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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 `
t less than 8 112 x 11 inches in size. Plan must rOl
Attach complete site plan on paper riot
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. LL
Please print all Infonraation. Reviewed by z Daattel-
Personal information you provid4 may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner~YE Property Location
Govt Lot S f` 114 V(k)114 S( 1 T Z N R
\ ~~p 1 E (or)@)
0
k # Subd. Nam
L t # Bloc
0
ProPafh' Owner's Mailing Address
A `I_3 X04 ZO t~ ei,~ 5
City State Zi Code Phone Number ❑ City El Village Town Nearest Road
uC~ ~l oI CROihCOUNT;"
New Construction Use: Residential I Number of bedrooms _ 3 Code derived design flow rate GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material _--G S I^ - Flood Plain elevation if applicable h•
General comments Sys e r~ 212 V
and recommendations:
T
❑ Boring # ~R Boring J9 Pit Ground surface elev. G ft. Depth to limiting factor - in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
I CH l 1 312- S; 2 rn5 _ e 1 v~'
2 (l-ZQ 10 t{1 Si cI 2 fir. - •`11 I
7 Boring # Boring /
(g. pit Ground surface elev. ft. Depth to limiting factor in.
_ Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKf
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
11)4r- Z- _ i I 2m5b ter LS 1 v~'
2 IO /t{ - ~cl 2rn r c - ~1
1.2
Effluent #1 = BOD > 30:< 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (P ee Print) Signature CST Number
Ad~ W , ,
Address Date Evaluation Conduct Telephone Number
' ih I ,~1`~ J 1.~_~~_{~c115-7 - ~
f Parcel ID # Page of _
Property Owner
❑ Boring # Boring
3 ❑
Ground surface ft. Depth to lin>ffing factor - in.
/~6 d
~It elev. Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKf
Gr. Sz. Sh. 'Eff#1 'Eff#2
in. Mansell Qu. Sz. Cont Color
1 - to 312 SII 2 ~ I v-~
2 -5i I - 5 2 _ ti
Boring # ❑ Boring
❑
❑ Pit rGround surface elev. ft. Depth to limiting factor in, Soil A lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 'Eff#GPD/lt~Eff#2
in. Munseli Qu. Sz. Cont Color Gr. Sz. Sh.
❑
❑ Boring # Boring Ground surface elev. ft. Depth to limiting factor in.
❑ pit Sod A lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDMe
in. Munsell Qu. Sz. Cont Color Gr. Sz_ Sh. 'Eff#1 'Eff#2
' Effluent #1 = BODS> 30 < 220 mg1L and TSS >30 < 150 mglL " Effluent #2 = BODS < 30 mg/L and TSS < 30 mglL
fhe 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.
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M4330 (R.07/00)
PAGE3OF 3
NAME;~( e r' LOT# Z CJ LEGAL DESCRIPTION:5f1/4&,(A/4,S /1 T N,R, E(or)f
SCALE: 1"= 1/0,
6 m l ELEVATION: ) OCR o I
BM 1 DESCRIPTION:
BM 2 ELEVATION:
BM 2 DESCRIPTION: Io~J_y ~Pe
SYSTEM ELEVATION: `',S-.
SYSTEM TYPE: Oa rt u e Irv i`0. \
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SIGNATURE: DATE: ~~'G`l1,