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Wis. Dept. of Safety— s SOIL EVALUATION REPORT Page of
Division of SafelY ano, il�JAVC
in accordance with 'SPS 385, Wis. Adm. Code
County
Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (13M), direction and Parcel LD.?M4 01
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all Infonnation. I R ed by Date
Personal informaWn you pwovWe may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). J A
Property r Property Loca t
_J I
Govt. Lot N R (OrLW
1- 114 1/4 S T E
, i. eli, _.�L
Property C OwneesMakg Address Lot # Moa # SUlXl.,Nwm or Sm�
City SU ft, Zp-Oxle Ph" Nmber 0 G iavy V*age OTown Nearest Road
Now Consbuctim Use: Residential / Number of bedrooms
n ReDent ❑ Pubfic or real W D cribs:
Parent material Mar Flood Piain elevation If applicableVA
General co"W"ts
eM recornnnermUtims:
a..
Code derived design flow rat "M��
GPD
ft.
0 Boring
Boring # M Pit
I .
Ground surface elev. Depth to Umiting factor In.
2L
JC4
SoH!llcatlon Rate
Horizon
Depth
Dominant Color Pwdox Des"Ow Texture I
Structure nsistence oundary
Roots
GpD/ft 2
In.
Munsell Qu. Sz. Cont Color
Gr. Sz- Sh.
ff#1 *1:.ff#2
LAI
A2Q1
IL
El
Boring #
Pit
Ground surface elev. ft. Depth to limiting factor L
Soil icaticx Rate
Horizon
Depth
Dominant Color Redox Description Texture
Structure sistence ndary
Ro&s
GPD/ft
in.
Munselll
Qu. Sz. Cont. Color
Gr- Sz. Sh.
ff#1 *1 iff #2
e)
Y
/4
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 51 50 mg/L Effluent #2 BOD < 30 rrg/L arwJ TSS < 30 Mg/L
." P sigriatuf CST Numtw
CST N
Addriw/ Date Evaluation Conduded TeW"ie Number
ZIMLJ-0.3-3v I 1ki U I
0BorkV # pit &MM w1we ewv. 99, ft.
Depth to Yrnitlrg fador.,//k - N.
Page of
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[MIN
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M.,MM
MOWAM.
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F"l # Or"I AL &qL--AML-- AL- t*.#A#-- t-
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Harman Depth D�ornirCOW t ox Deacrjrlion Texh,re SMX*Ke onsistenoe FCaata GPDM z
In. Mtn Qu. Sz. Conti Color Gr. Sz. Sh.
EfteM #1 a SOD i a 30 1220 mgIL and TSS >30 150 mglt. " EMwA #2 s SOD 6 130 mglL and TSS S 30 m9IL
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 608-266-3 l S 1 or'TTY through Relay.
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