HomeMy WebLinkAbout026-1294-25-000 (2)
' Wisconsin Department of Commerce SOIL EVALUATION REPORT Page L._ of y
Division of Safety and Buildings RE~SLYOVE
in accor, ance dm. ode
County
C'~L• C
Attach complete site plan on paper not less than 1/2 x 11 inches in size. Plan mus J 1
Include, but not limited to: vertical and horizontal efereng~ goln BB t~jr ion and Parcel l,p, r
percent slope, scale or dimensions, north arrow, nd lodahbh a t fl® neare road.
Please print all in orm~,~,j~pROIX COUNTY Rev' Dale
Personal Information you provide may be used for seco dary purposes (Privacy Law, s. 15.04 ( (m)). Q
Property Owner Property Location I t9
Govt. Lot N 1/4`5l,)1/4 SD~ T 3t-) N R 1 E ( W
Property Owners Mailing A dress Lot # Block # Su ame or CSM#
111 9DI-" At) C)~s I et or
City State Zip Code Phone Number ❑ City ❑ Village EATown Nearest RoY
fi
DIY, MN .53.36I L3) Y I - ~s t-, o t., J-9 - j -1 3q
New Construction Use: Ik Residential / Number of bedrooms Code derived design flow rate GPD
❑ Replacement ~y..❑ Public or commercial - Describe: _
Parent material Flood Plain e!evation if applicable ft•
General comments ' '
(VIt'(\.J
and recommendations: S a 8') -~r 4~
y S
. --r-, ( -T,
~,~C~~ ~"fr4„'7( 3SJ
3 (65, Y,
FT Boring # ❑ Boring
Pit Ground surface elev. h. Depth to limiting factor / D _ in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
r 6
r
Boring # ~ Boring F r
Pit Ground surface elev. 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
'Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L V Eftluept #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Number
CST Nalne (Please Print) c Signature
a.r 5~1 =
Address 1 Dale Evaluation Conducted Telephone Number
7 p , r,
a ,,-1? 7/5
5 1/ 4? C~ LIP
Property Owner
Boring # Boring Parcel ID # Page_ of _
~ Qc~
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/fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
~.1~,b 41n`Tf ~y5 r~i ,,JI,~ L~~. '`o ~.1 ~^'''ll P d ~,1 ~ J.
f
n Boring # El Boring
I I 'A Pit Ground surface elev. ft. Depth to limiting factor 9S in,
Soil Application Rafe
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Cotor Gr. Sz. Sh. •Eff#1 'Eff#2
F-1 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
' Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 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 altemate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of _4
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
Coun S~ , C IcU i 7<
Attach complete site plan on paper not less than 8 1/2 x 11 it -4~-f &Vi st ty
include, but not limited to: vertical and horizontal referlence point (BM),' direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and Pbcation and distance to nearest rood.
t Revi ed by Date
Please print all information. - t,
N <
Personal information you provide may be used for secondar~ purposes (Privacy Law, s. 15.04 (1) (mk). /j / QS
ity Property Owner f ZONING O Ire Lo r ti on
S01/4
`3e rot-l . o o r 1/4 S aj T30 N R E (or
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
I 1 90 oe. NW a5 a`t' o F K, c moN c rc
city State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road r
X New Construction Use: T~ Residential / Number of bedrooms Code derived design flow rate GPD
❑ Replacement ❑ Public or commercial - Describe:
.ta 4~_?c o~ _ t ( (M y- Flood Plain elevation if applicable Parent material
General comments L
v 5 S C 5 } Q. ~i « 1~ IJ a 4; ,3 /
and recommendations:
r
Cbes&A aha 9 1 3 can-tote
R~~L 1 ~'LZ1o {'3^~~
r
~ sue- ~ ~
n Boring # Boring r
L1J to Pit Ground surface elev. a ft. Depth to limiting factor _75- 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
Gt
-1
Fa-1 Boring # Boring g 1,35
Pit t
Ground surface elev. _ ft. Depth to limiting factor 7_ 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
-
S < 30
- t #2 BOD< 30 /
-
_ m9L nd TS
Effluent #1 BOD m L
- > 30 220 m9/ 9 Land TSS >30 < 150 m /L Effluent 9~
' -
T Name (Please P ' Signature C CST Number
Dc~ 7
Add ss ..1. E, a.Jr Date Evaluation Conducted Telephone Number
41 "7% v~ C9 + -7 IS -d Va --35 9?
$((Vale
1
Page of
Ger,a}~ Parcel ID#
Property Owner e in. Soil tjtion Rate
® Boring ft Depth to limiting factor 5~ - GPDIff
a Boring # Pit Ground surface elev. _ Texture Structure Consistence Boundary Roots •Eff#1 Eff#2
Redox Description
Gr. Sz. Sh. . ,
Horizon Depth Dominant Color Qu Sz Cont. Color
In. Munsell
~i
t
factor in. Soil Application Rate
Boring # Boring Depth to limiting GPDIff
Boun arY Roots
❑ Pit Ground surface elev . ' Texture Structure Consistence •Eff#1 Eff#2
Depth Dominant Color Redox Description Gr. Sz. Sh.
Horizon Qu. Sz. Cont. Color
In. Munsell
❑ Boring Depth to limiting factor in. Soil A lication Rate
Boring # Ground surface elev. --ff' Roots GPDIff
❑ Pit Texture Structure Consistence Boundary `Eff#1 •Eff#2
Redox Description
Horizon Depth Dominant Color Gr. Sz. Sh.
in. Munsell Qu. Sz. Cont. Color
i
` Effluent #2 = GODS < 30 mg1L and TSS < 30 mg1L
> 30 < 220 mglL and TSS >30 < 150 mg/L
• Effluent #1 = BODS
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
n alternate format, please contact the department at 608-266-3151 or TTY 608-264-9777.
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