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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
County
Attach complete site plan on paper not less than 8 112 x] I 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. C
Please print all Information. Reviewed by Date
Personal information you provide mF-y6.u s (Pre cy Law, s. 15.04 (1) (m)),
Property Owner Property Location
t ChC3a~C~ GovL Lot 1144(,l 1/4 S) ( T Zq N R / E (or
Property Owners Mailing Address Lot # Block # Subd. Name yftkv"
1 l 5 O l s v iew 4 es I 1
City State, P C ~~NI G OFFICE city ~Illae^ Town Nearest Road
(9 New Construction Use: Residential 1 Number of bedrooms Code derived design flow rate GPD
❑ Replacement r ❑ Public or commercial - Describe:
Parent material JUG l \ Fiood Plain elevation if applicable l ft
General comments S 'S4 -e v✓\ e- Ic V, q'3,
and ~tx (~Y~' -s7 710,
"
recommendations:
❑ Boring # Boring 12
Pit Ground surface elev. A - O ft. Depth to limping 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. 'Eff#1 -Eff#2
-1~ I~ ir311 2 c-5 v ~j 8
C- Lj
-Li y r'3 ~ . S. 2 Mau c s - y
4 q S - 1 Z
t
72- Boring # rn~ Boring _
Lt pit Ground surface elev. 421vL.3 {1 ft. Depth to limiting factor __L? 5 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
I 0 ►U vr- 3/1 - 51( 2rn~b ~5 v S
2 1~-2 11 O r 4 4 - 5; d 2rr r c - , 44
1: Z
3 ZI I C) `f/o y S p yy-) _-7
Effluent #1 = BOD > 30 < 220 rng/L and TSS >30 < 150 mg/L ' Effluent #2 BOD < 30 mg/L.and TSS < 30 mg/L
CST ame (Please Print) Si lure CST Number
_ VhQM41C1►r _ Z's-
Address Address e, Date Evaluation Conducted Telephone Number
21i3 ~51 W 766-UZ`
of
eY Property Owner Parcel ID # _ Page --2L
❑
Boring # Boring Z(-ft. Depth to limiting factor ' in.
® Pit Ground surface elev. _ T _ SApplication ate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Fin. Munsell Qu. Sz. Cont Colcr Gr. Sz. Sh. 5 '31
Z y 3 I- 1 itII3 ~lF y 5" c1 rno~bk mfr c s - -
❑
❑ Boring # Boring ❑ Pit Ground surface elev. . Depth to limiting factor in.
ft 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
i
❑ Boring
E 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 GPDlftz
'
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Eff# 1 'Eff#2
i
' Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L
I - -
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
department at 608-266-3151 or TTY 608-264-8777.
i
need material in an alternate format, please contact the
seD-8330 MOVOm
PAGE-3 OF
NAME: (3 e. P r LOT# LEGAL DESCRIPTION: E- I/4-V-k-/1/4,SI l T-?-q`N,P,_E(or)lc
SCALE: 1"= ~U
'f i
ELEVATION: 160 - ~ - ,
BM I DESCRIPTION: 4oP of 10vc p AO e +
BM 2 ELEVATION: ZO
BM 2 DESCRIPTION:-vP_v_~ oo- I Qu P~
SYSTEM ELEVATION: q 3. I U
SYSTEM TYPE: C O h Ue v~?. o r.a
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SIG ATURE: / DATE: