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Wisoonsin Department of Commerce SOIL EVALUATION REPORT Page I of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County
. Croy
Attach complete site plan on paper not less than 812 x 11 inches in size. Plan must
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. 671- - Z2-- '16o
Please print all information. Re v 'Date
Personal information you provide may be used for cY Law, s. 15.04 (1) (m)). (N v ✓ 6 Q 3
Property Owner RE _ Property Location
Govt. Lot f\j Q 1/4 N W/4 S Q T 29 N R ("1 E (oiQ
Property Owner's Mailing Address 3UN 10 Lot # Block # Pbd. Name or CSM#
1 'a Z 2- G-"A- sL
City state Zip a SIP IN _ ❑ City _ ❑ Village. Town Neares Road
Ave,
E, New Construction Use: a Residential /Number of bedrooms Code derived design flow rate U J~ano GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material 4/ 1 Flood Plain elevation if applicable AJ ft.
General comments e (e~' `1 r o ~A4
s y7r 3 ?A
and recommendations Co 'A 4 L3 d
2 v ~Yj °~S~rn rr+ i (.f f era ~e~
= a 2±!:
F I ❑ Boring r f
Boring #
El Pit Ground surfaceelev. ft. Depth to limiting factor T 5 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1ft2
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Z t2-y (U S" Ca c t{
3 r I ' 2 Sc l 2m YY-Xr y
Boring # Boring ~j
-1 pit Ground surface elev. ! 7•~~ ft. Depth to limiting factor 3G in.
F
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
1 I ip r Z m~ C 5
14' l 51 gi 2 lL YYI~ c
3 ^y 5jr4 5d - y
Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = GODS < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) S' nature CST Number
e - Z
Address Date Evaluation Conducted Telephone Number
~L-_ ~U'`= ~f. Spnn ~ 5 2 ___Z,- -S -c z (~i5)2Y7-yov~
Y
Property Owner P l Parcel ID # Page of
Boring # ❑ Boring
~r7t Ground surface elev. V J~ ft Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/112
In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2
a_, 10 1? s;I r cg .S .0
2 I- 51(~ r St d c
3 - 1 CZ 7. Sc l 2 < m r - y
❑ Boring # ❑ Boring
Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Sal 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
❑ Boring # ❑ Boring
pit Ground surface elev. ft. Depth to limiting factor in.
❑
Sal 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 mgA_ and TSS >30 < 150 mg/L • Effluent #2 = 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 services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
SBD4330 (R07/00)
PAGE_ OF 3
NAME LOT#?- 7- LEGAL DESCRIPTION V lit XU~ 14 Z7
SCALE: I"= yO A i
BM I ELEVATION
BM I DESCRIPTION i2Q C) PVC A -e - 4-
BM 2 ELEVATION 11. 0 y
BM 2 DESCRIPTION 12 Q Q C 10 D e S e c
SYSTEM ELEVATION qT 5C)
SYSTEM TYPE J -f - (r oa c( -2
CONTOUR ELEVATION 00
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NAME n t ~ I OT#~ 7 LEGAL DESCRIPTION ~ AJ Yd/t-l X ,S I T Z 9 .N,R,
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BM 1 ELEVATION /6D C~
BM 1 DESCRIPTION ~6 c}~ I eVC Pf'D e
BM 2 ELEVATION 12,0c)
BM 2 DESCRIPTION]~Q Q C l PT R Sec .
SYSTEM ELEVATION 9K. 5 O
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