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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page _ i of 3-
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County _ C,roi
Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. -7/+,
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. T
Please print all information. Reviewer , y 1 Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). vwvV !/"Qv
Property Owner RECEIVED ProperiyLocation
C Govt Lot S E 1 /4 A/F 114 S I( T? N R I E (o
Property Ownei ssM ling Address 1 APR 2, 3 2004 Lo# -Block 1# Subd. Name or CSM#
City State Code_ pip 4 m 1 Village Town Nearest Road
i . Cr,Mpl;I~UI` I El City [I
It ►1 UI KING OFFICE
New Construction Use: Residential / Number of bedrooms Code derived design flow rate _ y5 _O0GPD
❑ Replacement ❑ Public or commercial - Describe: /1
h•
Parent material ' ~-rw a Flood Plain elevation if applicable 1,61L,4
General comments cyS4 e yv\ e l e U r ! s U
and recommendations: f
F-il Boring # F] Boring p tt
Ground surface elev. ! ft. Depth to limiting factor
V Pit 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
-5
f - 1 SL 1 rm bk rr-Ar C5 V1
Boring
72- Boring # ® Pit Ground surface elev. P2-b2__ ft. Depth to limiting factor 115 in.
Soo Application Rate
Horizon Depth Dominant Color Redox Descrip(on Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
I o-~ Ip r31~ _ 5~ 1 mbr c S V~ . 5 .9
2 l~ 41c~ _ S Os m I - --7 1-Z
Effluent #1= BOD > 30:5 220 wgtL and TSS >30 < 150 mg/L ' Effluent #2 = BO D < 30 mg/L and TSS < 30 mg/L
CST Name (P Print) Signature T_Number
3C
Address Date Evaluation Conducted Telephone Number
Property Owner Parcel ID # Page of
❑
❑ Boring # Boring Q ft. Depth to limiting factor ' - U in.
pit Ground surface elev. ~X • 9 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
d^► 1. - 5 ~m mfr- GS 1v - 5 •9
I.2
2 1y-118 l -
❑
❑ Boring # Boring
❑ Pit Ground, surface elev. it. Depth to limiting factor in. Soil A IZc lion 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
❑ Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
F-I ❑ Pit 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
' Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg1L ' Effluent #2 = BOD, < 30 mglL and TSS < 30 mg/L
-fhe Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in as alternate formal, please contact the department at 608-266-3151 or TTY 608-264-8777-
saD-8330(a.07/00)
PAGE3OF
Z 1 LEGAL DESCRIPTION5C-1/44c ZI/4,S J I T-4~IN,R,AqE(Oti~)
: S-If e -f LOT#
NAME
SCALE: I"=
~rn1 ELEVATION: K) Q
Jc - fi
-c~~ ~L-
BM 1 DESCRIPTION:
BM 2 ELEVATION:_~ 30 = ~ S 2C
BM 2 DESCRIPTION: p oS I Py-c A-g-e- '
t
SYSTEM ELEVATION: Yw
SYSTEM TYPE: (~v e n ti a
a
91.00 _
DATE:
SIGNATURE:
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ire 00