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wisoonsii%Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County
Attach complete site plan on paper not less than 812 x 11 inches in size. Plan must r0(
include, but not limited to: vertical and horizontal reference point (BM); direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information. R by Date
Personal information you provide may be us for cy . s. 15.04 (1) (m)). l ~/Jtirti
Property Owner _ Property Location
l Z
Govt. Lot /V L,._) 114rj to 1/4 S T N R/7 E or
Property Owner's Mailing Address Lot # Block # Subbd..^Name CSM#
I T-jAJC ST. CROIX COUNTY fU~
City State Zip Cod Pii36ft 1 i L ❑ City _ ❑ Village aTown Nearest Road
®--New Construction Use: a Residential ! Number of bedrooms 3-`{ Code derived design flow rate O 4-Od GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material I Flood Plain elevation if applicable AJI-4 ft.
General comments ~yS Pw~ e ee U r 106-416 /l~ . P3 'm-,;-
and recommendations: e 2 U c~'~J s- --~y
CU d1 ~o~ s / 7' 11 /Ob - D ~ wcc ~ ~.~eLGc,c.~~Q• /rrk.e~tlz- /~,e'p»~ s' 0
F-1 I Boring # ❑ Boring
Pit Ground surface elev.
® ft, Depth to limiting factor 1- in. Soil Application Rate
Horizon Depth . Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1ft2
In. Munsell Qu. Sz. Cont Color Gr. Sz. Sti. 'Eff#1 •Eff#2
S g
1 IU r3Q- - 3 i( 2iri4 n-Ce 5 14
Z 1) -Z-6 ( rq/f S1'(- r CS - `-1
5 Z0-30 f U r Sc.l nrr~r ~S 40
`f Ap-j)p 16~(-J(a CIP-7.5 r `f Sc/ 2m m~[
in.
a Boring # ® ping Ground surface elev. 66. qQ it. Depth to limiting factor
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/112
in. Munseli Qu. Sz Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
cs Iv~ .5
I2-2 l0 r`{I - Sri , l r C - J 8
3 ~146 ~p 3 FIF "1.5 SL k mFr _ 15 ,
Effluent #1 = BOD5 > 30 < 220 mg/I- and TSS >30 < 150 mg/L ' Effluent #2 = BODs < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) gnature CST Number
Address Date Evaluation Conducted Telephone Number
211 80L~L...S~ i W( 5W t5- e!~~ ~s~- 0 z <71n,'W y~ -
Property Owner+ Parcel ID # Page 2 of 3
Boring # r❑~--77 Boring
UJ Pit Ground surface elev.. 99, 70 tL Depth to limiting factor 3- in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Efff11#1 - 'Eff#2
t bit I ~Z 2 r C5 Iv E
Z IZ- y Sr I c - S 8
-7T
Boring # ❑ Boring
F-1 ❑ 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. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
❑ Boring # ❑ Boring
Fit Ground surface elev. ft Depth to limiting factor in.
❑
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
in. Munsefl Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 'Eff#2
• Effluent #1 = BODS > 30 < 220 mg/- and TSS >30 < 150 mg/L ` Effluent #2 = BOD5 < 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 services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
S13D-8330 (807/00)
V
PAGEa _OF
NAME R6:8 4 e T OT# /-'-)-LEGAL DESCRIPTION N W X UIa ,S T Z Y N.R. /-i'E(oz~/
SCALE: I"= 1/6' Q
1
BM I ELEVATION /OCR , d
BM 1 DESCRIPTION
BM 2 ELEVATION yo
BM 2 DESCRIPTION 2
SYSTEM ELEVATION /00 . '/Q
SYSTEM TYPE rn nu O d S yS err
CONTOUR ELEVATION
100,0
U~
0
~D
(o
1 ~
SIGNATURE