HomeMy WebLinkAbout020-1492-06-000 (2)Pr
t!icons Department of Safety ofes ' nal rvic
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��sion of Industry Services.:_ J1
SOIL EVALUATION REPORT
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• In accordance with SPS 385, Wis. Adm. Code
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Atta h complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include,
but tot limited to: vertical. anql horizontal reference point (BM), direction and percent slope,
scaf or.dimensions, bMW '1 6 a d cation and distance to nearest road.
Parcel I.D.
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ease print all Information.
Reviewed by Date
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Personal information you provide may be used for secondary purposes Priva Law, s. 15.04 1 m .
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Property Owner` / V,l
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Property Location ❑
Govt. Lots Y. Al T 29 N R E (or)
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Property Owner's Mailing Address
Lot #
Block #
Subd. Name or CSM#
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CitmState Zip Code Phone Number
❑ City ❑Village
[ Town Nearest Road r..
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It New Construction Use: ❑ Residential/Number of bedrooms Code derived design flow rate GPD
❑ Replacement &Public or commercial — Describe: 7
Parent material Flood Plan elevation if applicable _— ft.
General comments and recommendations:
❑El Boring % 9
r Boring # *Pit Ground surface elev. , d ft� Depth to limiting factd"r in.
Soil Aoolication Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft2
'Eff#1
'Eff#2
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7\5
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F41 Boring #
❑ Boring
Pit Ground surface elev. J
Depth to limiting factor in.
Soil Aoolication Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft2
'Eff#1
'Eff#2
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CST Name (Please Print)
Signature
CST Number
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Address
Date Evaluation C ucted
Telephone Number
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1
Boring #
❑ Boring
*Pit
Roots GPD/Ft2
Ground surface elev.�' f!r' Depth to limiting fa or { n.'
y Soil Application Rate
Gr. Sz. Sh. 'Eff#1 'Eff#2
Horizon
Depth
Dominant Color
Redox Description
Texture
Structure
Consistence
Boundary
F� Boring #
❑ Boring
El 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/Ft2
In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. ff# 'E1 `Eff#2
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/Fe
In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh.
*Eff#1 *Eff#2
' Effluent #1 = BOD, > 30 5 220 mg/L and TSS > 30 5 150 mg/L ' Effluent #2 = BOD, > 30 5 220 mg/L and TSS > 30 _< 150 mg/L
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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/Fe
In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh.
*Eff#1 *Eff#2
' Effluent #1 = BOD, > 30 5 220 mg/L and TSS > 30 5 150 mg/L ' Effluent #2 = BOD, > 30 5 220 mg/L and TSS > 30 _< 150 mg/L
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' Effluent #1 = BOD, > 30 5 220 mg/L and TSS > 30 5 150 mg/L ' Effluent #2 = BOD, > 30 5 220 mg/L and TSS > 30 _< 150 mg/L
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El
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-- - --
s I LOT 2
JlC 1 I 2.00 ACRES :
6
:RES 3 ,
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LOT 5
2.30 ACRES
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