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HomeMy WebLinkAbout008-1071-95-000 (3) RECEIVED P AJLJ) Wisconsin Department mete FSHVEK6HAN2 TION REPORT Page /of Division of Safety and tBIA" 010 in accordance with Comm 85, Wis. Adm. Code ST CROiX COUNTY County Attach coml3ftV #,MfE Vr0Mr-GPM n 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizon I reference point (BM'), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. • 0t,(i / 0A yS Please print all information. Revi d by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Z- L C1 Property Owner ( f~ti ;tr r c ~i., Property Location E (o VH1 Govt. Lot rV k) 1/4 T .-1 ~ N R ~ G Property Owner's Mailing Addres Lot # Block # Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑ Village (9'I own Nearest Road (,l ccx v/yl ~ Ll 1 -y~ (1/5-) CG<< II ~ 97 J New Construction Use: ❑ Residential / Number of bedrooms rz Code derived design flow rate S C.- GPD ❑ Replacement ❑ Public or commercciia-l -/Describe: Parent material C C°f / r I l Flood Plain elevation if applicable ft General comments f ~ S . ~ G Ll 1. t • ! C'~ { / - C CL;~DC ~-c G < c l)~ - ~ and recommendations: - ° 6 -'k C e 1l A 4&C i,( ❑ Boring Boring # l~ Ground surface elev. ft. Depth to limiting factor c- in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 -w!I k E f'b o",` /r, P t L A 10 fad 7. s ~ 1 v - f , L ❑ Boring Boring 1= t Pit Ground surface elev. ft. Depth to limiting factor- in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 to `C 1~ Yc~ L/ 3,( 7 vfi~ ` Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD 5 30 mg(L and TSS 30 mg/L CST Name (Please Print) Signatur CST Number VA A Address Date valuation Conducted Telephone Number ✓<c~f , J~l ' /"1 ~ ~ t r E'i " i` , : ~ K ~ ` /o (7/ S j7 111, 1 ~ nMI\\ S `f7~ . Property Owner Parcel ID#~~ 71 fS ) Page of Boring # ❑ Boring ❑ p t Ground surface elev. r/ ft. Depth to limiting factor ~ / in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary < Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 v~ c~'Vf, x.3 1 1,> Yk4- (-k a ' S - i' J J 4t C 7 - Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate i Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 i I Boring F-1 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/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 i i i- i ' Effluent #1 = GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L "I'he 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. S130-8330 (R.07/00) Property Owner y~A 6% Parce) ID # _ %b 7/r 1 S = Page ~ of Boring # ❑ Boring Ef 0 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/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 -Eff#2 C~ l(J C)A ; - a C~ v - L yR t f.3Et 7, yYR - q0 t C. Boring ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate I Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1fP I in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 -Eff#2 h 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/ff° in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 i j_ I Effluent #1 = BODE > 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent #2 = BODE < 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. 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