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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page _ of _
` Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code C'
County ~1 - ~ ~i
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must V1
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. C ~/~l
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. I-W V
Please print all information. vie~wye~d Date
Personal information you provide maybe used for se s.,1 0) (m)). w Sri L l~t/~~
Location q
Property Owner m~ - tF'rope
j C1
I t~ UYYI r fl t S+ Govt. of 1111= 1 /4 1/4 S I T 2 N R 1 E (or) VII
Property Owner's Mailing Address r ')n,^, .l of # Block # Subd. Name or CSM# /
34 I z~ 5 Phe~+ a is
City State Zip Code b~rt, ❑ C ❑ Village Town Nea st Road ~
&P = < NQm ~nnorc~ I .
(T=Z7(-
New Construction Use: [Y Residential / Number of bedrooms Code derived design flow rate GPD
❑ Replacement ( ❑ Public or commercial - Describe:
Parent material Flood Plain elevation N applpa,ble - / ft
General comments ~ysf~Y~l ~~E'r/r 100 ` S`U ~Z -J-1 O_ PL
and recommendations: tl 00 G CJ ^Y f
NI'~ v~Q 0 S s ar41z
,t3/h s and
F # Boring
Boring C~$ 70
® Pit Ground surface elev. ft. Depth to limiting factor ~ - in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
0-10 tO 31 S - S i I Zrr.k u r S t j 5 g
C
2
*36o IQ r'(o 7 5 y (o Sc I 2rn5bk
Fz-- I Boring # Boring
® pit Ground surface elev. 99.10 •10 ft. Depth to limiting factor in. Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
6-10 10 r313 5. 2 rno~ k r,n~r e I'l 5 - 6
2 - t y I s I Z k rrcr- q
'4 r 3 ID C I P 1. !S ~(c Sc I 2rnSbY--
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
Sch k~ r - 25.3-109
Address Date Evaluation Conducted Telephone Number
svozs-
Property Owner Ir~±i fJIYV} I 1 YUJ ' Parcel ID # Page of
FS1 Boring # ❑ Boring ,1
Pit Ground surface elev. ft. Depth to limiting factor _ 3__ in.
Sod 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
6- I D 3 S i l 2N-14 bk n4r CS I v-C 5
2 rp- ~j I y - Sic 2 m k rn-Cr
iP 1.5 4rf Ito 6C l 20-,s k ryxk
❑ 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
F1 Boring # F1 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/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 'Etf#2
Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30:s 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.
SBD-8330 (n.07/00)
• PAGE 3 OF -3
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