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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County Orb
Attach complete site plan on paper not less than 8 1/2 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. '/V- (09 -
Please print all information. Reviewed)b Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner-- Property Location
`~~L Govt. Lot If.(,/ 1/4 W 1/4 S~U T N R j~ E (or) \10
Property Owngts-MN ing Address Lot # Block # Subd. Name or CSM# - vZT,.2n 1,4
i Aq-\)& k e Tr. 2- - s
City State Zip Code Phone Number ❑ City ❑ Village 0 Town Nearest Road
Uh 10 0 ( 15 )514 - 7 1 Ae?PM mpn saw S~
[R New Construction User Residential/ Number of bedrooms 3 -y Code,d2fi~ed design fl to _Z ~y O a GPD
❑ Replacement I ❑ Public or commercial - Describe:
Parent material ~~r 1 FloodPdaih ele do*a aUcablef vT ft.
General comments / frF1~.(
and recommendations: ` v f
L►prJ-b0 ✓ el-ev 71171
Boring ZG~tttJG
❑ Boring #
® Pit Ground surface elev. t) ft. Depth 6`4imiting 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
O--IZ 10 )2 n c C5 V~ 5 8
2 )Z-`f 10 r -1114 - 5ic_l 2m k m r
3 qq-~ao r31(n KIF 1.5 r t4/-5 sL 2rn5hk n4i
Boring # ❑ tBoring
F2-] Pit Ground surface elev , 90 ft. Depth to limiting factor C~ 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
iD ( 3~Z 5il mfr c5 I~~ 5 $
Z )O-Z 10 -4r q I ~►c) r C5 -
3 2 -96 ( FIF 3.5 ~l~ L k t q
* Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L
C T Name (P!~Ivluiyynke-y- Print) Signature CST Number
-~,3,56 9
Address Date Evaluation Conducted Telephone Number
'211 7-
7 yoo
211 ' .
EM2 12-r~-d X7/5.4
SBD-8330 (R07/00)
Property Owner NOU T Parcel ID # Page of 3
Boring # E] Boring
F-31 [a pit Ground surface elev. Depth to limiting factor 30 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
► C-12 I '/r 12 -51 1 rp~ c5 I _VS . 5
Z 12.'36 !0 r414 - 5icl 2n-) r c5
5 X -5d -7 -,S -1 la-A
❑ 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/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
❑ Boring
❑ Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit 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 = BODS > 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-8330 (R.07/00)
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PAGE 3 -OF
NAME Sf~ v 4. LOT# a LEGAL DESCRIPTION,040 X Sw 14 ,S 30 T 29 ,N,R, E(orX
SCALE: 1"=
BM 1 ELEVATION & . O
BM 1 DESCRIPTION ~P a / ",ell
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BM 2 ELEVATION Zff. ~Q
BM 2 DESCRIPTIONP a ~T✓G ~O
F ~
SYSTEM ELEVATION I o
SYSTEM TYPE /I1 au A a(
CONTOUR ELEVATION UQ
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90` OG
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SIGNATURE DATE -/l>