HomeMy WebLinkAbout018-1099-49-000 (2)
Wisconsin Dhpartmei!t of Commerce SOIL EVALUATION REPORT Page _ of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code County 34 Crn X
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must / / O
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. Olt percent slope, scale or dimensions, north arrow, and location and distance
to nearest road.
Please p iewe by Date
rint all " m $
3
es l!ve"• s. 15L04 (t) (m)). /f/yl1
Personal information you provide may be used for econdpr{os 0
Property Owner Prooerty Location
i 6' i f l? Gov. Lot 5 11451,j 114 S 9 T 2 °I N R/ 7 E (or
U `t~YYI ( Tr 3 11
Block # Subd. Name or CSM#
Property Owners Mailing Address Lvolty
r,4 Rld e, ISi- A"
tv►i Phec~
City State e Phone dernbei C-r- -C=' - ❑ Village ® Town Nearest Road
OO
New Construction Use: 5P Residential I Number of bedrooms Code derived design flow rate GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material Flood Plain elevation If applicable fl
_
~ ~ i
General comments mot' y~j-ery\, ete U - loo. U
and recommendations:
CfX-
62 /0/0 Ran
i
Boring
❑ Boring #
® pit Ground surface elev. ft. Depth to limiting factor -7 ~31 -in. Sol A ate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 2
v~ 2 (U-iS 10 ry~ 51'c/ Z r CW771 5 - -
1~ r LP Zin-lbk- "-Cr -
® Boring # Fn1 Boring
L~ pit Ground surface elev. U • (o ft. Depth to limiting factor _ 0 in. f*Eff#l il A lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efff#2
i C) 16 3 5,'/ 2en k fY)J~,- r5 V 5
2 _Z! 16 2vv, k W,,G c
3 Z-9-60 lU 5C Zn SbL ryrcr
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature CST Number
Adam ck o trio-k er t 25 33d
Address Date Evaluation Conducted Telephone Number
2►3 b'` 5~4 Sornerse-- 4 Cv l 5 6 zS z - r -a Z X7/5 Z 7,-'100
14 i
Property Owner L4 7 P r-1 S - Parcel ID # - - - - - - - - - - - Page 2 of _v
FBoring # ❑ Boring 3 Ground surface elev.
Pit L_J~ft. Depth to limiting factor-7</- -_--in.
Sod A lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDffP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
3 2 7~ r 3/G - Sc_ I - S
❑ Boring # ❑ Boring
❑ 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/fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
F-1 Boring # ❑ Boring
❑ 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/ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 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-5330 (R V/00)
PAGE 3 OF -3
NAME r4 LOT# ~y LEGAL DESCRIPTION SF %Sw X,S T E(orf
SCALE: I"= ~p
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BM I ELEVATION /6 0,
BM I DESCRIPTION -lo~2 o l Sit e / /jv cP
BM 2 ELEVATION '7q, 7-0
BM 2 DESCRIPTION ,)P oir 'LIe e / d 4
SYSTEM ELEVATION /6U O
SYSTEM TYPE ('o u f ✓4 ,'c'N CL (
CONTOUR ELEVATION
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