HomeMy WebLinkAbout026-1097-80-100Wisconsin Department of Commerce SOIL EVALUATION REPORT Page ( l� of�
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code p ---
County
Attach complete site plan on paper not less than 6 V? x-11 inchesiCsize. Plan must _
include, but not limited to: vertical and horizonlal,reference point (SM), drection and Parcel I.D. p Z�Q �U� 7Q cz7o
percent slope, scale or dimensions, north arrow, and location and dfstance.lo nearest road.
Please print all informal`9n 1, Reviewed by Date
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Personal information you provide may be used for seconda�! 0106ses (Priv Law, s. 15.04 (1) (.np. F� • 2-1 ZDn 1
Property Owner _ x �_ Property Location 1 Govt. Lot A X" 1/4/t W114 S , T 30 N R Ik E (or W
Property Owner's Mailing Address Lot # Block #iSubd. Name or CSM#
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City State Zip Code Phone Number ❑ City ❑ Village [�Town Nearest Road
%k) pici, MOvdj X1 Sya/7 (7 � �y cG, rl o,� i� 13 0 sr:
❑ New Construction
Use: Q Residential I Number of bedrooms
Code derived design flow rate _
C C (i f r pw GPD
1 Replacement
F1 Public or commercial - Describe-
Parent material S��fl2i
li r"i Cl7—W, } S "�_
Flood Plain elevation if applicable
t
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General comments
and recommendations'
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Boring # ❑ Boring 9S- Cr 2—//j
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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/ft'
in.
Munsell
Cu. Sz. Con(. Color
Gr. Sz. Sh.
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Boring # ElBoringp
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Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/ft'
'Eff#1
'Eff#2
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Effluent #1 = BODs > 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent #2 = BODE < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature CST Number
,Re,13F/R ;% Z C ??43 Z S
Address Date Evaluation Conducted Telephone Number
S
111hricht
Private Sewage Consultants
665 O'Neil Rd.
Hudson. Wis. 54016
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Property Owner Parcel ID # Page of
❑ #
Boring �/ D
FTI Boring
pit Ground surface elev. ft. Depth to limiting factor in.
Snll LnnliMinn Rate
Horizon
Depth
in.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/ft'
'Eff#1
'Eff#2
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❑Aoring #
n pit Ground surface elev. ft. Depth to limiting factor in,
Cr.il Annlrralinn Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/ft'
-Eff#1
'Eff#2
❑ Boring
❑ Boring Al Ground surface elev. ft Depth to limiting factor in.
❑ Pit Soil Application Rate
Horizon
Depth
in.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Slruclylre
Gr. Sz. Sh,
Consistence
Boundary
Roots
GPD/ft'
Eff#1
'EB#2
—77
Effluent #1 = HODS > 30 < 220 mgFL and TSS >30 < 150 mg4. ' Effluent #2 = BODr < 30 mglL and TSS < 30 mg1L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate formal, please contact the department at 608-266-3151 or TTY 608-264-8777.
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