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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3
Divisiorof Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County 4. Croi x
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. U
Please print all information. Rev' ewe Dat
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
Ql ftr ( i Govt. Lot W 1/4 1jaJ 1 /4 S 3 C T L~ N R/ jr E (or)10
Property Owner's Mailing Address TO6 Block # Subd. Name or CSM#
I. 53 -ee T. 5meraO Acre-s
City State Zip Code Phone Number I] City ❑ Village R Town Nearest Road
s
t 01~ (~L5) 519-Co-13~ /44,n ,.mac .So t!,- 1
New Construction Use: ® Residential / Number of bedrooms -5 -41 Code derived design flow rate c7/ SeJ/6o O d GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material ri I I Flood Plain elevation if applicable,,",
General comments 5 ySf ens e) 'c tj' ff"570
and recommendations:"
(10/1 ~u r
M -'y4~~• :.a
❑ Boring
❑t Boring #
/ 1 t; ~~v ~t0+
®pit Ground surface elev. /V ft. Depth to limiting factor in. GO
pccation Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence An ary Roots , GPD/ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
o!-/~~f r z s I 2 bk ►~r~-~r C v.C
z / 7 ;3 I /1 i e Zw1Gb m r G - y
3 q b lbyL,31 1P C3 1.5 r✓ Y/ 5 r_ 2m5l* m - S 9
Boring # ❑ Boring
F-2-1 pit Ground surface elev. 77.7-6 ft. Depth to limiting factor Z ~ in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munseli Clu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
8
d -I Z 3lZ 5 2mabk rr»-(r c l V_C .5
Z l2- /Q l - Sic/ 2rr,4bl< ~r ~5 - .44 .
3 24-21 'If 3 /to C3P 7.5 r -1 .SL 2m 5bk wr~✓ _ - .5 .G
* Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 < 30 mg/L and TSS 30 mg/L
CST Name (Please Slumaker- Si nature CST Number
d4 253369
Address Date Evaluation Conducted Telephone Number
2113 Z'' . 3bme 5e-4 (Ai X0z5 /2-/7-0/ (-7i5)zv7-y00,Y/
cnn-uzzn 1emrnm
f
Property Owner Parcel ID # Page 2- of
I-S] [I Boring # ❑ Boring _
Pit Ground surface elev. • yd ft. Depth to limiting factor 2S- in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Rexture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
o-~ Iz Z k m ~s 1j 8
3 2 3c~ / C 3 7. ca 2►~ b I< - ' S 9
I
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
F-1 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/ft2
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 = 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 (R.07100)
PAGE 3 OF -,3
NAME s+~ U LOT# 16 LEGAL DESCRIPTION SW XAuw X .S 30 TO ?',N,R,_ L? Rorlg
SCALE: 1"=
BM 1 ELEVATION 100, O
BM i DESCRIPTION ?Sp a-~ / 'Or c- N-+
BM 2 ELEVATION q: S"d
BM 2 DESCRIPTION -,p p-F / " NYC PG 3
SYSTEM ELEVATION I Sd
SYSTEM TYPE VJt G r. vt d S.if vr►
CONTOUR ELEVATION
~e
S
flo
3M-2
_ 1)
V
Y~
~.3 x4 - Z
SIGNATURE DATE"