HomeMy WebLinkAbout018-1096-21-000
aWisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County
than 812 x 11 inches in size. Plan must `-r Y
Attach complete site plan on paper not less
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. - 2r --tom
Please print all information. R e by Date
3/6 d 3
Personal informatieon you provide may be used for secondary purposes (Privacy Law. s.15.04 (1) (m)).
L
Property Owner Property Wcation
Govt. Lot Ai 1,f 1/4/ jUJ 114 S q T 211 N R E (or&W
Property Owners Mailing Addres Lot # Block # Subd. Name or CSM#
To 21 Zd
.1 3.
City State Zip Code Phone Number ❑ City _ ❑ Vllage Town Nea t Road
t l~l 15 c 15) -117(0 l - '
Ave-
aNewConstruction Use: & Residential /Number of bedrooms Code derived design flow rate GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material - Flood Plain elevation if applicable ti 41j ft.
General comments Sy~v✓i lev /Uz SZ~ (/UZc~i_, ,O~if 6 yy+z
and recommendations: r J~ eked IOZ - 06
I
I Boring # Boring O ~
E1 Pit Ground surface elev. L fL Depth to limiting factor L_~ In.
Soil Application Rate
Hort= 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
t 0-1Z t'3 -5( 1, rn c S 1 .5 .8
Z- tie-2 (b vr LA Sid 2 -fir- c -
C- ZnD
4 y5_ l0 5 CZP-). scl 2 - ~t
Boring # pBoring
in.
it Ground surface elev. ft. Depth to limiting factor y b
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft=
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 'Eff#2
O~t2 (0 Z c ( $
Z (Z-Z 10 5, Cj rnpr- C-5
Effluent #1 = BODS >-30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) -sinnatureb CST Number
ILI 11 253W-3
Address Date Evaluation Conducted Telephone Number
tU
1
Property Owner Parcel ID # A r/- Page of
131 Boring # ❑ Boring
Ground surface elev. laZ fL Depth to limiting factor in.
Pit 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. `Eff#1 'Eff#2
~ l Z S~ I Z.nr~bk r C S d ~
14
[ Cp U- -i o ,~I Zmsbk vY4~
Boring # ❑ Boring
F-1 ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dorninant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
❑ Boring # ❑ Boring -
Pit Ground surface elev. tt. Depth to limiting factor 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. 'Eff#1 'Eff#2
' Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = 1301)5 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.
SBD-8330 (R07/0%
PAGE_aOF
NAME f2cy' e" LOT#Z ( LEGAL DESCRIPTION PW X4t UJ 14 ,SS TZ!7 ,N,R, I? EWd-f)
SCALE: I"=(~ I
BM I ELEVATION &J- 6
BM I DESCRIPTION Ap f d-f "Fu
c. P, p C -t-
BM 2 ELEVATION q9, CC)
BM 2 DESCRIPTION 4,, EC4 ~ Pic f ,pe ~ ec,
SYSTEM ELEVATION /OZ, S~
SYSTEM TYPE JL -raj e-
CONTOUR ELEVATION 10Z~ a d
I
101.6
I~ ~ QroQoS~ Qd
o 0
btit
l
„ram
o ~~JY c
d~
SIGNATURE DATE
D/ 1 MIV dH.L Ju -11v t I Lb--M j JI I I V Of I.L
s
ro bil MN 3H1 -40 3N17
X
- - - - -T - - - - - - -
:Z
I 51 c ; Go 1 t-
o
~ r
I. .a••
' X O O W X
e ro o''
(A
' , Q~ i
0)
CD nt 1
ti
W I lO ~
' ~ to
z r ,
0o NO 0• Osc
x 339.
cu
I X ~ `
IN ,10'09" 'cNn o 0
I 22 . %
a ~
N CA
,r Iv r x N /
W iwv x v16 ro rn va Z; ro o o ci g~
a) la
c~ ~ n 4f `
,A r
' $1 r
1 O , O I
ig.90 09ON pol
r
0) I
x rn O. if .
i
N