HomeMy WebLinkAbout020-1464-12-000
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of _
Division of safety and Buildings
in accordarx:ia with Comm 65, Wis. Adm. Code
County C
Attach complete site plan on paper not less than 8 112 x 71 inches in size. Plan must 54. ty,
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. (J~ ( y' 2 -Vi 2~
Please print all lnfornfatlon. Reviewed by Date
Personal rn/onnation you provide my be u T s (Priv cy Law, s. 15.04 (1) (m)},~/ 2~K
PropertyOwner Property Location
IC lp Govt Lot 114V_r 114 S T ZR N R Jer E (or)
Property Owner's Mailing Addre4 ~ t-vult Lot f1 Elock # Subd. Name or CSM#
2- City State C ;(3J t ^ ❑ City ❑ Village JJ} Town Nearest Road
C1 an LX) I LP _ 11 H"C,sp Hound d U re
1 New Construction Use: Residential / Number of bedrooms- Code derived design flow rate GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material Flood Plain elevation if applicable h•
General comments ' r Q Y✓\ I! 3 S o lou-c r ?Z, -s U
and recommendations: f
M Boring # El C4 Pit Boring n
4 Ground surface elev. g ~ ft. Depth to limiting factor in.
_ Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bounday Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
p- Ib f 3 S L 2rn f`n-~r C' S v - 9
2 lb-29 ID - 'cj 2 vnsbk lY,,fr CS - L' , lv
3 29-JS 1 y - S - 7 Z
Boring # Boring
® Pit Ground surface elev. ft. Depth to limiting factor 11 _ in.
Soo Application Rate
Horizon Depth. Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1W
in. Munsell Qu. Sz. Coni. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
14 Y- :-k)/ 'k 2 nAr CS v -S
1 b- ll~
-cj 2 ( I y S 2 rn5 rr,J~r C
3 1 91l0 5 ,rY~t _ _ 7 :Z
Effluent #1 = BOD > 30:< 220 mg/L and TSS >30 < 150 mg1L ' Effluent #2 = BUD < 30 mg/L and TSS < 30 mg/L
CST Name (Pleas Print) Signature CST Number
Address Date Evaluation Conducted Telephone Number
211 c60 Sory) e.C~t W( `at,}-()2.s q--1 42-O 157-7k1) -dZ79
Property Owner Parcel ID # Page 2 of
❑ Boring 1 1~
7(-5 Boring # q~~ ft Depth to limiting factor - in.
Pit Ground surface elev. Sod A ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •E GPDIft~Eff#2 rr~nb
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh.
i b-~ No ,3/3 SL 2 sbl > C5 I Yl
T t cl 2 mfr c - L
2-Z~ I S C~5 l - _ 1. 2
❑ Boring
❑ Boring # Ground, surface elev. ft. Depth to limiting factor in
Pit Soil A lication Rate
❑
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •EGPDIft2Eff#2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ pit Soo lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
' Effluent #1 = BODS > 30:S 220 mg1L and TSS >30:S 150 mglL ` Effluent #2 = BODS < 30 mglL and TSS < 30 mglL
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.
MD-8330 (R.07/00)
• PAGE~OF
NAME: L 2>.e r LOT#j Z _LEGAL DESCRIPTION.-SE 1'4A LI/4,SJ.LT~N,R,aE(or V
SCALE: I"= l _T_
Ern ELEVATION: U
BM I DESCRIPTION: 4m y dI J n our TP,~e e
l I
BM 2 ELEVATION: ~(0
Ste,
BM 2 DESCRIPTION: 4y 12 of A°-
SYSTEM ELEVATION:- ? ? 3, So Iaw, r P Z sC' -
SYSTEM TYPE: CAD n u e n A
Z
AV
6
SIGNATURE: df~ DATE: - O S~