HomeMy WebLinkAbout014-1034-20-000 (2)
Wisconsin Department of Commerce ~ eA,i SOIL EVAN ORT
' Division of Safety and Buildingst
l3 Page ~ ofa
in accorAj~91P&Wth Comm 85, Ws. Adm. e
Attach complete site plan an pagq[tts®t~~ss than 8 1/2 x 11'inches in size. Plan must unty X
include, but not limited to: v4i*9t and horizontal reference point (BM), direction and
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D.
P /ease prim all inforMation. Reviewe y - 0
Personal information you provide may be used for secondary purposes (Privacy Dat
Law, s. 15.04 (7) (m)). ~
' 4 L y7.7 P~,
Property Location Govt. Lot IA) 1/4 (::J 14 S / T
WPropert er
er's Mailing Addr N E (or W
Lot Block # ubd. ame or State Zip Code ~ Z~
leae A V S yD0 El City ❑ village Town Nearest Road
V (7I5) a 63 x553 ore S+
❑ New Construction User Residential /Number of bedrooms
Code derived design flow rate S GPD
,Replacement ❑ Public or commercial -Describe:
Parent material JAGS
Genera; cornments Flood Plain elevation if applicable
r ft.
angd~recommend ations: `s V 552 S+ OL )1 -76' M DUN
pI S - •9'S~'7/ ~
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9 V'.Q Go h OV✓`
Boring # Boring qa
Eq LAI Pill Ground surface elev. / f;. Depth to limiting factor in.
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots S°il A lication Rafe
in. Munsell Qu. Sz. Cont. Color GPD/fl'
Gr. Sz. Sh_ "Eff#1 "'Ef(#2
e~r y 9Z ; QFS r a~ are ,
L @ FU K r/1 ~r Cw
3 7.5 y SL a 55 K
Cw
SiQ FIF7.SYiQb We C L."
Boring # ❑ Boring
L J ~i Pit Ground surface elev. ~~_..fi• Depth to limiting facfor
Horizon Depth Dominant Color
I Redox Description Texture w Soil A~ lication Rate
in. (vlunsell Structure Consistence Boundary Roots GPD/ft2
Qu. Sz. Cont. Color Gr. Sz. Sh.
Y / *EY#1 *Eff#2
~K M Q W a lrrl
6 6V- V- Cw 5YR wa
SL Cw
sh fz ~ F I D
Q `1 ~ Y2 b/ S L IM
b- 4Ry~ r
FI 1
" Effluent #1 = BODS > 30,n 220 mg/L and TSS >30.< 150 m /L
CST Name (Please Print g Effluent #2 = BODS K 30 mg/L and TSS < 30 mg/L
Signature CST Number
dress
~ ss aDa'~'~ Date Evaluation Conducted Telephone Number
76
7-31 1
Property Owner L ~ E .S Parcel ID # Page CW of
[31 Boring # E] Boring G~ q
Pit Ground surface elev. ft. Depth to limiting factor I • in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munnsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *EfF#2
10YF } r 5 b v- F r ~s to A+/~ V
iD y {2.sAl~ t 07 CFs 10 kV wit V- t
:7.519, a
SL 0- M 13
❑ Boring # ❑ Boring
L ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil A Iication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f -
in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. *Eff#1 *Eff#2
Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent = BOD,, < 30 mg/L and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access set-vices or
need material in an alternate formal, please contact the department at 603-266-3151 or TTY 604-264-3777,
SBn,gM (x..07/00)
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