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W'- 4nsin Department of Commerce SOIL EVALUATION REPORT Page _1- of
R
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code County
Attach complete site plan on paper not less than 8 1/2. x 11 inches in size. Plan must 1
include, but not limited to: vertical and horizontal refer9nce point (BM), direction and Parcel I.D. r /
percent slope, scale or dimensions, north arrow, and ication and distance to nearest road. " 2- - / 7W, 6 Z
Please print all information. Reviewed b j Date
200
Personal informer' n you provide ma be used for purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
U11
Govt Lot Sr, 1l4/(/(,u 114 S T Z N R E (or)t~
Property Owner's Mailing Address APR ®3 '2004 Lot # Block TSfubd._Nam!r CSM#
U~ ~ ~ Sys l ~
City State 7J (Code-l- ❑ City ❑ Village [RTC>Q own Nearest Road Z INC FFICE our'd Vie fG~h-
New Construction Use: p Residential/ Number of bedrooms Code derived design flow rate GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material U~,~3 a 512-- Flood Plain elevation if applicable ft.
General comments SY St M e{ e
and recommendations:
F T] Boring # E] Boring
® Pit Ground surface elev. ]o ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff=
in. Munseli Qu. Sz. Cont. olor Gr. Sz. Sit 'Eff#1 'Eff#2
t p -2 1 O 2,,5bk rnjpr- C5 I V y .2
2 2 -5% 2 ry-~SbK_ r C 4P
3 3~5-113 - S 5 m l - - "I 2
72- Boring # ~ Boring ,,11
Pit Ground surface elev.I V -ft. Depth to limiting factor _ 3 I in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKf
in. Munsell Qu. Sz. Con'. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
t 6.20 t0 f 1 2_n!2 CS 1 . t •2
Lio-59 io, 5 FI 4j S~'c1 2r,- t~4- r cw _
4 ,.131( y p m( J L2
' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD < 30 m91L and TSS < 30 mg/L
CST Name (Please Print) Si nature CST Number
~ 2533a~
Address Date evaluation Conducted Telephone Number
21 3 ~,r e~5e - t dz~ l42 -a 4 7/5-746
t
Property Owner Parcel ID # Page of-
Boring # ❑ Boring a l
L*~. Pit Ground surface elev.? 0 • 6~ ft. Depth to limiting tacflor! in. Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft*
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2
l D- 10 r_3 5 i( Z C S 1 v ~J
S,' C I 2rn c - `f
z 2 J3 (D r
3 s + 4 ~ F +p 7. Gr 2-rn5 rn
-5 -7
44
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 GPDO
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2
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/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. 'Eff#1 'Eff#2
' Effluent #1 = BODS > 30 < 220 mg/L and TSS >30:s 150 mg1L " Effluent #2 = BOD, < 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-8730(R.07100)
a
PAGE OF-3
NAME: e LOT#~LEGAL DESCRIPTION_S'E I t U!,u1/4,S 1LTZIN,R,~E(or w)
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SCALE: I'
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I, BM i DESCRIPTION: -k,P
BM 2 ELEVATION: O , <
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BM 2 DESCRIPTION: o~ o-~
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SYSTEM ELEVATION: I O
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SIGNATURE: DATE: l
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