrs~ , SOIL EVALUATION REPORT age / of 3 Division of Safety and Buildings TT JJ r~11 L ST. CROIXIC~do e with SPS 385, Ws. Adm. Code County Attach complete site pl"MVNMr5 t0fiVSLQj?MjEAfF1 inches in size. Plan must C/` d 4 include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. q/ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Z Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). w,/-rye 141 Property Owner Property Location rr7l !!l Iv (J FRED 3 0UR-L-.)P-: ArA s Govt. Lot 567 114SE I~ 2-`l 100 1/4 S T N R E (or(D Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 12-2_2, w 1 Z Q-r of ZG-60 ACRES City State Zip Code Phone Number ❑ City ❑ Village ®Town Nearest Roa an MWY o (3 ART s GU 1 S76 L3 1(7/5) 53P 701 I LA) A R R E ,J -67 New Construction Use: Residential/ Number of bedrooms - Code derived design flow rate _ v GPD ❑ Replacement ❑ Public or commercial - Describe: _ Parent material Flood Plain elevation if applicable _ /V/ Ok- ft General comments L p~-s $ O U R ~~C (q and recommendations: L 77//7 Area X SPot Tested suitable for A C'Onventional inground system (P.O.W.T.S.) /lJ Z A10 - 5'Lt l~ 4-P AJ6t &JIE ❑ Boring q 7 Q Boring # G Pit Ground surface elev. ft. Depth to limiting factor' in. LSoEil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 * ff#2 g 75y~ 5L 21m5bK im-PR CS d 2- 7- YR s s~ M, sb irAU R C5 o /aYR • S. 0, S~_ d 1z - . s 12:1 Boring # ~ Boring ® Pit Ground surface elev. ft. Depth to limiting factor in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 * ff#2 1 D- S SL i SbK s . 7 _/(Q 7 5 Yk -5 sL, 2 S (L [WA -F (z S .6 D 3 Ce- ~Z 77-6 1K - s 2 S (c c S -53 .5, K -553 S. I K s 3.19 7.5 1& s/ zfSb~ NfP- a_ X (_V /.0- '5- Asel- .7 s * Effluent #1 = BOD > 30:< 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BOD 5 < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature C T Number 8013PP-T ORI ekT- ~ f zz63 -7 S 4 Address Date Evaluation Conducted Telephone Number 7- 812- o t"Avie 5P P_ U'-11-e 5ff7~e7 '115 ~12- q9q 2- S BD-530 Rl j I/1 I r PART of Z (e .9 AO.e 5 FF OORDEFAk15 oq Z-10 q0 - Yo • 050 Z. 3 Property Owner c Parcel ID # Page of Boring # 3 Boring y 5 , 9 ❑ O Pit Ground surface elev. ft. Depth to limiting factor ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 y0 3 s f s s- / o o. N-07'37 2-Z /o 5" o U a' - Z--.5 33g ~ o .s g 5 o sGl S -FW1- r , • S a p LS YD a.s 7 Ls r ❑ Boring ❑ Boring # ❑ Pit Ground surface elev. ft. Depth to limiting factor in. HE Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 F] Boring ❑ Pit Ground surface elev. Soil A lication Rate ZText. factor n. El onsistence Boundary Roots GPD/ft Horizon epth Dominant olor Redox Description Boring # in. Munsell Qu. Sz. Cont. Color ft#1 ff#2 Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent #2 = BOD 5 < 30 mg/L and TSS < 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SBD-bi7Q (Rl 1!! 1) CCM~T CORM V~t ~ER~L 5 QAss © jo 13M 4 f SCT: T°P OF 1`'! ETA! Co &3 jgot T qq.0 z. ® o --r • dp Cow ~ou(Ze Lito~. NI 5D SF-r: TOP 0.f )2 z 0 m ETAI CoA)OutT' i l E 13.3 I_ pt le-Lz 15.90 c0 Lt to a • = 8,gckHoE ,Soil i TS PwoPEr-y PIN P o q-z- 10Y0 - VD • 05 a PREP ~'OUR~EAn1 Cop r.4 ~i ELD gRgS~ o ~ .9 Ac*65 PAS RECEIPT DATE No. ~ i o 'yy RECEIVED FROM 0' ' 5 Jul j C' r.S $,3 , c) G Frl'tJ75)a%;j*tctvN v'4 a-ldy~ yu-cl, ~ SG S DOLLARS 0 FOR I RENT ?,4 O FOR ~ t ~ ~ ~ ~cC V~ 5 1 ~ fd {vim ~'-e ~ ~ ~ OCASH CST - LL~ ACCOUNT / p, CHECK PAYMENT FROM TO O MONEY `J ORDER 7~E?( BAL. DUE O IT CARD BY