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s. Dept. of Safety and Pofe Services SOIL EVALUATION R P RT
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.Page of ..�
and o��a ��
velop Adm. Code
m'�n;�y ae in accordance with SPS 385, vvt.
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complete site plan on paper not less than 81/2 x 11 inches in size. Plan must
Include, but not limited to: vertical and horizontal rekience paint (BM), direction and
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05()
Paroel I.D.
nearest road.
percent slope, scale or dun�ensions north arrow, and location and distance to nears
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Please pant all Inform
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Personal snformation ma be used for second Prix Law, a. 15.04 (1) (m)).
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Propery
Propefty Location
Govt. Lot 14 1/4 S T
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pmpnOwner's Mailing Addrexs
Lot #
E&)ck #
Subd.t�rTor
CSM#
efty Sate tip Code 'Phone Number
0 City [3 Village
EaTown Nearest Road
New Constructim Use: Resklential i Number of bedrooms - Code derived design flow rate
GPD
0 Replacernent Public or commercial - Describe:
Parent material �'4sw Flood Plain elevation if applicable
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s
General comments
and recommendations: d ,W-1X)
l3cwing# Q 1343ring
Pit Ground surface elev. ft.
Horizon Depth Dominant Color Redox Description Texture
In. Mur"ll Qu. Sz. Cont Color
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Depth to limiting factor /
Structure sistence Roots
Gr. Sz Sly.
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Soil
Boring FT Borkv
Ground surface elev. � � ft. Depth to limiting factor in.
Pit Sod Ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence out 'Roots GPD
Muns ell Qu. Sz. Cont. Color Gr. Sz. Sh. 17#1 fi#2
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op" 400-
E t #1 ^ BOO > 30 < 220 rng1L and TSS >30 < 150
CST Na P t r .Sl!
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Adder
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Effluent #2 = BQD < 3o mgli. and TSS < 30
CST Nurnber
to Evaluation Conducted Telephone Number
- -917-
SBD-8330 (RI I / 11)
r Th
Property Owner
Parcel ID #
# dBodiv
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I pit Ground wface elev. -,� `� ftf Depth to fimbV Wor In.
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MIN 'Lego
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Bming #
E] pit Crowd surWe Wev. ft. Depth to kaftig Wor In. I SM AnnfirAtinn Rat - a
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Structure
Gr. Sz. Sh.
806% # Boving
El pit Ground surface elev. ft. Depth to limiting is in.
IGil Arw-J"Hr%n0ai,ftI
Eftk*nt #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent #2 = BUD 5:5 30 mg[L and TSS :S 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.
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