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HomeMy WebLinkAbout038-1109-60-100 (3) Wis. Dept. of Safety and Professional Services `FOIL EVALUATION REPORT Page-4of Division of Safety and Buildings in accord rtc {mt-;SPS 385, Wis. Adm. Code t(, County ~ Attach complete site plan on paper fibt less Nxa 912 I'Mc-hes in size. Plan must ~J include, but not limited to: vertical 9 l~tl4zbntal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 6 3S-~ Please print all information. Review by Date .p Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). (O Z~ ~O Property Owner Property Location Govt. Lot Al, L 1 /4 S 7 T N R E (or Property Owner' Mailing Address Lot # loc # Subd. Name or SM# 6 ✓a ( Z7 City at~ Zip Code Phone Number ❑ City ❑ Village [DTown Nearest Road' ® New Construction Use: [Z Residential / Number of bedrooms Code derived design flow rate Cu- GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material2~ Flood Plain elevation if applicable v ft. General comments and recommendations: Sy1 i=- r3'"~ F ' o- 0 Boring # Boring ® 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 F-7)] Boring # Boring ® 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 A /Z - v 5 E ' ent #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 CST Na leas r / Si a CST Number Address Date Evaluation Conducted Telephone Number SBD-8330(Rt111) Property Owner Parcel ID # Page of ❑ Boring Boring # 1-73-1 ❑ pit Ground surface elev. ft. Depth to limiting factor in. -go-5-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 ❑ Boring # ❑ Boring ❑ 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 z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 ❑ Boring # ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor in. El =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 Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD s < 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-8330 (R11/11) Property Owner Parcel ID # Page of _Z21 1) 13-1 Boring # Boring © pit Ground surface elev. (c 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 6-11 V, 12 X/ -6~ S c -,2 Al P7 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate s Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 *17ff#2 Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ pit 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 I ~I * Effluent #1 = BOD , > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD t < 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-8330 (RI 1/11) ii 72~y 170 3~ o; /4, ~33 Y~ ' ~ YG i G~ , _-i- N N--T -t- , ttf f t. z d . > 1 dy i - c, • ~ r i X . ki° o-~ ~ hkx xYS.7", t ~ . ,?•r '.nF~3 I~z 4 r aF ~.4 r 'jA r a t~~.yr fy it a` ~ yYr F 3~ f k A '4,. ~fw Qt" P 7 S :t J ~FT2 ~ ? _ E w.Ai+'. i Y`G' a^.??,- ~a ° it 'V.'rslJK S:f~"SmSKEZ: Pt` ~~a^'*t~+¢.. G5~ ~ 7hk p fi~~ " 5 I P" ,r~~yt ty-a t'xY~,a ~#~w ue n 5 kr ,,y' K w' WE iS fir.? ~u 1x N'~,'G ra ~ k F; -G~sq- s' T r ,c t ~Y sr'S. # 'r kb M1 t~ sue, 'Y r .t , w _ S X(4k - ,40 k~ of 3} 7-0 a~ - ei~i 5 xs~s ~ w , •.F ~ s~~~4~, t 'n ~ s t8 AG - i ~ s a F SOIL PROFILE DESCRIPTION Owner: CST: d' (-c) Af 0Z L System Eiev. Proposed: ft Syst. Range ft to ft Ld Rate: # Elevation: 5' 7i • S # Z Elevation: p~ g # 3 Elevation: QO. 6 o Boring o Boring o Boring C) Pit o Pit o Pit ~a~` --b - ro - - - _ s~ l - - S l s~ 8~ \ F T- o~ 9~0 d N T O G U 1D To d ,n mm o o ni o n N O h ? H ~ O N W ~ ui y N ~ ~ w m 3 `o y C N U oo m o c m U p a 3 rn T 0 o rn Z o 1-'~.r a t y LL = Z c E E m c x U m m m m= X m a E m C 6 T N E N w D ° t0 o .15 •O O N Ol " °o o E o m o m o aU U m ? ° n 'o o m o m a~ n E. 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